Why “Skinny Fat” Can Be Worse than Obesity - Transcript

Coming up on this episode of The Doctor's Farmacy.

Dr. Mark Hyman:
The truth is that if you are thin and you eat crappy and you don't exercise, it doesn't mean you're home free.
Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman, and that's Farmacy with an F, a place for conversations that matter. And today, I'm bringing you a special feature of The Doctor's Farmacy called Health Bites designed to improve your health, because taking small steps daily can lead to significant changes over time.
And today, we have a big fat problem. Yes, we're overweight, but some of us are not overweight, but we're over fat, and that can be just as dangerous as being overweight. Now we are, in general, a very overweight nation. Over 75% of us are overweight. 42% are obese. 40% of kids are overweight. And what's even more frightening is that new data shows that not only are 75% people overweight, but 93.2% of people are metabolically unhealthy. And what does that mean? That means even if they're not overweight, they still are unhealthy metabolically. And we're going to go what into what that means.
So that's why you see this enormous rates of what they call diabesity. This is a spectrum of pre-diabetes all the way to full-blown type 2 diabetes. And 90% of those people who've got it don't actually have it diagnosed. In fact, this new data that 93% of people are metabolically unhealthy means that there's somewhere along that spectrum of pre-diabetes. It may not be one in two Americans, maybe 9 out of 10 Americans have some degree of metabolic disturbance that you could say is related to insulin resistance and maybe hasn't crossed a threshold to full-blown type 2 diabetes or pre-diabetes. So this is a big problem and it's a risk for heart disease, for stroke, for cancer, for depression, infertility, and of course it affects your quality of life and increases your rate of aging and death.
So there's all these detrimental consequences that happen, obviously for overweight. But that can also happen if we're at our ideal weight or normal weight or even underweight. So if it's true that a lot of people who are thin are also metabolically unhealthy, then what is all that about? In fact, it may be up to 30% of people who are thin are also what we call metabolically obese normal weight or TOFI, thin on the outside fat on the inside. I call it skinny fat. They look skinny, but they're actually fat on the inside. And there are risks, it turns out, are as bad as those who overweight. And actually maybe even higher. In some diabetic studies, they found that thin diabetics are at higher risk of complications in death than overweight diabetics, which is very concerning. So we have this sort of epidemic of TOFI, or metabolically obese normal weight. It's not tofu, it's TOFI, thin on the outside, fat on the inside.
And it basically means we're over-fat and under-lean. And it may be the distribution of fat. Sometimes people are thin in terms of the scale, but if you look at them, they got a little pooch or a little belly. And you see this particularly in certain populations like Asians or Indians from India are often at their ideal weight, but they still have high rates of diabetes, even when they're not overweight. And that's because they are prone to develop this organ fat, this visceral fat, this belly fat. And this is really terrible, because they may have a low body mass index, so on their weight scale they look fine, but they have not enough muscle and they have poor metabolic health because their muscle is metabolically unhealthy as well. So not only they have lower muscle mass and are under lean, but their muscle quality is lower. So it's really a problem. And they can suffer all the same consequences of heart attacks, cancer strokes, dementia, even diabetes, by having this problem called TOFI.
So even if you're thin, it doesn't mean you got a free ticket. And you've seen people who are, "Oh, I'm eating junk, and sugar, and crap, and I don't gain weight, and I'm fine." So that's not about the weight, it's about what's happening on the inside under the hood. So technically they may not be overweight, but they are actually metabolically just like a diabetic person or pre-diabetic. They might have low muscle mass, inflammation, high triglycerides, their cholesterol may be wacky. They have low good cholesterol, they have high blood pressure, high blood sugar. So it doesn't give them a free pass that you're normal weight. Now if you're overweight or obese, you know you're kind of at risk, but if you're not, and you're like, "Maybe just think you're fine, you're actually not."
And there is actually a way to test for it, which is losing a body composition test. It looks at your body composition and the distribution of fat. So not only do you do body composition, you can do it on a scale and it'll tell you overall, and that also can be helpful. But looking at a DEXA scan, which looks at where the fat is distributed, is it in your muscle, in your arms and legs, but you got lots of belly fat, and your weight's normal, you're in trouble.
So those fat deposits, that belly fat, the organ fat is really the problem. And then the muscles also become like marbleized fat, like a rib-eye steak as opposed to a filet mignon. And that actually leads to poor metabolic function in the muscle and pre-diabetes, and you get low sex hormones, high cortisol, low growth hormone, pre-diabetes, insulin resistance, all of it happens. So it's really bad.
And you can tell, and I have many patients like this where they have this little belly fat, and they look like they're normal weight, but you do your lab tests and you see they have high triglycerides, low HDL, small LDL particles, high blood sugar, high insulin, all the signs that they have TOFI or have this problem. And doctors often will ignore this, because they're not overweight, so it's fine. But they really are at risk.
So what do you do if you have this problem? Well, first you have to diagnose it. And that can be lab testing. It can be a body composition test. But it's very similar to someone who's got diabetes. So it's get your muscle mass up, get your body fat down, and increase the metabolic health by the kinds of foods you're eating, the kind of exercise you're doing and the right supplements. So first you want to focus on a very low glycemic diet, which is low in sugar and starch, higher in fat, good fats, olive oil, avocados, nuts and seeds, good quality protein to build muscle. So you need about 30 grams of protein per each meal, at least I'll, that's really important. So diet is key.
And then if you do healthy fats, you're not going to be hungry, you're going to boost your metabolism. So avocados, olive oil, walnuts, nuts and seeds, nut butters, coconut oil, even virgin coconut oil can be very helpful. I've written a lot about this in the Blood Sugar Solution, the 10-Day Detox Diet. So you can learn exactly how to deal with this problem and how to fix it, but it's entirely reversible.
Now what else is really important besides the diet? Well, strength training, because you need to build muscle and muscle burns seven times as much calories as fat. When you have a high ratio of fat to muscle, it has huge impacts on your metabolic health, not just on your appearance because you can kind of look kind of flabby and frail even though you're not on overweight. But if you lose muscle, you're in trouble and you will lose muscle over time if you don't do anything about it. So you could be the same weight as you were when you were 20 at age 70, but be twice as fat because your muscles become replaced with fat. And we call this metabolically obese normal weight or skinny fat or TOFI, same thing. And you lose mitochondria. Your metabolism slows down, you lose muscle strength, you get increased frailty, and it's just bad. So you need to do strength training, particularly as you get older, to feel better to reverse TOFI, and reverse your risk of diabetes and other problems.
So you can do body weight training, you can do bands, which I do, stair climbing, pushups, squats, there's all kinds of apps and programs, will link to them in the show notes. But I like TB12, which is Tom Brady's training program with bands. I take them with me everywhere. I worked out today on the road. So it's really pretty easy to do.
Also, there's other things you might not think about when it comes to dealing with your metabolic health we've talked about, but dealing with cutting out inflammatory foods, and not just sugar and starch, but food sensitivities. Gluten can be a big factor. Dairy can be a big factor. And those things you might want to cut out for a short time in addition to sugar and obviously processed food.
Stress can be a big factor in terms of weight metabolism. So learning how to modulate your stress through meditation, yoga, breathing, things like saunas, Epsom salt baths also help you relax. Tracking your results can be really helpful. So making sure you kind of track what you're eating, track your exercise, track your sleep. I use different tracking devices. There's Apple Watches, and Fitbits, and I use the Oura ring, but it helps you identify what's working and what's not working. I make sure you stay hydrated because a lot of times people think they're hungry, but they're actually thirsty. And also it helps you flush out toxins, and it's great. Getting enough sleep. If you don't sleep enough, you tend to crave carbohydrates, and sugar, so you don't want to be eating all that.
And there's some basic supplements you can take to help, including a multivitamin, fish oil, vitamin D at the bare minimum. So there's a lot you can do to also supplement-wise to regulate insulin-resistance, but the truth is that if you are thin, and you eat crappy, and you don't exercise, it doesn't mean you're home free. I want you to be aware that you should get that checked and I think it's totally reversible. And be sure that you make sure that you're taking care of yourself and not just think you're fine if you're normal weight, especially as you get older.
So that's it for today's Health Bite. If you love this podcast, share it with your friends and family. We'd love to hear from you. Have you found out maybe you're skinny fat and what have you done about it, and know what's worked for you. Subscribe or get your podcast, and we'll see you next week on The Doctor's Farmacy.

Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit IFM.org and search there, find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.