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I’m Skinny but I’m Fat

04 July 2019

5 minute read

I’m Skinny but I’m Fat

Huh? It certainly is strange to hear two opposing adjectives to describe one person. How can you be fat when you don’t look fat? Apparently, being skinny fat is even more dangerous than being overweight! If this sounds a bit too much to digest, let Consultant Internal Medicine Physician, Dr. T Kalaiselvam A/L Thevandran from Columbia Asia Hospital – Klang shed some light on the matter.

Tools that can be useful for finding out skinny fat are caliper measurements, Bioelectrical Impedance Analysis (BIA), and clinical tests.

In general, some symptoms or signs that very suggestive of skinny fat:

  1. Feeling dizzy or light-headed after mild exercise
  2. Lack of resistance exercises for many years
  3. Flabby arms
  4. Weak muscles
  5. Increased Body fat percentage more than recommended.
  6. Excess belly fat
  7. Unhealthy eating habits with a neutral weight
  8. Family history of Diabetes, Hypertension, Ischaemic Heart Disease
  1. Is the term “skinny fat” a real thing?
    Yes, skinny fat is a real, remarkably common phenomenon and can be deadly even. It describes lean individuals (BMI < 25kg/m2) with a dangerously high percentage of body fat compared to lean muscle mass. Many terms had been coined with skinny fat like Thin Outside Fat Inside (TOFI), Metabolically-Obese Normal-Weight (MONW), Normal Weight Obesity (NWO) and Sarcopenic Obesity (SO). In a recent research study, it was estimated that 14% of the men and 12% of the women scanned with a BMI 20–25 kg/m 2 were classified as TOFI. Being lean doesn’t mean you’re healthy.

  2. What does “skinny fat” look like?
    Phenotypically, they look lean and healthy, but when we check them out they have high levels of body fat and inflammation. This ectomorph body build has hidden high levels of body fat. They appear thin and flabby.

  3. How do we know whether we’re considered “skinny fat”?
    What can we do to find out? What are the symptoms? Weight is not the main measurement to use when determining the presence of skinny fat. The best way to tell if a body has excess fat stores on a smaller frame is to have their body composition checked out.

    Once you’re able to get reliable information about your body fat percentage, you can compare it against the recommended percent body fat ranges. The recommended ranges for healthy men are between 10-20% body fat, and for women, the ranges are 18-28%. If your body fat exceeds these ranges, but you have a normal weight when you stand on the scale, you may be skinny fat.

  4. Who does this usually affect? Is it common?
    All age groups in both genders are affected and it is common.

  5. Why do people who are “skinny fat” end up that way?
    Most skinny fat people are the way they are because they don’t lift heavy weights or do any resistant exercise. Skinny fat people have low muscle mass. Their fat percentage is high compared to their muscle mass.
    If someone is slim (means have low-fat percentage), you would be able to see their abs and their bodies wouldn’t be flabby (especially their upper arms, thighs, and bellies).

  6. it a dangerous issue? Are there any health risks?
    Yes, skinny fat does lead to adverse clinical outcomes. The medical term for ‘skinny fat’ is technically MONW or “metabolically obese, normal weight” and “Sarcopenic obesity”. Skinny fat people are often a normal weight (or underweight!) but because of their sedentariness, lack of muscle, or poor diet, they have a high percentage of body fat.

    Often, skinny fat people are at risk of certain medical issues as listed:
    1. Raised blood sugar, leading to insulin resistance or diabetes.
    2. Increased inflammatory markers in the body, which is linked to an increased risk of certain cancers, heart disease, arthritis, psoriasis, and depression.
    3. Elevated blood pressure, which puts you at an amplified risk of stroke and dementia.
    4. High triglycerides, which can root to heart disease.
    5. Vitamin deficiencies that can lead to conditions such as chronic fatigue, anemia, and more
    6. Digestive issues like IBS or acid reflux.

    A study in the Journal of the American Medical Association (JAMA) showed that 1 in 4 skinny people have prediabetes and are ‘metabolically obese.’ This study also found that if you are ‘skinny fat’ at the time you are diagnosed with diabetes, then your risk of death is double that of someone who is an overweight diabetic.
  1. If the answer is yes, how do we combat that “skinny fat”?
    If you’re officially a part of the skinny fat club, what can you do about it? The good news is, your health is in your hands! It’s up to you to make a few lifestyle changes to go from skinny fat to strong, healthy, and balanced. Do these things to start making the transformation from skinny fat to healthy.

    1. Exercise Often (Including Strength Training)
      Being skinny fat, you need to switch from a sedentary lifestyle to one that includes both cardiovascular exercise and strength training. Building muscle is crucial to moving back the negative health effects of being skinny fat. Strength training can be done with weights or with your own bodyweight alone; there’s no fancy equipment required. Centres for Disease Control and Prevention, CDC recommends 150 minutes of cardiovascular activity for a week, and you may start strength training 2-3 times per week. Putting on muscle will re-balance your body composition, making you healthy and strong.

      Apart from gym workups, a simple taking more steps can be a good starter. Get a pedometer and aim for an initial goal of more than 5,000 steps daily and then ultimately, at least 8-10,000 steps daily. This will simultaneously allow you to increase endurance and strength.

    2. Manage Your Food Choices
      Ensure that you’re eating healthy with foods that nourish your body and muscles. Make sure you’re eating a vegetable-rich diet and include clean sources of protein (like lean chicken breast, salmon, and occasionally red meat) as well as healthy fats (olive oil, avocados, nuts) and fruits, legumes, and whole grains. Importantly, lowering carbs is vital to lower fat.

    3. Manage Stress
      Stress management is vital for general overall health. Studies show that chronic stress predisposes onto visceral fat which is harmful. Make meditation a daily practice, take time to unplug from devices, try yoga, and practice deep breathing when faced with difficult situations. The most important thing to remember is that your health is more internal than external.

    4. Regular checks and tests
      Take charge of your health and get all your numbers checked, not just your weight. The important numbers to know for your health are your body composition (the ratio of muscle to fat), your blood pressure, your blood sugar, and your cholesterol (including the “good cholesterol,” the “bad cholesterol,” and your triglycerides). Getting these numbers in the normal range is so much more important than any number on the scale.

What Not to Do

  1. Don’t starve with very low-calorie diets. When a person is looking to increase their muscle mass, calorie restricting is the last thing they want to do. Human bodies need those calories for energy, and a lot of energy goes into beefing up muscle mass.

  2. Don’t overdo the cardio. When a person puts themselves through an intense cardio session, especially when they don’t have the calories to burn, their bodies will start consuming muscle. This is the last thing they want to happen when trying to rid themselves of skinny fat.

This article first appeared in Female Magazine, Issue June 2019

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04 July 2019

5 minute read

I’m Skinny but I’m Fat

Dr. T Kalaiselvam A/l Thevandran

Internal Medicine And Nephrology

Learn more about Internal Medicine And Nephrology in Columbia Asia

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