What is skinny fat and why is it so unhealthy?

Conventional wisdom says that if you are thin you are healthy and if you are overweight you are unhealthy – but new research points to just how dangerous being skinny can be — if you are a “skinny fat” person, that is.

The medical term for this is “MONW,” or metabolically obese normal weight, which I prefer to refer to as being a skinny fat person. This is someone who is not overweight and has a skinny look but still have a high fat percentage (especially belly fat) and low muscle mass. Usually those people have a low calorie diet, that's why they are skinny, but are not involved in any sports activities or training and that's why they don’t have any muscle. To the uneducated, untrained eye, a skinny fat person may appear to have a physique of the same caliber as an individual who is comprised of significantly more lean tissue.

While we know that 63 percent of Australian males and 48 percent of females are overweight (1), and that most have diabesity — being somewhere on the continuum of pre-diabetes to Type 2 diabetes — the shocking news from a study published in the Journal of the American Medical Association is that nearly 1 in 4 skinny people studied have pre-diabetes and are “metabolically obese.” (2)

It seems it is better to be fat and fit than thin and out of shape. It turns out that if you are a skinny fat person and get diagnosed with diabetes, you have twice the risk of death than if you are overweight when diagnosed with diabetes (2). Perhaps having that extra muscle on your body from having to carry around those extra pounds protects you.

Get the Right Tests

So how do you know if you are a skinny fat person? There are a few criteria you can use that can help you identify yourself as having diabesity or being skinny fat, including family history of Type 2 diabetes or early onset of heart disease (heart attack in relative under 50 years old), or even looking down and see a little pot belly. And if you are of Asian or Indian descent, you can get diabesity at a much lower body weight.

There are some important blood tests that you should have your doctor do:
Fasting blood sugar or glucose (normal 4.0 – 6.0 mmol/l*)
Triglycerides (the recommendation is for less than 2.0 mmol/l*)
HDL (“good” cholesterol (normal greater than 3.5 mmol/l*)
Blood pressure (normal is 120/80*)

*Please be aware that reference ranges or “normal” depends on a number of factors including patient age, gender, sample population and test method, and numeric test results can have different meanings in different laboratories.

There are a few special tests your doctor may not do that you should insist on that tell the true story and help to detect diabesity much earlier. They are:

1. An insulin response test (what most doctors call a glucose tolerance test but with the addition of insulin measurements) that will measure glucose (blood sugar) AND insulin levels while fasting and one and two hours after a 75-gram glucose drink (the equivalent of two soft drinks).

2. A NMR Lipid Particle Test which measures the number and size cholesterol particles. Most cholesterol tests just measure the total amount but the particle test is MUCH better at predicting risk for heart disease. When you are a skinny fat person with diabesity you have too many particles, and they are the small, dense, dangerous kind.

The Treatment for Skinny Fat Syndrome

The treatment for the skinny fat syndrome is the same as the treatment for someone who is overweight with diabesity.
It is quite simple actually.

Get enough Sunlight — 15 to 20 minutes to 20% of your body per day will do it unless you're dark skinned.

Get enough Sleep — Sleep deprivation alters metabolism and increases cravings for carbs and sugar. Sleep is sacred. Make your bedroom a sleeping temple and stay there for 7 to 8 hours a night.

Eat a Low-Glycaemic Load Diet — Meat and vegetables, nuts and seeds, some fruit, little starch, no sugar.

Power Up with Protein — Start the day with protein and at each meal. This makes your metabolism run hotter and cuts hunger. Incorporate eggs, nuts, seeds, chicken, fish or protein shakes.


Don't Drink Your Calories — No soft drinks, juices, sweetened drinks and no more than 3-4 glasses of wine or alcohol a week with meals.

Avoid the Deadly White Powder or Flour — Including gluten-free flour products. Even whole grain flour acts like sugar in your body.


Beware of Frankenfood — Factory-made foods are often science projects with fake ingredients including MSG (which causes ravenous hunger and is hidden as “natural flavoring”), high fructose corn syrup, artificial colours, preservatives, and chemicals.


Get an Oil Change — Eat omega-3 fat-rich foods including sardines and wild salmon and avoid refined and processed vegetable oils except olive oil.


Get Fit and Get Strong — Both cardio and strength training are key (3). Cardio builds fitness and improves metabolism, and strength training builds muscle so you won't be a skinny fat person.

Supplement if necessary — Fish oil (EPA/DHA,) and vitamin D do the trick for 95 percent of people – if they can't get what they need from food.