[This is a guest blog by Laurel Zimmermann. Laurel is an Exercise Science major with minors in both Business and Biology at The College at Brockport. She is currently an Athletic Development Intern at Athletic Lab. ]

skinnyfatHave you ever met someone who can eat anything they want and never gain any weight? Growing up, I was one of those people. I didn’t eat McDonald’s for every meal, but I definitely wasn’t very health conscious. In college, I was required to take different nutrition classes in which I learned that I need to be much more careful about what I eat, not only to look good, but also to feel good. People often assume they are healthy as long as they weigh a certain number or look a certain way. Unfortunately, this isn’t always the case.

In the past, we have measured health based on a person’s Body Mass Index (BMI). If you have a high BMI, you are likely overweight and at a higher risk for cardiovascular disease than someone who has a lower BMI. According to the CDC, “More than two-thirds (68.8%) of adults are considered to be overweight or obese” (Ogden, Cynthia L., et al. 2014).

laurel1Some common health risks of being overweight or obese include type 2 diabetes, heart disease, high blood pressure and stroke. What about the people who are normal weight? Are they safe from these risk factors? Unfortunately, research is beginning to show that they are actually in more danger than someone who has a high BMI. A recent study published in Annals of Internal Medicine has shown that “Normal weight central obesity defined by Waist-to-Hip Ratio (WHR) is associated with higher mortality than BMI-defined obesity” (Sahakyan, Karine R., et al. 2015).  BMI values are important and should be used as a general assessment tool, but it doesn’t explain how much of your weight is fat compared to how much is muscle and tissue, or the location of your fat stores. On the other hand, a higher WHR is more accurate when it comes to estimating abdominal fat, which is associated with visceral fat and increased health risks. Research has shown that “Excessive visceral fat is associated with insulin resistance, hypertriglyceridemia, dyslipidemia, and inflammation” (Sahakyan, Karine R., et al. 2015). Visceral fat increases blood pressure, triglycerides and lowers levels of HDL (good) cholesterol.

Many people don’t have a BMI that places them in the overweight or obese range, yet they are still at a very high risk of disease. Dr. Jimmy Bell came up with a phrase for this phenomena: Thin on the outside, fat on the inside, or TOFI (Hyman, 2015). The biggest issue is that people often don’t realize this is a problem until it’s too late. What you eat and how much you eat will directly affect your body. If you are constantly eating junk food, you may be one of the lucky ones who still manages to look good, but looking good on the outside doesn’t mean your insides match. Eating the right foods can help lower your cholesterol, reduce high blood pressure and ultimately reduce your risk of disease and mortality. Atherosclerosis is a process of plaque buildup that leads to hardening of the arteries. When it affects the arteries of the heart, it becomes coronary artery disease, which is the number one killer of Americans, according to WebMD.

laurelWhat can you do to avoid being thin on the outside, fat on the inside? There are two lifestyle changes you can make to avoid TOFI. The first is adjusting your eating habits – you can’t outwork a bad diet. If you eat fast food or excessive amounts of sugar on a regular basis, it will eventually lead to various health issues. The second change is adding regular exercise to your routine. A study published in the International Journal of Medical Sciences found that “16 weeks of strength training results in improved muscle quality, skeletal muscle fiber hypertrophy, accompanied by concomitant changes in biochemical markers known that contribute to whole-body insulin sensitivity” (Brooks, Naomi, et al. 2007).  Working out and eating healthy might take a little bit of time now, but adding both will increase your lifespan and create a better quality of life in the long run.


  • Brooks, N., Layne, J. E., Gordon, P. L., Roubenoff, R., Nelson, M. E., & Castaneda-Sceppa, C. (2007). Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. International journal of medical sciences4(1), 19-27.
  • Hyman, M. (2015). Why “Skinny Fat” Can Be Worse than Obesity. Retrieved July 13, 2016, from https://drhyman.com/blog/2015/07/16/why-skinny-fat-can-be-worse-than-obesity/
  • Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Jama311(8), 806-814.
  • Sahakyan, K. R., Somers, V. K., Rodriguez-Escudero, J. P., Hodge, D. O., Carter, R. E., Sochor, O., … & Lopez-Jimenez, F. (2015). Normal-weight central obesity: implications for total and cardiovascular mortality. Annals of internal medicine163(11), 827-835.