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I’m skinny (or slim, which I prefer) but I’m starting to wonder if I may in fact be fat. What? Let me explain.

Post updated Sept, 2018


Last week I quietly contemplated giving up sugar. I say quietly, in case I grabbed a big piece of cake while I was contemplating, and someone saw me! 

I grew up in the 70’s and this is significant for us sugar loving TOFIs – Thin on the outside and fat on the inside. It was during this decade that fructose consumption began to climb.

In the late 1960s and through the 1970s several medical investigators from southern England, suggested that CHD (Coronary Heart Disease) was strongly related to refined carbohydrates (white bread, pop, juice, white pasta, white rice, sugar) and a low intake of dietary fiber. 

The sugar scandal


However, the hypothesis that refined carbs leads to CHD, never gained widespread acceptance. One possible reason was that the sugar industry in the USA paid researchers to publish papers that emphasized the role of SFA (saturated fatty acids – cream, cheese, butter, whole milk) in the cause of CHD while minimizing the role of sugar. This sugar industry scandal only came to light in 2016.

At around the same time the sugar/fat debate was taking place, other investigators were studying the relationship between fats and CHD.

The evidence that saturated fats were the causative factor for CHD became widely accepted after about 1974.  This led to the first dietary practice guidelines on fat. In response to these guidelines, the food industry modified their food products to meet the demand for low-fat. Introduce low fat EVERYTHING!

However, controversy has emerged in recent years regarding the interpretation of medical trials that aimed to prevent CHD through reduction of saturated fats.  The weight of evidence now indicates that SFA play only a minor role in CHD.

Low fat everything


Removing fat from our food, gave us food that tasted like cardboard, so the food industry had to find a way to make food palatable. So they upped carbohydrate – specifically, refined sugar.

Consuming refined carbs leads to a surge of insulin, which causes energy to be stored as fat. This caused widespread obesity and a surge in Type 2 Diabetes. 

Decades ago there wasn’t the understanding of good fats, and as a result, all fats were labelled dangerous. In 1993, The Women’s Health Initiative began an 8-year study on 50,000 post-menopausal women. Fat was decreased in their diets to 30% of their total calories. There was no change found in their incidence of heart disease or stroke. In other words, it isn’t the fat making ‘us’ sick.

Skinny fat

In Dr Robert Lustig’s excellent book, Fat Chance – The Bitter Truth About Sugar, he explains that up to 40% of us skinny types have insulin resistance and 20% demonstrate fatty livers – aka skinny fat! So what is going on here?. Why are skinny people dying of Heart Disease and Diabetes?

A calorie isn’t A calorie, after all

Not all calories are created equal. There are two types of carbohydrate – starch (peas, potato, rice, grains, beans) and sugar. Starch is made only from glucose, isn’t very sweet and every cell in your body can use this for energy.

Fructose(refined sugar) on the other hand, is VERY sweet and gets converted to fat and it is this carbohydrate that Dr Lustig dubbed, The Primary Villain.

Fat is good

Subcutaneous fat (think “big butt”) is better for your health. Studies have shown that those with more subcutaneous fat live longer than us skinny types.

The fat that is dangerous, is the fat inside your abdomen and inside your organs (especially the liver). So is being overweight actually good? YES, says Lustig, “provided the weight is in the right place.” Being too skinny or thin, is trouble for our bones. Maintaining reasonable body weight is better for strong bones.

Further Resources: Posturecise (Level 1) – 21 days to create a healthy posture habit for life

If fat doesn’t cause obesity, then what does? Insulin is the greatest cause of obesity, says Lustig and, “there is no fat accumulation without insulin.” High insulin – from high consumption of refined sugars – is responsible for 75-80% of all obesity, he warns.

Four ways to increase body insulin


  1. High carbohydrate consumption – think North American breakfasts
  2. A sick ‘fatty’ liver
  3. Stress – Increases cortisol which raises insulin and makes you feel hungry
  4. Medications – steroids and anti-psychotics (to stabilize mood)

Are you skinny fat?


The easiest way to determine if you are skinny fat (TOFI – thin outside fat inside), if you don’t happen to have an abdominal MRI to hand, is to measure your waist-hip circumference.

Lustig warns that a waist size greater than 40 inches for men and 35 inches for women is a good indicator of visceral fat and it’s the visceral fat that counts most when measuring health.

An even better measure is your waist-to-hip ratio. A ratio less than or equal to 0.85 for women and 0.9 for men, is considered normal or ideal. You’ll need a tailor’s measuring tape – or a piece of string – simply mark the string with a marker and hold it up to a carpenter’s measuring tape.



What causes skinny fat?


When energy supply overwhelms the body’s ability to cope, the result is a build up of fat in the liver. What food stuffs cause this dangerous energy overwhelm?

  • Trans fat – man made fats found in many processed foods
  • Corn – animals like beef and pork fed on corn instead of grass
  • Alcohol – however a small daily amount (red wine) has been shown to be beneficial
  • Fructose (refined sugar) – Dr Lustig refers to fructose as “The Toxin”

How To Lose Visceral Fat


Fructose will turn your liver to fat and will denature your proteins and age you prematurely. Fructose tells your brain you are hungry, causing you to eat more and more of it.

We are a nation addicted to sugar. When you go on a diet and lose weight, the weight you are mostly losing is muscle.  The fat you want to lose is visceral fat.

Unless you are exercising while you are on a diet, you are making your body more vulnerable. 

The toxic villain is fructose. If we want to lose visceral fat and reduce our chances of metabolic syndrome – increasing risk of Cardiovascular Disease and Diabetes, we’ve got to get serious about our sugar consumption. 

God made vs man made

So am I skinny fat? No, I don’t believe that I am. I’ve always eaten well (a lot of God Made food vs. Man Made food). I never drink juice or pop. According to Dr Lustig, freshly squeezed juice is worse than pop! I exercise daily, sleep eight hours a day (but peri-menopause makes this a struggle – sigh); and my waist to hip ratio is normal.

Sugar does however have its hold on me. I grew up in the 70’s having dessert after every meal. I suffer the daily cravings of sugar and often still use sugar as a reward for finishing work tasks.

I don’t binge on sugar, but I have some form of sugar daily – even if just chopped fruit with plain Greek yoghurt. But I don’t like the control sugar has over me.

Health is what I value most in life – even above love and family! I figure if i’m not healthy, I’m not my Paula best, and have so much less to offer, than healthy happy Paula.

I ate a yummy cupcake yesterday – sigh – yes sugar is still in my life and yes, I still seem to have quite a bit of control around it. I do dream of taking an entire year off from all refined sugars and writing about my experience.

Watch out for future posts about this juicy behemoth goal. Please, don’t hold your breath – it isn’t likely imminent.

I’d love to hear from some of you. Do you think you’re skinny fat? Do you remember the low fat craze of the late 70’s, early 80’s? Are you a reformed skim milk/margarine consumer? 

December 9, 2014 No comments

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