Having a normal weight with high body fat levels is actually much more dangerous than it looks.

Are you skinny-fat?

Are you a person who can maintain a normal weight, or even a slender frame, without trying too hard? Or are you thin everywhere except for the stubborn muffin top stuck in the middle?

If you fall into either category, chances are that you are skinny-fat, which, in medical terminology, is also called normal-weight obesity. Individuals with normal-weight obesity are characterized by having a normal body mass index (BMI), but having body fat percentage of more than 30%. 

Although BMI is easy to measure and use, it does not differentiate between muscle and fat mass, and hence, it cannot account for why normal-weight (but fat) individuals can actually be at high risk of developing cardiometabolic conditions like coronary artery disease and diabetes. 

Normal-weight central obesity is another form of skinny-fat, in which most of the body fat is located in the abdomen. In fact, such individuals may even have normal body fat percentages, but are centrally obese. 

Why is skinny-fat so dangerous to your health?

Being skinny-fat is inherently unhealthy because excess body fat is intrinsically pro-inflammatory. Fat cells are capable of producing biologically active chemicals that affect your hunger, metabolism and even your immune system. 

Due to chronic overeating and sedentary lifestyles, fat cells accumulate too much fat, which in turn, causes them to launch an inflammatory response that becomes dysregulated in the long run. That is why obesity, especially central obesity, produces a state of chronic, low-grade, systemic inflammation, which is a precursor to developing cardiometabolic diseases, and even cancer.

As in obesity, skinny-fat individuals tend to display an unhealthy metabolic profile like decreased insulin sensitivity, increased triglycerides and cholesterol and even fatty liver, all of which are hallmarks of chronic inflammation and major risk factors of developing a heart attack or stroke.

What makes being skinny-fat even more dangerous is that such individuals may also tend to take their body weight for granted and are unaware of their health risks. In fact, a longitudinal study by Hamer, Donovan, Stensels & Stamatakis (2017) found that among people with and without central obesity, those who had normal-weight central obesity had the highest risk of dying from cardiovascular disease, even more so than their obese counterparts.

In addition, skinny-fat individuals tend to have low muscle mass due to the fact that they maintain a normal body weight in spite of having a high body fat percentage. Having low muscle mass is profoundly detrimental to your metabolic health.

Muscles play a critical role in maintaining metabolic health. Besides enabling you to burn more calories throughout the day, muscles are also a major storage reserve of carbohydrates in the form of glycogen. During physical activities, your muscles will convert the stored glycogen into expendable energy. Hence, being physically active and having a healthy muscle mass optimize your insulin sensitivity and reduces your risk of developing cardiometabolic conditions.

What should I do if I am skinny-fat?

If you are skinny-fat, your top priority is to build lean muscle so as to optimize your body composition (i.e. muscle to fat ratio). Building lean muscle can be achieved by (1) regular resistance training and (2) a balanced diet consisting of adequate protein.

Perform resistance training at least twice a week

Resistance training targets your musculoskeletal system, and stimulates your body to build new and stronger muscle fibers, as well as improve bone density. With the increased muscle mass, your ability to process nutrients, especially carbohydrates, will also improve. This means that your body becomes more physically and metabolically resilient, even as you age.

Eat a healthy, balanced diet with adequate protein

Build your meals using the plate concept. Half of your plate should be filled with fruit and green fibrous vegetables. Dedicate at least one quarter of your plate to lean protein like fish and white meat. If you are vegan or vegetarian, soy products like tempeh and tofu as well as lentils may be used to replace meat. You may adjust your carbohydrate intake based on your activity levels. 

Eating this way will ensure that you are feeding your body with adequate protein, vitamins, minerals and antioxidants, all of which will ensure you to build muscle more easily and reduce chronic inflammation.

References:

(1) Jean N, Somers VK, Socher O, Medina-Inojosar J, Llano EM & Lopez-Jimenez F. Normal-Weight Obesity: Implications for Cardiovascular Health. Current Atherosclerosis Reports (2014), 16:464.

(2) Hamer M, O’Donovan G, Stensel D & Stamastakis E. Normal-Weight Central Obesity and Risk for Mortality. Annals of Internal Medicine (2017), 166(12), 917.