Many people mistakenly believe that being ‘slim’ equates to good health, but this isn’t always the case. Experts have now drawn attention to a lesser-known factor that’s often associated with an amplified risk of type 2 diabetes.
Jonathan Wolf, CEO of ZOE, discussed his experience with Professor Tim Spector and Dr Suzanne Devkota on a recent podcast. The firm co-founder admitted that he once never really considered his body shape and was regularly told by others to ‘put some weight on’.
But one hospital visit revealed some ‘very bad news’. DEXA scan analyses told him that he was ‘thin on the outside and fat on the inside’ – a condition that Professor Spector nicknamed ‘a toffee’.
“Thin on the outside, fat on the inside,” Professor Spector said in the recent episode. “Which a lot of people are in a way. They don’t realise that they have poor metabolic health because of that.”
To this, Jonathan responded: “…I know we’re going to talk a little bit about your own experiences, but actually, that had pushed me to eat this very classic Western diet, huge amounts of sort of refined carbohydrates. And I’d assumed that it was having no impact on me.”
Remarkably, ‘TOFI’ – standing for Thin on the Outside, Fat on the Inside – is a genuine term used to categorise individuals who have a ‘normal’ BMI but higher-than-average levels of visceral fat. This generally refers to the ‘invisible’ fat that surrounds our internal organs, as opposed to the more noticeable ‘subcutaneous fat’ visible on our arms and legs.
As Professor Spector points out, being TOFI is a significant sign of ‘poor metabolic health’, or metabolic syndrome, characterised by high blood pressure, high blood sugar and lower levels of the ‘good’ HDL cholesterol. Regrettably, many of these factors are linked with a higher risk of numerous serious conditions, including type 2 diabetes and cardiovascular disease.
“Metabolic syndrome is the name for a group of health problems that put you at risk of type 2 diabetes or conditions that affect your heart or blood vessels,” NHS guidance states. “It’s different from metabolic disorders which are rare genetic conditions.
“…It is linked to insulin resistance. This is when your body does not respond to the hormone insulin properly. It may also be linked to having too much fat around your tummy.”
Although genetic factors can amplify your risk of poor metabolic health, several lifestyle choices can play a part too. Excessive alcohol intake, lack of exercise and poor diet choices are among them, in addition to smoking cigarettes.
As a result, the NHS recommends the following tips to steer clear of poor metabolic health:
- Lose weight if you’re overweight
- Eat more fruit, vegetables and wholegrains
- Do at least 150 minutes of moderate to intense exercise per week spread across four to five days
- Quit smoking
- Eat less saturated fats, meat and dairy products
Its advice adds: “You may not have any symptoms of metabolic syndrome. You usually find out you have it after a blood test or check-up.”