Have you ever wondered why some people can eat loads of junk, avoid exercise, and appear to never put on much weight while other people’s waistlines expand just from looking at food?

You would probably think that they’ve won the genetic lottery, but don’t be fooled; they are actually at much greater risk of developing type 2 diabetes and insulin resistance, fatty liver disease, metabolic syndrome, and a number of other chronic diseases.

These people are referred to as TOFI (thin on the outside, fat on the inside), and it largely comes down to genetics.

When you’re carrying excess calories, you store it as fat on your body. Although you can store fat in other areas of your body, your subcutaneous adipose tissue (around your belly) is the prime location—and what it’s designed for in the first place. Normally, when these fat cells are full (like a full car park), you grow new fat cells to accommodate. It essentially acts like a bugger or storage belt, which is important because you don’t want fat to clog up your arteries or accumulate in your organs.

Some people’s fat cells are not very good at multiplying, so they become overly full, which stresses out the cell and contributes to inflammation. When they do hit capacity, it creates a spillover effect. The fat needs to go somewhere, so it’s shuttled around your body and ends up being dumped in and around your organs (we call this ectopic and visceral fat). This puts significant strain on your organs and is very harmful metabolically. These people develop fatty liver disease and are at very high risk of type 2 diabetes.

Lipodystrophy illustrates how important subcutaneous fat is to our health. Lipodystrophy refers to a problem with the way our bodies use and store fat, particularly the fat that’s under our skin, changing the way we look. Those who suffer from it develop significant hypertriglyceridemia, ectopic fat deposition, liver damage, and profound insulin resistance in muscle and the liver. Our other organs are at serious risk without the subcutaneous reservoir.

Now, it’s important to note that it’s not just one or the other; you don’t only store fat on your belly or around your organs. If you have a large waistline, it’s very likely that your fat cells have been under duress and there’s been some spillover.

It’s easy to see if someone has fat accumulation around their belly, but it’s not so easy to know whether someone is carrying excess fat around their organs. Visceral fat can be measured by doing an MRI or CT scan, but it’s not something that’s routinely done.

There are two markers that can indicate whether you have developed visceral and/or ectopic fat:

  1. A large waist circumference > 90cm (>35 inches) for men and >80cm (31 inches) women for women.
  2. Triglycerides (TG) >1.5mmol/L (>150mg/dL).

How do you get rid of internal, harmful fat?

1. Weight Loss 

Weight loss can be very effective. Even modest weight loss of 8-10% of your body weight is associated with a 60% reduction in liver fat.

2. Avoid Processed Foods

Cut down on or avoid processed foods, particularly refined and processed carbohydrates. These are essentially any products made from flour or sugar that are packaged, such as chips, chocolate, baked goods, pastries, bread, ice cream, soft drinks and soda, etc…) Many of these foods contain high fructose corn syrup, which is a potent form of fructose. Fructose contributes to fatty liver and is very harmful metabolically. 

3. Minimise Saturated Fat

Minimise saturated fat, as saturated fat is more likely to fill up fat stores and cause fatty build-up in the liver. 

4. Exercise

Exercise is a great way to melt away the fat in and around your organs. Even if you look in the mirror and think you don’t need the exercise, remember, it’s not only about what you see on the outside. If you haven’t been physically active in a while, start small. Try going for a walk, standing more often throughout the day, taking the stairs, or picking up an outdoor hobby that gets you moving around.

Caloric Overload

Després, Jean-Pierre, Abdominal Obesity and Cardiovascular Disease: Is Inflammation the Missing Link?, Canadian Journal of Cardiology, November 2012, Vol.28(6), pp.642-652Caloric