The American Medical Association has just adopted a new policy regarding the use of Body Mass Index, a widely used statistical measure that is computed based on a person’s height and weight, to assess health or determine medical treatment. As AMA Immediate Past President Jack Resneck, Jr., noted, “There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity.”
As we explained in a 2022 article,
BMI as a measurement…does not differentiate between weight from fat, muscle and bone. A muscle-bound athlete could have an “overweight” number, and a senior who had lost bone density and gained abdominal fat could retain a “normal” number.
However, even if BMI did measure only the proportion of fat on the body, it would still be misleading as a diagnostic tool. Why? Because it’s not the amount of fat on your body that matters, it’s the location.
Which leads us to the acronym TOFI—”thin on the outside, fat on the inside.” The phrase has been around since at least 2006, and the idea that someone could be of normal weight and yet still carry excess amounts of fat was described in medical literature as far back as 1981.
“Fat on the inside” refers to visceral fat, which can surround or settle on your internal organs and is associated with a range of negative health conditions. As described by the BBC:
Visceral fat makes it harder for the hormone insulin to work and causes insulin resistance, which can lead to prediabetes and type 2 diabetes as well as obesity. It is a risk factor for 13 different cancers, including cancer of the stomach, gall bladder, breast, ovarian, endometrial, prostate, kidney and liver… having visceral fat can also be a sign that someone has a fatty liver, which can lead to liver disease.
How can you tell if you have a visceral fat problem? Obvious external obesity (“fat on the outside”) is a clue, since it increases the likelihood of fat on the inside (unless you happen to be a Sumo wrestler, but that’s another story). An apple-shaped body or beer belly is also a clue. But as we’ve discussed in an another eSavvyHealth article,
The only certain way to measure visceral fat is an exam using ultrasound or other such technology. Failing that, there’s always the measuring tape. A man is considered to have “abdominal obesity” with a measurement greater than 40 inches, and a woman with a measurement greater than 35. (The tape should be placed above the top of the hip bone.)
If you suspect that you have excess visceral fat, don’t panic. Just like fat on the outside, it can be reduced. eSavvyHealth’s many resources can help you better understand how your body manages fat levels. You might want to start by learning about a hormone called cortisol.
