Addressing Metabolic Health Risks in Asia: Evolving Underwriting Practices for Life and Health Insurance
By Si Xie and Jason Christopher Alleyne
Actuary of the Future, July 2025
Introduction: The Emerging Challenge of Insulin Resistance
The rapid economic development of Asia has ushered in profound lifestyle changes, particularly in urban centers. Increased disposable income, urbanization, and the proliferation of convenient food services have contributed to dietary habits associated with elevated health risks. Among these, insulin resistance (IR) — a metabolic condition linked to diabetes, hypertension, and cardiovascular diseases — has emerged as a critical yet underrecognized threat. IR is also strongly associated with an increased risk of dementia, particularly Alzheimer's disease and vascular dementia. For life and health insurers operating in markets such as Greater China and Southeast Asia, traditional underwriting methods face significant challenges in accurately assessing these evolving risks. This article investigates the limitations of conventional approaches and explores the potential of continuous underwriting methodologies to better align risk assessment with dynamic lifestyle factors.
The Unique Risk Landscape in Asia
Asia’s metabolic health profile differs markedly from that of Western markets. Urban populations, particularly in high-income cities, exhibit dietary and behavioural patterns that accelerate the onset of insulin resistance. In China, for instance, diabetes prevalence has reached parity with the United States, affecting approximately 12.8% of adults.[1] However, IR — a precursor to diabetes and other chronic conditions — is estimated to affect a far larger proportion of the population.
Several factors contribute to this disparity:
- Dietary Shifts: Urbanization has increased reliance on processed foods and meals prepared outside of the home.
- Extended Eating Windows: Late-night dining, facilitated by 24-hour food delivery services, disrupts metabolic rhythms and exacerbates IR.
- Low Adoption of Health Technologies: Despite rising health risks, utilization of continuous glucose monitors (CGMs) remains below 10%[2] among diagnosed diabetics in Asia, limiting early intervention.
These trends suggest that historical incidence rates for metabolic diseases may underestimate future claims, particularly among affluent urban populations targeted by insurers.
Limitations of Traditional Underwriting Models
Conventional underwriting relies on static, point-in-time assessments, such as blood tests and physical examinations, to classify risk. While effective for identifying overt conditions like diabetes, these methods fail to capture the progressive nature of insulin resistance. For example:
- A 35-year-old applicant with normal fasting glucose levels may already exhibit elevated IR, signaling a high likelihood of diabetes within a decade.
- Single assessments cannot account for behavioral variability, such as dietary habits or sleep patterns, which directly influence metabolic health.
This gap creates two critical issues for insurers:
- Underpricing of Risk: Policies issued to individuals with undetected IR may lead to unexpected claims as conditions manifest years later.
- Adverse Selection: Affluent urban populations, who are more likely to adopt IR-inducing lifestyles, may disproportionately seek coverage without commensurate premium adjustments.
Toward Continuous Underwriting: A Data-Driven Approach
To address these challenges, insurers should explore methodologies that leverage continuous lifestyle monitoring. This paradigm shift involves three core components:
1. Integration of Dietary Data
Insurers can develop dynamic risk profiles that reflect dietary habits. For instance, algorithms analysing eating windows, meal frequency, and nutritional content could generate a Dietary Risk Score (DRS), providing a more comprehensive evaluation of metabolic health than conventional biomarker measurements alone.
2. Dynamic Product Structures
Continuous data streams enable insurers to adjust underwriting requirements, premiums and/or coverages based on ongoing risk mitigation. Policyholders demonstrating sustained improvements in DRS metrics — such as shortening eating windows or adopting balanced diets — could qualify for more coverage or premium discount. Conversely, those exhibiting deteriorating habits might receive targeted interventions, such as subsidized nutritionist consultations, to curb further risk escalation.
3. Preventive Product Design
Parametric insurance products, which trigger benefits based on predefined health metrics, could incentivize proactive risk management. For example, a policy might provide annual comprehensive metabolic screenings for individuals with the bottom 10-percentile DRS, reducing long-term claims by facilitating early detection.
Operational Considerations
Implementing continuous underwriting requires careful navigation of technical and cultural challenges:
- Data Privacy and Trust: Consumers often express skepticism toward data-sharing initiatives. Insurers must prioritize transparency, ensuring policyholders retain control over data usage and benefit directly from participation.
- Integration with Legacy Systems: Many insurers rely on outdated IT infrastructure ill-suited to processing real-time data. Strategic partnerships with InsurTech firms could accelerate modernization.
- Distribution and Consumer Education: Innovative products often require educating distribution and consumers about usage and benefits. Insurers should provide sufficient training to their sales force and effectively market to consumers.
The Role of Actuarial Science in Risk Redefinition
Actuaries will play a pivotal role in translating lifestyle data into sustainable pricing models. Key priorities include:
- Developing Predictive Models: Correlating long-term claims data with DRS trends to quantify the financial impact of IR.
- Scenario Analysis: Stress-testing portfolios against varying rates of metabolic disease escalation across demographics.
- Regulatory Collaboration: Advocating for standardized frameworks to ensure consistency in continuous underwriting practices.
Conclusion: Aligning Insurance with Metabolic Health Realities
Asia’s evolving health landscape demands a fundamental rethinking of risk assessment practices. Static underwriting, designed for slower-moving risks, is increasingly misaligned with the rapid progression of lifestyle-driven conditions like insulin resistance. Continuous underwriting methodologies, grounded in real-time lifestyle data, offer a path to greater accuracy and sustainability.
For insurers, the transition involves not only technological investment but also a cultural shift — from viewing policies as financial contracts to fostering partnerships that prioritize policyholder health.
As metabolic risks continue to rise, the industry’s ability to adapt will determine its resilience in one of the world’s most dynamic insurance markets.
This article is provided for informational and educational purposes only. Neither the Society of Actuaries nor the respective authors’ employers make any endorsement, representation or guarantee with regard to any content, and disclaim any liability in connection with the use or misuse of any information provided herein. This article should not be construed as professional or financial advice. Statements of fact and opinions expressed herein are those of the individual authors and are not necessarily those of the Society of Actuaries or the respective authors’ employers.
Si Xie, FSA, FCIA, CERA, is the director and CEO, Reimaginerisk Limited, Hong Kong. Si can be contacted at si.xie@reimaginerisk.ai.
Jason Christopher Alleyne, FSA, FCIA, is the head of analytical solutions, APAC, AON Life Solutions, Hong Kong. Jason can be contacted at jason.alleyne2@aon.com.
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