The dangers of skinny-fat

For decades we’ve judged the state of our health by our weight. If the scales say we weigh 60 kilos and we fit into our size-10 clothes, it’s natural to assume we’re in good health and our lifestyle is working for us. Many women don’t even see the need to exercise if they’re slim and they complacently carry on as before, under the misconception they’re doing everything right.

Yet medical and nutritional experts are growing increasingly concerned about a condition commonly known as ‘skinny-fat’, which relates to slim, slightly apple-shaped, people who have high levels of fat inside their bodies.

“It’s natural to look at someone who is slim and assume they are healthy,” says Dr Davina Deniszczyc, well-being medical director for Nuffield Health in the UK. “These people don’t have gym membership because they think they don’t need to exercise, but when they get checked out, they find they, more than anyone, need to exercise and gain more muscle.

“It’s sometimes the case they’re unhealthier than an obese person who exercises. They may be a size 10 or 12, naturally skinny and an ideal weight on the scales, yet their weight is mostly fat and they have very little lean. They’re usually not very toned and they may feel a little wobble of fat when they walk.”

Dubai-based nutritionist Dalia Shukri agrees that looks can be very deceptive when it comes to health. “A slim person may have a high metabolism but there can be a lot of dangerous things going on under the surface,” says Dalia, who is head nutritionist at Nutridiet.

So what is the difference between subcutaneous fat – the fat we can see just under our skin – and this internal invisible fat, which is known as visceral fat? “This visceral fat coats the organs and puts pressure on them, virtually suffocating them,” explains Davina. “It acts differently from the fat people get around their arms and legs.

“A slim person might not see the dangers until they have a disease, but there are some really easy things they could do before they get into a diseased state.”

“Being more metabolically active, the fat around the middle can cause problems with blood-sugar balance, and these problems can turn into type 2 diabetes if left untreated,” warns Davina. “If the fat is putting pressure on vessels in the heart, there’s a risk of heart attack and an increased chance of stroke.”

“The cause is simply overeating calories and doing little physical exercise,” continues Davina. “If you take in more calories than you burn up, the extra will be laid down as fat. In pear-shaped people fat is stored on hips and thighs, arms and legs, but on skinny-fat people, the fat goes inside where it often can’t be seen.

“The big problem is physical inactivity and a lot of sedentary behaviour. People who work behind desks all day or in places such as call centres are much more at risk. This skinny-fat issue is also a concern with older people because muscle mass reduces with age.”

Dalia stresses exercise is important but day-to-day activity is key. “We have a big exercise society in Dubai and we have plenty of gyms,” she says. “But because of our infrastructure, our weather and long working hours, we don’t build exercise into our normal days.”

Until recently, having a healthy BMI, body mass index, which is determined by height and weight, was an indicator of good health, with a reading of 20-25 a healthy score. But skinny-fat people often have BMIs in the low 20s and doctors have realised that what they see on the outside isn’t always an indication of what’s going on inside the body.

“Doctors will look at your BMI and your lifestyle, which includes your diet and exercise,” says Davina. “They will also ask you about your family history. If there have been any early heart attacks or strokes in your family, they might prompt doctors to investigate further. They may ask about your parents as obese parents tend to have obese children. Inactive adults pass on their behaviour to their children.

“They could do blood tests to see how healthy your liver is or they may refer you for an ultrasound scan to see if there is any fatty infiltration to the liver.”

Other tests include blood pressure, examining fasting blood sugar or glucose levels and measuring good cholesterol levels. But an insulin-response test that measures both blood sugar and insulin levels while fasting is a more accurate method of diagnosing skinny-fat. Other experts suggest MRI scans.

“If you’re diagnosed as skinny-fat, it can be an easy thing to turn around in the early stages if you’re committed,” adds Davina. “The hardest part is psychological. Changing behaviour is often difficult because you look so healthy and you feel fine. Doing 30 minutes of cardiovascular exercise five times a week will help, but it has to be exercise that gets your heart up, has you sweating and out of breath along with some core exercises such as Pilates and weight resistance.”

As for dietary changes, Dalia suggests, among other things, anyone diagnosed with MONW should cut out fatty and junk food and sugars.