One of the most overlooked areas that I know of in health and fitness is nutrition. To top that off, one of the most misunderstood areas of nutrition is the concept of under-eating which can easily result in what is known as “skinny fat”. Because I feel that both of these words, skinny and fat, can have a negative connotation, let’s refer to skinny fat by its medical terminology, metabolically obese normal weight, MONW.
So what is MONW? MONW is essentially when someone appears to be at a healthy weight, but their lean muscle mass to body fat ratio is very lopsided with a higher than healthy percentage of body fat – raising the likelihood that they are internally unhealthy. Your lean body mass is very low and your body fat is higher than what is recommended or deemed normal for a man or woman. Some possible physical displays of this are “fluffy” areas on the body, loose skin, soft jiggle in certain areas of the body, or simply just a very thin person with not a lot of muscle tone.
There is a big misconception in weight loss with people thinking they need to lose weight vs. losing FAT. There’s a huge difference. A lot of times, in my experience, when people tell me they want to lose weight, I ask what their true goal is and they tell me, “I want to get abs”. If you want abs, this does not always mean you need to just lose weight, but you need to lose body fat. I like to use the metaphor that the body fat that lays on the outside of your abs, your subcutaneous fat, is like the icing on the cake, or in this case, your abs! Subcutaneous fat is fat that is between your organs and your skin and is less worrisome than visceral fat, which is fat that sits inside and amongst your organs. Visceral fat is the fat that is most prevalent in insulin resistant individuals and we already know that insulin resistance is closely correlated to the MONW or skinny fat body type.
Aside from a body composition imbalance, there is a more serious side to a MONW person’s health internally. A MONW individual is very susceptible to develop some level of insulin resistance, meaning their pancreas does not produce enough insulin to keep their body’s blood glucose levels in the normal range. The importance of discussing this topic comes from the severity of insulin resistance and the likelihood of predisposition to many life threatening diseases such as type 2 diabetes, central obesity (a collection of adipose tissue in the thoracic cavity), and cardiovascular disease, which, in turn, are both gateways to additional health concerns like neuropathy and ischemic heart disease. (1)
To sum things up so far – not everyone who looks healthy on the outside is healthy on the inside! This summation could obviously be split into several different domains (e.g. mental health, emotional health, and physical health, among others), but for the purpose of this discussion, I am going to stick to the physiological impact and treatment for these individuals. Speaking of treatment, the good news is that because of the likelihood that MONW people are younger and do not already have several pre-existing health concerns, research suggests that the best treatment involves good, old-fashioned nutrition guidance and exercise!
Let’s start with a suggested nutritional approach. It seems to be a current trend or an attempt at rebellion by going against the science in the fitness world right now to be able to say “don’t count your food, eat what you want, just eat clean, etc.”. While I wholeheartedly believe in living a life of balance and doing what helps you maintain a level of mental and emotional stability with your relationship with food and exercise, as a previous collegiate athlete and personal trainer, I have always operated with a goal-oriented mentality. Identifying a goal helps formulate the methodology for your nutrition and training regimen, which can also be thought of as your roadmap to your destination! As it applies to a MONW person, to work on reversing the body composition by lowering body fat and increasing lean muscle mass, it is vital to your success that you know what your caloric consumption consists of to make sure you are eating in a way that yields those changes.
Without any foundational basis of knowledge of knowing where you are currently at and what you are eating, you are doing yourself a huge disservice with going about your fit lifestyle blindly and not having any idea if you are overeating, under-eating, or eating the right amount. To take things further than just counting calories, the type of calories you eat is also important and without tracking these vital macronutrients you could really mess up your body’s composition (i.e. body fat versus lean body mass). The most informed representation of what you are consuming and my personal preferred nutrition regimen is counting your macronutrients. The three macronutrients that our bodies need to function and perform are proteins, carbs, and fats.
Each individual person will need different amounts of each macronutrient in their diet based on starting point, lifestyle, goals, and various additional individual factors. There are several ways to calculate calories and macronutrient needs, but one simple way to get started is to establish the calories that your body needs for the specific goal that you are working towards (lose fat, maintain, or gain muscle) by multiplying your current weight by an activity level factor on a scale of 10-13 that represents your total daily energy expenditure (TDEE) with 10 being completely inactive and 13 being very active. For instance, I am 145 pounds and I have a very active job while working out 6 days a week so my TDEE would be 13. I would multiply 145 x 13 and get 1885 calories. This number will provide your caloric consumption goal for maintaining the weight you currently have. A basic way to alter calories based on goals is to increase your caloric intake to add mass and decrease your caloric intake to lose weight. For the purpose of the MONW person, I would just start with aiming for maintenance calories first and then adjust after a successful nutrition regimen is established. You will then break your caloric goal down into percentages of proteins, fats, and carbohydrates. Every person’s breakdown will be different as everyone has a different starting weight, goals, TDEEs, and responses to certain foods. Knowing what combination of your macronutrients are going to make up your caloric requirements should be your starting point.
To revert back to my frustration with going against the grain and eating whatever you want but considering it clean or “pretty healthy” since you work out daily, the percentages of your macronutrients are going to make a huge shift in the composition of your body. I always suggest starting out by recording what you are eating and looking at it after you have done this for one week. I have had SEVERAL personal training clients and online training clients tell me they “eat pretty clean” because they were eating healthy food, but after recording their nutrition for a week and looking back, they were made aware of the imbalance in their macronutrient consumption. The most common misconception I have seen is overeating fats or carbohydrates and an under consumption of protein (i.e. your daily calories may be made up of 60% fats and 40% carbs vs your fitness goal of 40% protein and 30% of carbs and 30% of fats for a client trying to lose body fat).
As I said before, everyone will have different prescribed macronutrient calculations, but be aware of what you are eating! I personally break my macronutrients down into 40% of my calories coming from protein, 30% of my calories coming from carbohydrates, and 30% of my calories coming from fats because that is what works for me personally. Slight tweaks in your intake can add up to make a huge change in your body!
Lastly, to accompany your refocused nutrition goals and to remind you that changes occur from a shift in lifestyle, make sure you are training your body to get stronger versus training to punish yourself or to lose weight or get thinner no matter the cost. With the change of dropping body fat and adding lean muscle, focus less on the scale and more on your lean body mass increasing and your body fat decreasing. If you have heard one pound of muscle is heavier than one pound of body fat, you have been misinformed. One pound of anything weighs the same as one pound of something else, but because body fat is less dense than muscle it takes up more space in the body. Adding muscle to a lean frame will provide you with definition you may have not seen before if you are a MONW person also! I love the confidence that comes from people experiencing progress in their own strength because I know the benefits of added muscle mass. Not only does a person look stronger and possibly more defined, but strength and muscle mass are vitally important in injury prevention and metabolism regulation. When starting with a strength and conditioning program, remember that everyone has a different starting point and to not be ashamed if you need to make a modification to an exercise to make it work for you. Start by figuring out how to effectively move your own body weight before adding resistance. Technique is very important and especially important for those who are just starting a fitness regimen to avoid injuries and setbacks in their pursuit of a fit and strong body.
To sum up the purpose of my article, I urge you to consider and keep in mind the differences in aesthetics and internal health. Take an overall note of the food you are eating, the way you are training, the goals that you have for yourself, and the way you are aiming to see progress in yourself. Often we are quick to judge a person who is thin and conclude that they are healthy or, on the adverse, make remarks to them that they can afford to eat and live however they want because they are thin or skinny. There is a lot that goes on in a person’s physiological, mental, psychological, internal and external health and we often do not know the whole story. I urge you to encourage everyone, no matter what their appearance, to be the healthiest versions of themselves and even more importantly, I hope that you too can focus on being the healthiest functioning person inside and out for yourself too. Aim to be strong inside and out, not to just be skinny. Aim to eat nutrient dense foods to fuel your body instead of just eating to get full. Aim to always be knowledgeable about your health knowing that you are eating and training in a way that will make you feel and function well both inside and out. In more ways than one, what is on the inside is just as important, if not more important, than what is on the outside.
- Pi-Sunyer, X., Schneider, S., Ruderman, N., & Chisholm, D. (1998). The Metabolically Obese, Normal-Weight Individual Revisited. Diabetes, 47, 699-713