We have a big fat problem. America is a fat nation, and we are failing to solve our big fat problem. Failing big-time. Almost 70 percent of Americans are overweight. The latest study from the Centers for Disease Control and Prevention (CDC) shows about 35 percent of Americans are obese.
It comes as no surprise, then, that one in two Americans has what I call diabesity— the spectrum of imbalance ranging from mild insulin resistance to pre-diabetes to full-blown type 2 diabetes. The scariest part is that 90 percent of those suffering from this serious health condition don’t even know it.
Our diabesity epidemic aside, being overweight or obese can increase your risk for numerous problems including stroke, some cancers, heart disease, and depression. It can also seriously diminish quality of life.
What many people don’t realize is that we can suffer all these problems – diabesity and all its detrimental health consequences – even if we’re normal weight or underweight.
In fact, about one-quarter of the remaining 30 percent of those who don’t fall into the overweight or obese categories are what I call “skinny fat,” and the ramifications can be even more devastating than being overweight or obese.
The “TOFI” Epidemic
While the word “diabesity” is made up of the concepts of obesity and diabetes, even those who aren’t overweight can have this problem. These are the “skinny fat” people. They are “underlean” (not enough muscle) instead of “overweight” and have a little extra weight around the middle, or “belly fat.”
Scientists have a word for this phenomenon: Thin on the outside, fat on the inside, or TOFI. Dr. Jimmy Bell coined this acronym to describe people who are thin but unhealthy.
These skinny-fat people have a low body mass index (BMI) but very little muscle. They maintain a normal weight while suffering all the consequences of diabesity on the inside.
You might know someone who falls into the TOFI category. They eat whatever they want and stay thin, and you might even envy their ability to devour a piece of chocolate cake and not worry about their weight.
They might do some brisk walking or yoga, but they rarely engage in muscle-building exercise. Even though they are average or below weight, TOFIs often lack muscle tone. They often look tired, haggard, and even pale.
While they may not be technically overweight and may even look skinny on the outside, TOFIs have the metabolic features of a pre-diabetic obese person: Low muscle mass, inflammation, high triglycerides, low good cholesterol, high blood sugar, and high blood pressure.
If you’re overweight or obese, you’re well aware of the repercussions. Unfortunately, TOFIs often aren’t aware they can suffer the same consequences, which ultimately makes “skinny fat” more dangerous than being overweight.
Overcoming TOFI Starts with Your Diet
Whether you are overweight or underweight, the consequences can become perilous. But there is hope. The right foods can help you attain and maintain a normal weight. The “prescription” for a TOFI is very similar to someone who is overweight, since the end goal is the same: Become lean and healthy, and maintain an ideal weight.
To do that, you’ll want to focus on real, whole foods. Every meal should contain copious non-starchy vegetables, four to six ounces of lean protein, and gluten-free grains (such as quinoa, black rice, and buckwheat) in their whole-kernel form.
Also include nutrient-dense starchy vegetables such as sweet potatoes and winter squash; low-glycemic fruit such as apples, pears, berries, or pomegranate; and beans and legumes.
Healthy fats become one of the easiest ways to normalize your weight, have glowing skin, and feel better. Have one serving of a healthy fat (e.g., ¼ avocado or 1 tablespoon extra virgin olive oil, walnut oil, sesame oil, extra virgin coconut butter, or nut or seed butter – such as almond or cashew) with each meal.
Never skip meals, especially breakfast. If getting the day’s most important meal becomes a herculean challenge, consider some of my easy-to-prepare recipes.
Don’t forget to check in with your primary healthcare professional. Always know where your lab results stand, including cholesterol, triglycerides, blood sugar, blood pressure and BMI numbers. If they’re out of the optimal range, talk to your physician to see what else you can do to start living a healthier life.