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February 4, 2016

Is Being Skinny Fat Worse Than Being Obese?


skinny fat

To start the New Year you join a fitness club and on the first day you meet with a personal trainer who does a fitness assessment including body composition determination. And, then he bursts your pride. He says you are skinny fat. “What?” you ask incredulously. He says, “I’m sorry. But, you are skinny fat. Your percent body fat is too high at 32%.”

You thought you were doing good. You are a female. You are 55 years old. You have a thin frame, stand 5’4″, and weigh 125 pounds just a mere five pounds more than when you received your college diploma 33 years earlier. Your body mass index or BMI which is based on your height and weight is normal at 21.5 (normal is consider 18.5 to 24.9).

While others you know – both men and women – have packed on the pounds over the years you are proud that you have been able to maintain a healthy body composition – or at least what you thought was healthy.

You ask yourself, “How can I have 32% body fat?”

What is Skinny Fat?

Skinny fat does not mean that you have a thin layer of fat or that your fat is thin. It means that despite being thin you are still carrying around too much fat. Skinny fat gets to the crux of a more important number you should know about for yourself. Your percent body fat.

Percent body fat tells us (you) much more about your state of health than BMI, but BMI is used most often because of its ease since it requires only knowing body height and weight and requires no special equipment or testing . Percent body fat takes into account lean body mass as well as your actual body fat.

A 55 year old female should have a body fat of 23% to 33% depending on her body frame. Given the height and weight of the female described above her percent body fat should trend closer to the 23% figure.

So to know if you are skinny fat you need to know your actual body composition (percent body fat). You need to know how much lean body mass you have and how much body fat you have.

Overweight and Obesity

According to the NIH 68.8% of us are overweight with 35.7% being considered obese. But….. but up to 25% of normal weight individuals carry too much fat – those individuals we now call skinny fat. Throw them into the mix and that means 76.5% of the American population is lugging around too much body fat. And, with that fat comes health consequences – the bad kind – even for the skinny fat.

Health Consequences for the Skinny Fat

Fat tissue is very inflammatory and inflammation is at the root of most, if not all, chronic disease. Fat is filled with inflammatory cytokines. In addition, fat tends to be a reservoir where toxins accumulate and then are slowly released back into the body. Excess fat leads to insulin resistance that leads to heart disease and diabetes and some cancers.

READ THIS. A study in the Annals of Internal Medicine found that skinny fat individuals are at higher risk of dying than those clearly overweight and obese. Why? We don’t know.

Who is Skinny Fat and What Does it Really Mean?

If you are normal weight and you are skinny fat, it means this. You have lost muscle mass. How else can you explain the skinny fat paradox or phenomenon?  If you had normal muscle mass for your frame and too much fat relative to your muscle mass you would simply be overweight and not skinny fat. So skinny fat means too little muscle.

Maybe it’s the lack of muscle (sarcopenia) that increases the risk of death in the skinny fat relative to those who are overweight or obese. Let’s use osteoporosis as an example. We do know that muscle mass is a very good predictor of who will get osteoporosis. The higher your muscle mass the less likely you will get osteoporosis.

The mortality rate following a hip fracture related to osteoporosis is 24% the first year. Also, a 50 year old women is just as likely to die from a hip fracture as she is from breast cancer and four times more likely to die than from endometrial cancer according to data from the International Osteoporosis FoundationPerhaps the best way to treat osteoporosis is maintain muscle mass and muscle strength which in turns improves bone strength. That is done through resistance or strength training. The three major sex hormones – estrogen, progesterone, and testosterone all improve bone density, too.

Maintaining muscle mass is one major key to longevity.

Who losses muscle mass? All of us do as we age and it is most obvious in the elderly. Many elderly are thin and frail and have little muscle. They are skinny fat.

Who else is skinny fat? Typically perimenopausal and post-menopausal women and occasionally middle-aged men but mostly middle-aged women. They may look good under the clothes, but squeeze them, or hug them, or grab them and their muscles are soft and flabby. Middle-aged men more commonly loss muscle but also gain more fat than muscle lost and simply become overweight.

In the end, maybe it’s the inflammatory load caused by too much fat coupled with too little muscle in the skinny fat population that raises the risk of death. That’s my theory.

How do I Prevent Becoming Skinny Fat?

You need to exercise and the importance of resistance or strength training cannot be emphasized enough. It also vital to maintain optimal hormone levels including testosterone even in women. It is virtually impossible to build muscle without adequate testosterone levels coupled with adequate protein in the diet even in the presence of strength training.

So is skinny fat worse than being obese?  It’s hard to know but it certainly is not desirable.

Becomming skinny fat is completely preventable. Don’t let it happen to you!

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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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