Thin Outside Fat Inside (TOFI) Bodies and Diabetes

Appearances can be deceptive when it comes to health. An individual might have the right Body Mass Index (BMI) and look seemingly thin and healthy on the outside, yet on the inside, their organs might be burdened with fat. Such people are said to have "Thin Outside, Fat Inside" (TOFI) bodies. They have a higher chance of developing type 2 diabetes and a whole host of other serious diseases, including cardiovascular issues and even cancer.

Let’s Get to Know Belly Fat

The fat that is visible to the eye at first glance, like around our arms and thighs, is called subcutaneous fat or fat under the skin. The fat that accumulates around some of our organs is called visceral fat and is, in general, invisible to the naked eye. Viscera is an umbrella term for the internal organs of the body, especially the organs within the abdominal and thoracic cavities, such as the liver, heart, and stomach. It also includes the intestines. Thus, visceral fat is the fat that accumulates around these visceral organs and makes up 1/10th of the total body fat.

Some of the visceral fat gets stored in what is known as the omentum, a layer or sheet of tissue under the muscles of the stomach. As it grows, it becomes thicker and harder as more fat starts accumulating. This can lead to what is known as "belly fat" if left unchecked, and that means huge waistlines in both men and women. Fat accumulating on the momentum is not a good thing since it plays an important role in regulating the immune system and regenerating tissues.

In some people, a growing belly might be a sign of both subcutaneous and visceral fat. In cases of visceral fat, a person’s limbs may still appear thin while their stomachs bulge out. These people are said to have an apple-shaped body.

Link between Visceral Fat and Diabetes

Visceral fat releases more cytokines (small proteins), which affect the growth of all the cells involved in the immune system, and an excess amount of cytokines can cause inflammation. Such inflammation may lead to the narrowing of the blood vessels, insulin resistance, and type 2 diabetes. Cytokines and other biochemicals reduce insulin sensitivity, increase blood pressure, and cause blood clotting.

Visceral fat also releases another kind of protein in excess, called retinol-binding protein 4 (RBPR), which can increase insulin resistance.

Visceral fat can be found near the portal vein, whose role is to carry blood from the intestinal area to the liver. Visceral fat releases fatty acids, which reach the liver and cause problems with lipids (fat found in the blood) and lead to insulin resistance. Visceral fat also produces more adipokines (cytokines secreted by the adipose tissue), which increase insulin resistance.

People with TOFI were found to have higher fasting glucose levels, and their glucose tolerance was found to be compromised. 

What Causes Visceral Fat or TOFI?

Let’s get to know what factors might be contributing to visceral fat:

• Food: In some cases, excess visceral fat buildup might result from certain genetic conditions, but for most people, food is the main culprit behind excess visceral fat, especially ultra-processed foods. Refined grains, added sugars, trans fat, excess sodium, and excess fructose were found to be equally responsible for visceral fat buildup. The Randle cycle explains how fat accumulates in our liver, skeletal muscles, and adipose tissue and how a person may keep gaining weight on their internal organs.
• Lack of Exercise: Physical inactivity may also lead to visceral fat. Fat gets stored in the body when we consume too many calories but don’t spend it by way of physical activities or exercise.
• Stress: It also plays a role in visceral fat. When the body is stressed, the cortisol hormone is released. In stressful times, cortisol contributes by increasing glucose in the bloodstream (so that you have the energy to fight or take flight) and also enhances the brain’s usage of glucose (so that you can create a strategy for fighting or flight). It also helps repair damaged tissues (so that you can fight or run better). However, in chronic stress, this happens repeatedly and causes problems. Many people also resort to stress eating to feel better. Cortisol and calories together are a bad combination. During stressful times or under chronic stress, fat is stored around adipose cells around the visceral organs. Most of the fat is stored in the adipose tissues at the center of these organs so that these vital organs remain protected.

In women, belly fat is also determined by the number of children they have given birth to. Post-menopause, when women have less estrogen in their bodies, their belly fat may increase.

Both genetic and environmental factors determine the amount of visceral fat one can gain and the body's shape.

How do you Figure Out if you have a TOFI Body?

An MRI is the best way to figure out the true extent of visceral fat in a person’s body. However, there are a few ways you can measure your body fat at home:

• Waist Measurement: Women with a waistline of 35 inches and men with a waistline of 40 inches are more prone to health issues caused by visceral fat. The waistline is measured by wrapping a tape around your waist, just above your hips.
• Waist-to-hip Ratio: A waist-to-hip ratio of 0.85 in women and 0.90 in men is a sign of abdominal fat. Measure your waist and the widest part of your hips. Divide waist size by hip size.
• Body Mass Index (BMI): A BMI of 30 or more means the person has visceral fat.
• Waist-height Ratio: A waist-to-height ratio of more than 0.5 is a sign of visceral fat.

How to Get Rid of a TOFI Body and be Thin on the Inside too?

• Diet: Avoid ultra-processed foods, and don’t consume diets that are rich in carbohydrates and protein at the same time. This will allow the body to use the fat already present in the body. Unused energy from carbohydrates is also stored as fat. Low-carb diets help reduce visceral fat quickly.
• Exercise: Exercising regularly is a great way to burn fat. Try to exercise for half an hour every day. Cardio training, strength training, high-intensity interval training (HIIT), and aerobic training all work wonders in burning fat faster.
• Intermittent Fasting: It may help reduce your levels of visceral fat. When you consume less calories, you need less insulin to transport glucose into your cells. Less insulin means more fat will be burned for energy.
• Adequate Sleep: Lack of sleep can lead to an increase in the levels of the hormone ghrelin, the hormone that makes us hungry. It also causes a decrease in the levels of the hormone leptin, which is responsible for suppressing appetite. This means people eat more and more and work out less, leading to an increase in visceral fat. As per a 2022 study, people who slept only 4 hours had an 11% increase in belly fat in comparison to people who got a full night’s sleep. Thus, adequate rest is important to keep belly fat in check.
• Reduce Stress: We have mentioned above how stress levels can increase visceral fat. Yoga, meditation, and being close to nature all help bring down cortisol levels, and thus visceral fat levels remain low.
• Reduce Alcohol: Men with belly fat are often said to have a "beer belly." Almost all types of alcohol are harmful to our health, but beer contributes the most to visceral fat. It increases your calorie intake. Beer consumption of over 500 ml per day can cause an increase in body fat, and the body prefers burning alcohol for energy rather than the already stored body fat. Beer gets its flavour from the flowers of the hop plant, which are high in phytoestrogens. It can mimic the female sex hormone estrogen and cause hormonal changes in men that increase body fat.

Conclusion

People who are Thin Outside Fat Inside (TOFI) have more chances of developing Type 2 diabetes. Improved eating habits, a good amount of sleep, and an active lifestyle help tremendously in the removal of visceral fat.