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Clinician issues ‘skinny fat’ warning after seeing ‘many patients’ with ‘wrong BMI’
BMI stands for Body Mass Index. Its one of the tools people use to work out if they are a healthy weight for their height. But its not foolproof. One physician who specializes in obesity reveals that many of her patients receive a score that doesnt reflect the healthiness of their body composition, and explains what is meant by the term skinny-fat.
BMI has come under flak from other popular medical professionals, too. One UK doctor says it should not be used in isolation to predict health risks. Dr Rocio Salas-Whalen, meanwhile, is a certified physician who works with patients with obesity, diabetes, and thyroid disorders. She finds value in using BMI as a health indicator but says medical professionals tend to under-diagnose more than [they] over-diagnose when it comes to conditions connected to weight. Heres why.
Majority of wrong BMI scores arent among bodybuilders, physician says
Early on in their conversation on Doctor Mikes podcast The Checkup, he and Dr Rocio Salas-Whalen get to talking about healthy and unhealthy body compositions, and the value of BMI as a diagnostic tool for health risks.
Mike says that when he thinks of BMi being inaccurate in labeling someone as obese or not obese, he thinks of bodybuilders. People with a lot of body mass whose muscle bulk skews their BMI in an upward direction.
But I could see every muscle in their body and theyre not actually an unhealthy figure. Theyre not carrying excess weight,” he says.
Rocio replies by saying that in her clinic, where shes seen over 2,000 patients, cases like these represent a minority.
You could be skinny fat even if you have a normal BMI
I would say thats the minority of wrong BMI [cases],” she says. Clinicians tend to under-diagnose more than we over-diagnose,” and should be more sensitive to body compositions that fly under the radar of an ostensibly healthy BMI score.
She goes on to say, Ive seen many patients with a normal BMI but once you look at their body composition, they have higher body fat than muscle mass.
And its coming out as a normal BMI because BMI is just a multiplication between height and weight.
This is true. To calculate your body mass index, you simply divide your weight (in kilograms) by your height in meters squared. So, if you weigh 70kgs (154lbs) and your height is 1.70m (5ft 7in), you square your height (1.7 x 1.7 = 2.89) and divide your weight by the resulting figure (70 � 2.89 = 24.2).
So if you average it out, body fat and muscle, you may have a normal BMI. But thats not metabolically healthy. Thats what we call sarcopenic obesity, or skinny fat.
What does it mean to be skinny fat?
Sarcopenic obesity refers to a combination of two medical conditions: sarcopenia and obesity.
The NIH defines sarcopenia as a disease in which muscle mass, strength, and performance are significantly compromised with age. It most commonly affects old and sedentary populations, and patients with other diseases that mean they cant, or dont, move around very much.
Having sarcopenic obesity means you lose muscle mass and function while also gaining weight. The combination causes a spiral, because more muscle mass is required to mobilize larger amounts of tissue, but less muscle mass is present to take on the task.
Strategies for managing sarcopenic obesity include taking medication and making lifestyle changes, such as increasing exercise time or modifying diet.
Skinny fat is not a medical term, writes Healthline, and doesnt have a standardized definition, so different people use it in different ways. However, it tends to refer to people who have a relatively high body fat percentage and relatively little muscle. Its similar to, and in some cases likely interchangeable with, sarcopenic obesity.
In 2018, Alzheimers.net reported that being skinny fat was associated with a greater risk of developing a neurodegenerative disease like dementia.
Dr Rocio Salas-Whalen is a certified physician who works with patients suffering from obesity, diabetes, and thyroid disorders. She appeared on Doctor Mikes podcast The Checkup on October 11, 2023. Find the full video on YouTube.
