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Are you a naturally lean person who can eat anything and everything without gaining weight or having to exercise? If you are relatively thin with a bit of pudginess around your stomach and jawline, chances are that you could be a TOFI, without even knowing it!
TOFI, sometimes also called as “Skinny Fat” describes a person who has normal body weight but is carrying around hidden layers of fat. Stored up around vital organs, this hidden fat puts outwardly healthy people at risk. Visceral fat can be a real killer, and is much worse than fat you can see from the outside. It contributes towards high cholesterol, inflammation, diabetes and heart disease.
The term TOFI was coined by Professor Jimmy Bell and stands for “Thin on the Outside, Fat on the Inside”. It refers to a fast-growing health concern in the Western world. The condition is notoriously elusive but dangerous, since everything seems rather normal from the outside. A person who is TOFI doesn’t really get to know of these dangerous levels of visceral fat that are definitely a cause for worry most of the time. The only way to know if layers are fat encapsulate your vital organs is to get lab tests and MRI scans.
A person who is TOFI is “under-lean” with not enough muscle mass, instead of being overweight, and such people carry a little extra weight around the middle. These people have a low BMI or body mass index but very little muscle. They maintain a normal weight while suffering all the consequences of being fat on the inside. In simpler words – you may be thin, but you’re still unhealthy.
So, why is this a problem? If you are TOFI, you are at higher risk of developing insulin resistance and diabetes type 2 because you have reduced physical activity, reduced insulin sensitivity and higher abdominal adiposity. Additionally, you have a tendency for fatty deposits in the arteries and elevated levels of liver fat.
Many of us have become side-tracked by BMI, a method of measuring fat developed 150 years ago in Belgium. The problem with BMI is that anyone with higher muscle mass would come out with a high BMI when in fact they have low levels of visceral fat. Also, BMI doesn’t take bone-structure into consideration. If you have a smaller bone structure, you may have a lesser BMI than a person who of a similar height but is broader and wider, even if you are carrying more fat.
So, what causes visceral fat? Poor diet and lack of exercise are the usual culprits. Unlike subcutaneous fat that is located just under your skin, visceral fat is deeply embedded in your abdominal region and is not visible from the outside. It lies deeply inside your abdomen, filling the spaces between your organs. Visceral fat wraps around organs such as your liver and spleen, interrupting the regular function of your organs.
Visceral fat is associated with diabetes, heart disease, metabolic disturbances and sleep apnea. Studies have clearly linked visceral fat with insulin resistance and glucose intolerance as well, which can cause prediabetes and lead to full-blown diabetes if not addressed in time.
Excess body fat is bad for your health, but we all need at least a little fat. Fat cells are crucial in sending out hormones which affect your mood, ability to think clearly and fertility levels. People who have excess subcutaneous fat are often aware of it, since their excess weight shows outwardly. Subcutaneous fat is the kind you can grasp with your hand on any part of your body, including around your middle. It’s important to point out here that while visceral fat is the more dangerous of the two types (since it can easily go undetected), subcutaneous fat isn’t benign. Any extra fat you’re carrying will put excess stress on your joints and increase your risk of heart disease.
Genes also play a role in body shape. For example, many women who gain weight become pear shaped – storing fat in their hips, thighs and backsides, while men usually become more of an apple shape – storing extra fat on the belly. Post menopause, women start gaining more visceral fat too, becoming apple shaped. Also, constant dieting may interfere with the way the body lays down fat, and it may lead to increase in visceral fat.
Visceral fat comes with a cluster of health-related risks. Heart disease, insulin resistance, fatty liver, systemic inflammation, and high levels of bad cholesterol are all strongly linked to visceral obesity. And, perhaps most alarmingly, visceral fat is mostly hidden inside the body and only detectable through medical scans and lab tests. You might be of normal weight, but have high triglycerides, low HDL, small LDL particles, and high blood sugar and insulin — all “TOFI” signs.
Unfortunately, unless a person is overweight or obese, doctors may not always catch the early warning signs of being TOFI that ultimately increase risk to many health hazards. A quick way to know if you are TOFI is to measure your waist to hip ratio (WHR). Ideally, you want your waist to be smaller than your hips. Abdominal obesity is when your WHR is greater than or equal to 0.9 for a man and greater than or equal to 0.85 for a woman.
So, what can you do if you are TOFI (Thin Outside, Fat Inside)? The idea is to lose visceral fat through a healthy diet, gain muscle mass and maintain ideal weight.