Her Health Matters: Resolve for Better Metabolic Health

A Familiar Story: From Menarche to Menopause

My story with metabolic health began long before I had the language for it. It started with weight gain after moving from India to the United States, where abundance felt celebratory and processed foods were woven into daily life. During my first pregnancy, I embraced it without fully understanding its impact. After my first child was born, I began to exercise and started to eat healthy. By my second pregnancy, I was stronger and more toned. Yet like many women, I found myself in the lifelong rhythm of weight loss, and weight regain. I chased rising blood sugars and prediabetes with half marathons, strength training and yoga. Each one of them taught me something new about resilience, discipline, and the complexity of the female body. Now, in perimenopause, the journey continues with fresh challenges and deeper insight. The desire to maintain better metabolic health inspired me to pursue advanced training in obesity medicine and lifestyle medicine. That personal pursuit evolved into purpose. I founded the Stanford Metabolic Health Interventions and Lifestyle Empowerment Support Program (SMILES) to help patients move beyond cycles of frustration and toward sustainable metabolic health.  This is not just professional expertise. It is a lived experience.

What is Metabolic Health?

Metabolic health is not a buzzword. It is the quiet engine that powers our energy, hormones, heart, liver, bones, and brain. When that engine runs smoothly, we thrive. When it sputters, the ripple effects show up as high blood sugar, high blood pressure, high cholesterol, heart disease, fatty liver, infertility, and more. They are connected by a common thread: insulin resistance and inflammation quietly weaving through the body because of the increased fat between organs called Visceral fat .For South Asian women, the stakes are even higher. We develop metabolic diseases earlier, at lower body weights, and often with fewer outward warning signs. You can look lean and still carry high cardiometabolic risk. This is a call to awareness, not alarm. Because the good news is this: metabolic health is modifiable.

Beyond BMI: The South Asian Reality

Standard BMI cutoffs underestimate risk in Asian populations. The World Health Organization thus changed the criteria for normal BMI to be under 23 for Asians. The body composition analysis, knowing the amount of fat and muscle distribution, visceral fat percentage, waist circumference gives a better picture of metabolic risk in South Asians. 

Screening for Diabetes

South Asian women should be screened if they are:

• Age 25 or older

• Diagnosed with PCOS

• Have a history of gestational diabetes

• Have a family history of diabetes

• Have abdominal weight gain

When to Screen?

• Every 1 to 3 years

• Annually after age 40

• During preconception planning and pregnancy

How to Screen?

• HbA1c

• Fasting blood glucose

• Oral glucose tolerance test, especially during pregnancy

Menopause: The Metabolic Shift

As estrogen declines during menopause, the body rewrites its metabolic script, Even without weight gain, body composition changes. For many women, menopause becomes the tipping point toward diabetes, fatty liver disease, heart disease, and osteoporosis. Women live about 5 to 6 years longer than men. That longevity should be filled with vitality. Heart disease in women often presents with atypical symptoms. Fatty liver disease is silent. Depression can be amplified by social isolation. Osteoporosis risk rises sharply after menopause. The focus should be on improving health span in addition to lifespan. This is best done by changing lifestyle. Lifestyle Medicine has six pillars. They are whole food plant predominant nutrition, physical activity, stress reduction, sleep hygiene, avoiding risky substances, Social connectedness. 

Practical strategies for better metabolic Health 

Nutrition

Our cuisine is rich in flavor and tradition. With proper meal planning and attention we can enjoy our cuisines and lead a healthy life. We have to change from grain forward to vegetable forward meals. We have to intentionally increase plant based protein in our diets. 

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A Healthy South Asian MyPlate Approach

• Half the plate non starchy vegetables

• One quarter protein, plant or lean animal based

• One quarter whole grains 

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Exercise 

Muscle is metabolic currency. The more we build better will be our insulin sensitivity. 

Aim for:

• 150 to 250 minutes per week of aerobic activity

• Resistance training 3 days per week

• Total 200 to 300 minutes weekly

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Stress and Sleep: The Invisible Drivers  

• Practice one minute meditation each morning

• Consider yoga for flexibility and calm mind

• Aim for 7 to 8 hours of sleep

• Keep phones on do not disturb from 10 PM to 6 AM

• Seek psychological counselling with therapy if needed

Chronic stress elevates cortisol, increases insulin resistance. Sleep is not a luxury. It is metabolic repair time. Small, consistent steps reshape long term outcomes. Her health matters. Not someday. Not after retirement. Not after the kids grow up. It matters now and here. 

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Closing Reflection

Metabolic health is not an isolated goal. It is interwoven with cultural identity, family roles, professional demands, and generational expectations. When South Asian women are equipped with evidence based  science, culturally personalized care, and community support, the narrative shifts. From silent risk to empowered prevention. From reactive treatment to proactive longevity. Her health matters. And she deserves the best. As a final note, I would like to share my poem.

Resources for South Asian Metabolic Health

Author Bio Dr. Varalakshmi Niranjan is triple boarded in Internal Medicine, Obesity Medicine, Lifestyle Medicine and an Author. She also holds an MBA from UMass Amherst. She is a Clinical Associate Professor at Stanford University.  She is the founder and Program Director of cardio-metabolic and Lifestyle Medicine program at Stanford called SMILES - Stanford Metabolic health Intervention with Lifestyle Empowerment Support Group.  She has a special interest in global public health and has conducted a variety of health awareness and wellness camps in rural India. She has published her work in many peer-reviewed journals, and has been a speaker in many national and international professional conferences. In addition, she has authored several books and e-books, including a health education book and an e-cookbook of vegetarian soups for weight loss and multiple spiritual poetry books.