Skinny fat has been a buzzword in the fitness community and is often referred to being active but not having noteworthy muscle mass. For example, I heard a fitness influencer explain how she was skinny fat in college while running for the cross country team. She didn’t understand the importance of weight lifting at the time and because she wasn’t very strong she was therefore skinny fat. I’ll start there, skinny fat is not someone who solely does cardio and doesn’t lift weights. If you’re exercising consistently and eating healthy, chances are you’re not skinny fat, so don’t feed into this myth.

While I’m not in love with the name, the term skinny fat represents an actual health issue. It’s when one’s weight is considered normal for their height (aka a normal BMI), but they are metabolically sick. By appearance, these people walk around in “normal” body sizes but have developing or potentially full-blown health issues that are more commonly known to affect the obese. This may include insulin resistance or elevated blood sugar, high cholesterol, elevated blood pressure, and over time these conditions increase a person’s risk of things like diabetes, heart disease, strokes, and dementia to name a few.

Overconsumption of calories and more specifically excess sugar and high caloric foods that don’t provide significant nutritional benefit are risk factors for being metabolically sick or skinny fat.  The term metabolic syndrome is a diagnosis given to a cluster of symptoms that often run together including excess body fat around the waist, high cholesterol or triglyceride levels, elevated blood pressure, and elevated blood sugar. Having 3 out of 5 of these symptoms gives you a diagnosis of metabolic syndrome. Other lifestyle factors such as lack of exercise, too much alcohol, or smoking also contribute to poor metabolic health.

How does this happen? When you gain fat mass, it deposits in different areas of your body. In my case, call my Happy Gilmore because “it’s all in the hips.” After four full-term pregnancies, I also have what’s often lovingly called a “mummy tummy,” a small pudge of soft skin on the belly that is fully resistant to any ab workout. Some people gain it on their hind end or flappy wings under their biceps. All lovely terms, I know. This is all subcutaneous fat or fat that sits under the skin. It’s there to protect us, keep us warm, and is available as an energy reserve if our body is in distress. I can do sit-ups all day every day, but unless I choose to place all my energy in counting macros, calculating protein, and working out 3 hours a day, that mummy tummy isn’t going anywhere. And even if I chose to live like a bodybuilder, the minute I discontinue that lifestyle, the mummy tummy is probably coming back. Subcutaneous fat is very difficult to lose permanently. The number of fat cells you have is most likely predetermined and while they fill and empty during different seasons of life, they aren’t going anywhere. The good news is, however, subcutaneous fat is not unhealthy. Visceral fat is.

Visceral fat is fat which deposits in and around your organs like your liver, stomach, intestines, kidneys and even muscle. Visceral fat is what leads to metabolic dysfunction and its associated problems. Sometimes we can assume high visceral fat is present when someone has a “beer belly” or “spare tire” (the large, pregnancy-like belly some people carry). Dr. Robert Lustig, an endocrinologist and obesity expert, cleverly describes subcutaneous and visceral fat as “big butt” fat and “big belly” fat, respectively. We’re not worried about the big butt fat, that’s the subcutaneous fat. But the big belly fat is a problem. Some people with high levels of visceral fat don’t have a large midsection. And as it turns out, 40% of people with a normal BMI have too much visceral fat. They are a normal weight for their height but have too much visceral fat and have the same risk as those with obesity.  

As it turns out, you can’t have your cake and eat it too. You know those people we look at with envy because they’re skinny as a rail but seem to eat whatever they want? Now you know that’s probably not the case. Those people could very well be skinny fat or certainly at risk for it.

So if you’re working out consistently, eating well, and frustrated because you aren’t fitting in your pre-pregnancy jeans, don’t lose heart. That subcutaneous fat is stubborn but it’s also good for you. We need it. Adequate subcutaneous fat is linked to improved long-term health and longevity. And guess what? The first fat to go when you start exercising is that pesky visceral fat. Your body doesn’t want it and is happy to get rid of it first! So rest assure exercise is still very beneficial to your health, even if you’re not seeing results in the form of a smaller caboose.

How do you know if you’re skinny fat? You could go to a university research facility and have MRIs and true body fat composition measured (not the hand-held or scale devices that are wildly inaccurate), but obviously, that isn’t feasible for most people. I recommend two things. First, evaluate your lifestyle. If you’re not eating a variety of fruits, vegetables, and healthy fats and consume a lot of processed foods, fast food, and sugar, there’s a good chance that even if you’re not metabolically sick now, you will be eventually.  The second thing is to make sure you’re going to a primary health care provider yearly for checkups or participating in annual health screenings. Even in young “healthy” patients, I typically screen yearly or at least every other year with a fasting blood sugar, cholesterol panel, and blood pressure reading. I often catch unsuspecting issues in young adults with these test. If your blood sugar is a little high, your triglycerides or cholesterol is creeping above normal, or your blood pressure is on the high end of normal, these are things that need to be monitored and are a wakeup call to start incorporating healthy habits. On the other hand, if these numbers are normal, you’re fairly active and for the most part, eat well, you’re not skinny fat just because you indulge in comfort food and desserts from time to time. Also, know sometimes these measurements can be abnormal even if you are leading a healthy lifestyle. Things like genetics play a role too. 

It’s important to know the pendulum swings the other way. While an alarming 40% of normal weight individuals are metabolically sick, about 20% of obese people are perfectly healthy, with a large volume of subcutaneous fat and an unconcerned amount of visceral fat. They are “healthy fat” with no signs of insulin resistance, hypertension, cholesterol problems, or high risk of diabetes or heart disease. These people are often overweight but very active and for the most part, make healthy choices. The bottom line is healthy habits like eating well and exercising regularly, REGARDLESS of your weight or weight loss, is vital for overall health. I encourage you to prioritize your health, stop putting so much value on your pant size, and continue those habits that are keeping you healthy.