Ask JJ: Skinny Fat

Nobody's arguing being overweight or obese doesn't have detrimental repercussions. But this study shows we often neglect the potentially fatal consequences of being normal weight but carrying a little extra midsection fat.
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Dear JJ: I recently read an article talking about how something called skinny fat could be more dangerous than being overweight. That doesn't make sense to me, so could you explain?

A recent study published in the Annals of Internal Medicine found normal-weight people carrying belly fat have a greater mortality risk than people who are overweight or obese.

The study looked at 15,184 adults (men and women almost equally) over 14 years. Its objective was to "examine total and cardiovascular mortality risks associated with central obesity and normal BMI [body mass index]."

Turns out folks who were of normal weight but had belly fat had a higher death rate than those with a higher BMI. Normal-weight men with belly fat, in fact, had twice the mortality risk of participants who were overweight or obese.

How could this be? Researchers point to visceral fat, or belly fat, as one potential culprit.

"There are two types of belly fat: visceral belly fat and subcutaneous belly fat," writes Dr. Jade Teta. "Visceral fat is underneath the abdominal muscle and in close proximity to the organs. You can't pinch it, and those who have a lot of it, can have abdominal muscles that feel tight and ridged despite the bulging protrusion. Subcutaneous belly fat is above the abdominal muscles and can be pinched. This is the stuff that hangs over the belt."

Among its other problems, studies link visceral fat with increased inflammation, insulin resistance, and cardiovascular disease.

While there are other culprits, a high-sugar-impact diet definitely feeds this dangerous midsection fat. "Eating junk will put on junk around your middle -- even if it is invisible," says Dr. Mark Hyman. "We call the fat inside your belly 'VAT' or visceral adipose tissue."

Now, nobody's arguing being overweight or obese doesn't have detrimental repercussions. But this study shows we often neglect the potentially fatal consequences of being normal weight but carrying a little extra midsection fat.

Skinny Fat: More Dangerous than Being Overweight

The latest study from the Centers for Disease Control and Prevention (CDC) showed almost 69 percent of American adults 20 and up are either overweight or obese. You might assume the remaining 31 percent fell into the "safe" category, but not quite.

About half of those 31 percent fall into a unique category called "thin on the outside, fat on the inside," also known as TOFI or "skinny fat." Dr. Jimmy Bell coined the acronym TOFI to describe people who stay skinny (with maybe a little belly fat) but maintain little muscle mass.

You know the type. They look fabulous in skinny jeans, but witness them in a bikini and they look saggy and, well, un-toned. TOFIs probably order pasta at dinner, indulge guilt-free in dessert ("everything in moderation" becomes their favorite phrase) and avoid gyms and free weights like the plague. No exercise means they don't build lean muscle, so they have a higher body fat percentage relative to their weight.

Because doctors overlook concerns like Type 2 diabetes for normal-weight people, Hyman argues skinny fat or TOFI can become more dangerous than being overweight or obese.

"If you're overweight or obese, you're well aware of the repercussions," he writes. "Unfortunately, TOFIs often aren't aware they can suffer the same consequences, which ultimately makes 'skinny fat' more dangerous than being overweight."

How you eat becomes the most effective way to reverse skinny fat. Hyman recommends going low-sugar impact and increasing your protein and healthy fats.

Breakfast becomes the best way to incorporate these healthier options. Studies show a high-protein breakfast can curb hunger and cravings so you're less likely to eat belly fat-triggering high-sugar impact options.

My favorite breakfast, a protein shake, makes the perfect way to get protein, healthy fats, leafy greens, fiber, and antioxidants to crush hunger and cravings for hours.

Diet aside, getting quality sleep can also help optimize hormones like insulin so you're less likely to struggle with sugar cravings. Studies show even a partial night's sleep deprivation can increase your risk for insulin resistance.

Maybe the most obvious way involves lifting heavy. I've long called muscle your metabolic Spanx, and studies show resistance training can increase lean mass and reduce obesity. If you're a newbie, start with 20 or 30 minutes of heavy lifting several times a week. Lift the heaviest weight you can in good form for eight to 12 reps, and consider a personal trainer in the beginning.

What strategy would you add to reverse skinny fat and develop a lean, healthy, toned physique? Share yours below. And keep those fab questions coming at