Are You ‘Skinny Fat?’

woman cutting pear_skinny fat

Lose Fat, Gain Muscle, Reverse Aging

If you looked at two of my clients, Bill and Jim, side by side, you’d most likely pick Bill as the healthier of the two. Bill is tall and lean with a seemingly favorable body makeup; he even sports 6-pack abs. Jim is short and stocky, a little on the heavy side, though quite muscular. Bill runs marathons, so you’d probably think he’s in better shape than Jim and might even put money on it. 

Put your wallet away. You’d be wrong. Bill is skinny and fat. He’s “skinny fat.” I’ll explain.

While Jim might not beat Bill in a race, he’s metabolically the healthier of the two men. Though you can’t see it, Bill has a higher percentage of body fat than Jim. He’s “skinny fat.” Bill has a medical condition known as “normal weight obesity,” which is characterized by being technically acceptable but with a body fat percentage typically predictive of the disorders of aging. High body fat percentage in a person who looks lean may disguise visceral body fat located deep in the midsection of the body surrounding the organs. 

Visceral fat is hormonally active, meaning it secretes biochemicals that negatively influence other processes in the body. As visceral fat increases, for example, levels of a metabolism-protective hormone called adiponectin drop. Low levels of adiponectin and insulin-regulating hormone are linked to type 2 diabetes and cardiovascular disease. Also, people with high visceral body fat often have high cholesterol and triglycerides, high blood pressure, high sugar, and underlying chronic inflammation. Bill has all the above except hypertension. By contrast, Jim has a higher percentage of muscle mass compared to his body fat, and he suffers from none of those metabolic disorders. 

What Does ‘Skinny Fat’ Mean?

skinny fat_vegan

“Skinny fat” describes people who look good, suggesting they’re a healthy weight for their height, yet beneath the surface, they have high body fat percentage and low muscle mass. The scientific term for age-related muscle loss is sarcopenia. Being skinny fat can be even more dangerous than being outwardly obese. A study published in the Annals of Internal Medicine found that normal-weight people who carried excess weight in their midsections had the highest risk of dying early, even when compared to overweight or obese people. 

How does one become skinny fat? Well, of course, everyone is unique. However, skinny fat happens to most people when they restrict calories, eat too little protein, and don’t do muscle-building, or resistance exercises. That’s Bill. He runs miles every day but does no strength training whatsoever. And from his food logs, I see that he’s a vegan. It can be difficult to consume enough protein daily on vegan or plant diets, especially if you are as physically active as Bill. His healthy appearance is misleading. Bill thought he was doing fine because he said his Body Mass Index (BMI) was within the “healthy range” at 24.2. But BMI can be highly inaccurate. This is when an individual has a high or in-range BMI and a lot of muscle or a low or in-range BMI and little muscle and a lot of fat like Bill. 

A much better indicator of body fat distribution and health risk is the waist-to-hip ratio. To find yours, wrap a tape measure around your waist at your belly button and write down your waist circumference. Next, wrap the tape measure around your hips at their widest part. This is your hip circumference. Divide your waist circumference by your hip circumference to get your waist-to-hip ratio. Abdominal obesity in men is a waist-to-hip ratio of 0.90 or higher. For women, it’s 0.85 or more.

 When clients are seen at Comite Center for Precision Medicine & Health, we use a far more accurate way of measuring fat and muscle mass called bioelectrical impedance analysis. You stand on what looks like a weight scale and hold onto electrodes that send a weak electric current through your body. The machine calculates a detailed breakdown of your weight in muscle, fat, and water. We also have our clients undergo a DEXA scan, which measures their bone density. It also provides an assessment of the amount of muscle and body fat in their body. 

How to Move from Skinny Fat to Healthy 

exercise not skinny fat

It can be hard to break out of being skinny fat. This is because our diet culture encourages people to eat less and do more cardio – the very things that can lead to this condition. However, it’s possible to change your body composition by adding well-balanced muscle and keeping it. Muscle mass is what gives you that toned, lean appearance. It also boosts your basal metabolic rate and encourages fat loss because muscle uses fatty acids and glucose as fuel.

  •     Practice regular strength training: Studies show that strength training helps decrease losses in muscle mass when in a caloric deficit. So, even if you’re trying to lose weight, you can avoid losing muscle. Instead, focus on fat loss by hitting the weights. Aim to work all the main muscle groups on a weekly basis. 
  •     Eat a balanced diet: Many skinny fat people eat a diet that’s high in carbohydrates and refined foods. Others eat too few calories to lose weight. Instead, follow the basic rules of good nutrition: eat mostly fruits and vegetables, whole grains, nuts, seeds, dairy products, eggs, lean meats, and fish. Consider taking micronutrient supplements (vitamins and minerals) to make up for any that you may be lacking in your diet.   
  •     Eat more protein: Protein is key for growing and maintaining muscle. It also fills you up and keeps you satisfied so you aren’t reaching for snacks an hour after dinner. In general, you should eat 1.6 grams of protein per kilogram of your body weight per day when working out.
  •     Check your hormones and metabolic health: Ask your doctor to prescribe blood tests to check your Free Testosterone (which is essential for muscle growth) and such metabolic health markers as glucose, insulin, and thyroid balance.

Ultimately, everyone’s body is different. The way you react to food and exercise will likely be different than the next person. If you need help pinpointing the right approach for your unique body, visit the Comite Center for Precision Medicine & Health or check out Groq Health, our new digital health app. 


Florence Comite, MD is a Yale-trained endocrinologist and founder of the Comite Center for Precision Medicine & Health in New York City, Palo Alto, and Miami Beach. She is also the CEO +  Founder of the digital Precision Medicine app Groq Health.

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