Skinny people can be fat inside, warning Indians that just weight or BMI is not an indicator of health.
Is your Body Mass Index (BMI) less than 23 and you’ve always thought of yourself as healthy? Before you start doing a jig about not having those layers of lard, you might need to stop and consider whether you’re a TOFI – Thin Outside and Fat Inside. The acronym describes someone who carries visceral fat around vital organs that can significantly increase their risk of dying permanently.
Thin people often consider themselves lucky and assume they are in the clear health-wise. However, appearances can be deceptive. Someone who is of normal weight may still be harboring a significant amount of bad fat inside, especially when combined with low muscle mass. “South Asians, particularly Indians, tend to accumulate visceral fat around t he heart, lungs, liver, and other organs even when they seem to have optimum body weight. This fat produces inflammatory cytokines or toxins, leading to a whole of metabolic derangements.”
Thin-fat Indians with a BMI of less than 25 or even less than 23, but having a high waist circumference. The study found that they were at a higher risk of non-communicable diseases, including diabetes and heart disease. Patients with a slim build, but still having elevated cholesterol levels. The main reason for thin people having high cholesterol having high cholesterol is a genetic tendency. “Despite maintaining a lean physique, some accumulate significant cholesterol deposits, leading to arterial blockages.” In some cases, thyroid disorders like hypothyroidism can also contribute to high cholesterol levels in lean individuals. Another contributing factor is the consumption of an unhealthy diet by thin individuals, which may include excessive amounts of sugar, meat, and dairy products. This can increase blood cholesterol levels, regardless of body weight.
BMI is a reliable indicator of health in the Indian population. While it provides some insight, it’s effectiveness is limited. BMI is calculated by dividing the weight in kilograms by the height in meters squared. So, if one’s weight is 70 kg and height is 170 cm, the BMI would be 24.22. A body mass index between 18.5 and 23 is considered normal, 23 to 25 is overweight, and above 25 is obese in South Asians.
The primary drawback of using BMI as a measure of obesity is that it relies solely on body weight, which does not differentiate between fat, bone, and muscle mass. “For instance, a highly muscular individual such as an athlete or weightlifter may have a higher body weight due to their substantial muscle mass, which is a sign of good health. Consequently, it has been recognized that body weight and BMI are not precise indicators of obesity or excessive body fat, particularly among Indians.”
Many are now tuning to gauging central adiposity by measuring waist circumference. This is measured around the umbilicus or, to be accurate, the midpoint between the lower border of the ribs and the upper border of the hip bone. According to World Health Organization (WHO), a waist circumference of 90 cm (35.4 inches) or more for men, and 80 cm (31.4 inches) or more for women is associated with an increased risk of metabolic complications. “In our experience, and based on our own research, a simple waist measurement divided by the height of the individual is also a fairly reliable metric, as good as or maybe slightly better than the waist measurement alone. This is called the Body Roundness Index or BRI.”
Other doctors suggest that body composition analysis (BCA) is particularly important for South Asians. BCA — which only takes a few minutes and is done by a machine — not only gives you the percentage of body fat, but also visceral fat and muscle. “You just stand on a machine, and it does the calculation for you.” BCA should be part of health check ups in hospitals. BCA testing is relatively cheap, typically a few hundred rupees per test.
Experts point out that consuming an adequate amount of protein and engaging in regular physical activity are crucial for building lean muscle, which can improve your body composition and reduce the negative impact of carrying extra fat.
WHY INDIANS ARE THIN-FAT?
One reason why Indians exhibit a body composition characterized by a lean exterior and a higher proportion of internal fat is the thrifty gene hypothesis. During periods of inadequate nutrition, the body would respond by storing energy as fat in the abdominal region. This visceral fat accumulation served as a survival mechanism, allowing the body to draw upon these energy reserves during times of scarcity. In times of plenty, this works against us. Combine this with a diet that is low on protein and high in carbohydrates, and overall malnutrition, and we have problems like diabetes.
“Lack of proper nourishment during the crucial stages of fetal development can also have long-lasting consequences.” When a child born to an undernourished mother is exposed to the modern energy-rich environment, including access to fast food, they are more likely to rapidly gain weight, particularly around the abdominal area and visceral organs.