Hidden Fat, Hidden Risk: Rethinking Hypertension in “Non-Obese” Adults

Dr Sanjay Kalra, Treasurer, International Society of Endocrinology (ISE), Vice President, South Asian Obesity Forum (SOF), Bharti Hospital, Karnal, INDIA

Even nonobese adults can have hidden visceral fat and metabolic risk factors that strongly predict hypertension, often better than traditional measures like BMI.

Hypertension is often viewed as a disease of excess weight, yet nearly half of adults without obesity may still be living with high blood pressure. New evidence suggests that the explanation lies not in body weight alone, but in how and where fat is distributed—and how it interacts with metabolism.

An analysis of data from over 12,000 nonobese adults drawn from two decades of national health surveys offers fresh insight into this hidden risk. Instead of relying solely on traditional measures such as body mass index or waist circumference, researchers examined newer obesity-related indices that combine triglyceride levels with markers of visceral fat and glucose metabolism. These included lipid-based indices such as the lipid accumulation product and visceral adiposity index, as well as triglyceride–glucose–based measures linked to body size and waist dimensions.

The findings were striking. Nearly half of nonobese adults were hypertensive, and several of these novel indices showed a strong and consistent association with high blood pressure. In fact, they outperformed conventional anthropometric measures in identifying individuals at risk. Importantly, the relationship between visceral fat indices and hypertension was not linear, underscoring the complex biology linking hidden adiposity to vascular health.

These results challenge the notion that a “normal” weight equates to low cardiovascular risk. Clinicians need to look beyond the scale and consider metabolic and lipid-based markers when assessing hypertension risk. For public health, the message is clear: cardiometabolic risk can remain concealed, even in those who appear lean.

(Source: Chen L, Yin L. Associations of Novel Triglyceride-and Triglyceride–Glucose-Derived Obesity Indices With Hypertension in Nonobese US Adults (NHANES 1999–2020). American Journal of Hypertension. 2026 Jan;39(1):108-21. )