The stage where it is easiest to change the outcome

What is worth acting on early

• Pre-diabetes — HbA1c between 5.7 and 6.4. Reversible in a large share of cases with diet and activity alone.
• Fatty liver — usually silent, usually found by accident, and one of the most diet-responsive conditions there is.
• Borderline lipids — where the aim is to avoid needing medication later.
• Blood pressure in the high-normal range.
• Central weight gain — waist circumference tells you more here than weight does.
• Insulin resistance — often present for years before sugars move at all.
• Family history — of type 2 diabetes, heart disease, thyroid disease or PCOS.

What actually moves the needle

Prevention work is unglamorous and effective. Four things carry most of the result:

1. Protein and fibre at every meal. This one change alters glucose response, appetite and weight together.
2. Refined carbohydrate reduced, not eliminated. Portion and pairing, again — this is a theme.
3. Movement after meals. Fifteen minutes of walking after your largest meal is the highest-return habit in this whole list.
4. Sleep. Short sleep raises insulin resistance and appetite measurably. It is not a soft factor.

Getting a baseline

Worth having before we start, and worth repeating at three to six months: HbA1c and fasting glucose, a lipid profile, liver enzymes, TSH, vitamin D, B12, and haemoglobin with ferritin. Plus weight and waist circumference — waist is the better predictor of metabolic risk and almost nobody measures it.

Numbers that improve are also what keeps people going when the scale stalls.

Screening in the family

If one parent has type 2 diabetes, your own risk is substantially higher, and it is worth knowing your numbers well before symptoms appear. The same goes for thyroid disease and PCOS, both of which cluster in families and both of which respond to being caught early.