Thin outside fat inside


Too many of us are focused too much on our body weight. It is understandable of-course since we always think the mirror is a reflection of who we are. And sure, body weight is a good indicator of health, since excess weight and obesity is associated with many bad outcomes.

However some fat is not necessarily a bad thing! Even if you’re extremely fit, it’s not just normal to have some level of fat on your body; it’s healthy. This is because the calories we eat eventually become energy, which ultimately becomes fat. Still, like much else in life, not all fat is created equal. 

Did you know that there were two types of fat? There’s subcutaneous fat, which is fat that sits just below your skin. And then there’s visceral fat, which lives in the abdomen around your internal organs.  It could very well be that you are thin but still have visceral fat. So see what we can do about it. 

What is visceral fat?

Visceral fat (or ectopic), is the the type of fat in cells that should not have fat. It is the type of fat you find in your abdomen. You’d recognize it if someone has a non-jiggly belly. The organs that this fat surrounds include the liver, intestines, and pancreas. On the other hand, any fat found on your arms or legs is subcutaneous fat. 

While too much of any kind of fat is bad for you, there’s a reason you should know about your visceral fat. 

  • It’s because it can cause glucose intolerance and put you at higher risk of type 2 diabetes and heart disease which both are metabolic syndromes.
  • It can also mess with leptin, you satiety hormone and make you eat more.


  • Visceral fat is the storage stored in our organs and a sign of metabolic syndrome.
  • Metabolic syndrome is the in appropriate storage of energy in the wrong form in cells that shouldn’t store it.

Visceral fat and insulin

The next lines are very important.

Fat is excess energy designed to be used at a later point in time. So the body should store fat mainly in our butt (the subcutaneous fat) while in the muscle and liver we store a limited amount of glycogen (sugar). That’s it! Fat stored anywhere else it is stored in places where it does not belong. That is the start of metabolic syndrome.

This is affecting normal weight people. Approximately 40% of normal weight people have metabolic syndrome, which means visceral fat but also high insulin levels. Hence the term thin outside, fat inside (TOFI).

One of the most well-characterized molecules related to visceral fat is called retinol binding protein 4 (RBP4), an adipokine, a signalling molecule secreted by adipose tissue or fat tissue. Although this molecule is mainly secreted by the liver, it’s also secreted by adipocytes or fat cells and they are related to inflammation and insulin resistance, which can, in turn, cause elevated blood glucose levels, as glucose will be trapped in the blood if it is unable to enter the cells.


  • The more the visceral fat the higher risk of developing insulin resistance. If you have a lot of abdominal fat—especially visceral fat—you have a higher risk of getting type 2 diabetes because insulin doesn’t work as well in that area of your body.
  • Visceral fat exists in thin people as well.

How is visceral fat put on?

What causes visceral fat? There could be many reasons. 

  • Some people tend to store fat around their belly rather than on the hips because of their genes.
  • Every person has a different level of how much subcutaneous fat he/she can store. When the body can’t store any more benign fat (in our hips and butt) it will spill over to our organs.
  • Drinking alcohol will also lead to more belly fat, while a diet high in processed junk food, low in nutrition will definitely get you there.
  • In women, getting older also changes where the body stores fat. Especially after menopause, women’s muscle mass gets less and their fat increases. As women age, they are more likely to develop more visceral fat in the belly, even if they do not put on weight.

Insulin resistance again!

High glucose levels become to what’s known as advanced glycation end-products or AGEs. These are the result of proteins or lipids becoming glycated or bound to glucose trapped in your blood. Some of these AGEs, like single amino acids (the building blocks of proteins) bound to glucose, can leave the body through the urine. However, many of the more complicated AGEs are too large to be filtered through the kidneys. These end up becoming metabolized by kidney cells. This process damages the kidney cells, reducing the ability of the kidney to process these AGEs, forming a positive feedback loop that can lead to permanent organ damage. 

This is just one example of how persistently high blood glucose levels can harm your body over time. Insulin resistance can create chaos on almost every organ in your body, and in also many serious disease.

What can we do?

There’s no one-size-fits-all. However, as always lifestyle is a critical preventative measure. 

  1. Get a CT scan to measure your visceral fat, a blood test to measure your insulin level and check your genes. It is important to know where you are.
  2. Eat a diet of whole foods. Cut consuming refined sugars and processed foods. There is no grey area here.
  3. Reduce the amount of alcohol you consume to the minimum, quit smoking if you’re a smoker, as these are both inflammatory and can adversely affect your organs. 
  4. Get moving! Do some type of exercise 4 times a week and keep moving through-out the day. Remember to avoid sitting for too long at a stretch!

Final thoughts

Skinny fat is a real thing and it is an issue to address it as part of a healthy lifestyle. Weight is only a red herring. Fixing the root cause means fixing your insulin levels and metabolic issues.

As visceral is more difficult to get rid of,  when it comes to optimizing your health, prevention is the name of the game here.  Take a look at the ketOntrack programs, and how you can built the right habits for a lifetime.

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