Your Health

Get the skinny on dangerous amounts of excess fat tissue

Many South Asians are “fatter” than they think. When I say “fat,” I don’t mean it in a derogatory way. I’m referring to the scientific condition in which someone has excess adipose (fat) tissue. This tissue can be visible or invisible and can cause metabolic changes that increase the risk of developing conditions such as heart disease and diabetes.

People who don’t appear fat on the outside but show internal biological signs of carrying dangerous amounts of excess fat tissue are casually termed “skinny fat” in the medical field. This means having too much fat and too little muscle, which describes the majority of South Asians in my practice. “Skinny fat” is becoming more common across all ethnic groups, so it’s important for everyone to be aware of its health risks.

A study in the Journal of the American Medical Association showed that one out of four skinny people have prediabetes and are “metabolically obese.” Surprisingly, the study found that if you’re “skinny fat” at the time you’re diagnosed with diabetes, your risk of death is double that of an overweight diabetic.

A skinny-fat profile

So, how can you tell if you’re “skinny fat”? Here are a few clues:

• Body measurements: Rely on waist circumference and waist-to-hip ratios to guide you. You can also visit the “Body Size” section of the Palo Alto Medical Foundation South Asian Health website at

• Cholesterol profile: If your cholesterol shows high triglycerides, especially in combination with a low HDL (good cholesterol), this is a sign of “skinny fatness.”

• Blood sugar: If your blood sugar is consistently in the prediabetic range, or you’re diabetic with inadequately controlled blood sugars, then you likely have excess body fat.

• Liver blood test: Many South Asians have an elevated liver inflammation test. This is an early indicator of excess liver fat, which can cause inflammation.

If these tests are abnormal, the fatty liver should be confirmed by an ultrasound. I recommend you get liver-function tests if you have any of the other signs on this list.

The most important hormone in your body that determines fat storage is insulin. The most significant cause of insulin release is carbohydrates in your diet. Ironically, fat doesn’t cause insulin levels to rise. Carbohydrate-rich foods will make you fatter than foods with excess fat. Many of my patients who have the most excess body fat are South Asian vegetarians who consume no meat or excess fat in their diet, but instead consume lots of carbohydrates in the form of rice, breads, lentils, beans and starchy vegetables such as potatoes. Crispy snacks and sweets worsen the problem. So to lower extra fat, lower your carbohydrate intake.

Next, it’s important to get your body moving. Get a pedometer and aim for an initial goal of more than 5,000 steps daily and then increase to at least 8,000-10,000 steps daily. In addition, try to get in at least two to three sessions of cardio training and two to three sessions of weight training per week.

If you show signs of being “skinny fat,” it’s important to work closely with your doctor and nutritionist to reduce your health risks.

Dr. Ronesh Sinha is an internal medicine physician at the Palo Alto Medical Foundation’s Los Altos Center. He also provides medical consults to high-risk South Asians.

The Palo Alto Medical Foundation and editor Arian Dasmalchi provide this monthly column.

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