Metabolic health in a changing world: widening the lens to climate, cities, and place

PURPOSE OF REVIEW: Individual-level interventions emphasizing diet, clinical management, and structured exercise have been the typical approach to addressing metabolic health. Growing evidence suggests that broader environmental factors that shape metabolic risk have been overlooked. In this opinion paper, metabolic health is reframed within the context of climate change, urbanization, physical activity, and local knowledge, highlighting them as interconnected determinants of metabolic wellbeing. RECENT FINDINGS: Physical activity and metabolic processes are greatly influenced by neighbourhood urban design, transport infrastructure, and climate effects such as extreme heat. Evidence shows that greener neighbourhoods that support walking, cycling, and public transport are associated with more favourable cardiometabolic outcomes. Critical to the integration of such approaches for embedding physical activity into everyday life are insights from Indigenous and local communities that take a relational, place-based approach to movement and wellbeing. SUMMARY: Addressing modern metabolic health may require a paradigm shift from an individual to a systems-level approach. It is proposed that, to achieve this, physical activity, climate resilience, urban design, and Indigenous/local knowledge should be considered together to create more equitable, sustainable, and metabolically supportive environments. This framing, therefore, has important implications for research, clinical practice, policy, and next steps.