‘Skinny Fat Warning Issued as Study Finds Obesity Hidden Behind Normal BMI
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For decades, BMI (body mass index) has been the number doctors turn to when deciding whether someone is underweight, “normal,” overweight or obese.
But new global research suggests that it is possible to have a normal BMI, look thin in clothes and still meet the medical definition of obesity.
A large study published in JAMA Network Open based on data from a World Health Organization (WHO) survey examined health data from more than 471,000 adults in 91 countries.
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The researchers looked at people whose BMI was in the normal range (18.5 to 24.9) but who had extra fat around their abdomen, measured by waist circumference.
The results showed that about 1 in 5 people with a normal BMI had abdominal obesity, a large waist linked to serious health risks.
The study found that many people who appeared thin still met the criteria for obesity. (iStock)
These so-called “skinny fat” individuals were not necessarily healthy just because the scale indicated so.
Compared to people with a normal BMI and smaller waists, those with abdominal fat were 29 percent more likely to have high blood pressure and 81 percent more likely to have diabetes. They were also significantly more likely to have unhealthy cholesterol and triglyceride levels.
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In short, their metabolism was more like that of obese people, even if their weight was not.
The findings appear to expose a blind spot in the way obesity is measured. BMI only considers weight and height, but says nothing about where fat is stored.
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According to experts, fat found deep in the abdomen and surrounding vital organs is particularly dangerous and fuels inflammation, insulin resistance and cardiovascular problems. Someone may be “thin on the outside, fat on the inside,” a concept researchers call TOFI.
Compared to people with a normal BMI and smaller waists, those with abdominal fat were 29% more likely to have high blood pressure and 81% more likely to have diabetes. (iStock)
Lifestyle also plays a role, the researchers noted. People with a normal BMI and abdominal fat were more likely to be inactive, eat fewer fruits and vegetables, and have office jobs or be unemployed.
That combination of little muscle and lack of movement makes it easier to pack on visceral fat even without gaining much overall weight.
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The latest research suggests that tracking waist size may be as important as weight.
For most adults, a waist larger than about 32 inches for women or 37 inches for men indicates excess abdominal fat and increased health risks.
People with a normal BMI and abdominal fat were more likely to be inactive, eat fewer fruits and vegetables, and have office jobs or be unemployed. (iStock)
The researchers noted several limitations. Because the study was cross-sectional, it cannot prove cause and effect, only associations.
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The data also came from many countries and time periods, and high-income nations were underrepresented, which may affect the breadth of application of the results.
The study did not include actual body fat scans and instead relied on people’s own reports of their habits, which may make the results less reliable. However, WHO survey methods are generally well validated.
Khloe Quill is a lifestyle production assistant at News Digital. She and the lifestyle team cover a range of topics including food and drink, travel and health.