TOFI stands for “thin outside, fat inside.”
It is a term that describes individuals who appear slim and healthy on the outside, but have excess body fat stored around their abdominal organs(liver, stomach, intestines).
“TOFI” can be used synonymously with the term skinny fat which is comparatively more common.
While being “outwardly” fat is a major health concern, TOFI also puts individuals at risk for many health problems including heart disease, diabetes, and cancer.
Some research suggests that TOFIs may be at higher risk for certain health problems than individuals who are visibly overweight/fat.
This article is my attempt to help you wrap your head around TOFI.
To start with.
You should understand that generally, your body can store fat in 2 ways: subcutaneously, and viscerally.
When Fat Is Stored Subcutaneously.
It means that it is stored just beneath your skin.
People with more than enough subcutaneous fat outwardly appear fat.
TOFI individuals will most likely have less fat stored subcutaneously.
This makes them falsely appear thin and sometimes even healthy on the outside.
Excess subcutaneous fat is a tell-tell sign of excess visceral fat – so it’s not something to celebrate.
When Fat Is Stored Viscerally(In TOFI).
It is stored deep inside, surrounding abdominal organs and it is hard to spot from the outside.
If you are TOFI, you have an excess amount of visceral fat and a less than/normal amount of subcutaneous fat.
This is what makes you appear thin Outside, while you are morbidly fat inside.
To Help You Better Understand How Fat Is Stored In TOFI Individuals:
The image below is of a Magnetic Resonance Imaging (MRI) showing the amount of fat in two men of a similar age, gender, Body Mass Index (BMI), and same % of body fat.
While the individuals are of the same size, the TOFI individual(on the left) has more internal fat(5.86 liters) than the lean individual on the right with only 1.65 liters.
But, what would make fat “decide” to stray off to your abdominal organs?
The following section explains that.
What Causes TOFI?
Research shows that the most notable cause of TOFI is the overconsumption of added sugars like table sugar(sucrose) and high fructose corn syrup(HFCS).
Consuming excess added sugars(especially fructose) leads to inflammation in your cells.
Once inflammation occurs, cortisol comes into play to suppress it.
Elevated levels of cortisol lead to the redistribution and storage of body fat, particularly in the abdominal area.
If this process is not controlled, it can contribute to the development of visceral adiposity.
While added sugars are the most notorious cause of TOFI, there are other specific and broad causes as to why it might occur:
The mechanisms behind how they cause tofi are technical and outside the scope of this article. I have linked relevant resources for further reference.
- Sex hormones.
Different studies demonstrate that sex hormones like testosterone, estradiol, and dehydroepiandrosterone(DHEA) play a role in determining how and where fat is stored in our bodies.
Since tofi is mostly a problem of where fat is stored, sex hormones play a role in its development. - Reduced growth hormone.
Low levels of growth hormone are linked to increased visceral adiposity.
Administration of growth hormone has been shown to somewhat decrease visceral adiposity.
Genetics, gender, and age are among other important factors that contribute to the development of TOFI.
Why TOFI Is A Health Concern.
TOFI is a health concern because while individuals who are TOFI will generally look healthy, they bear the same ramifications as those who are outwardly overweight/obese – such individuals have higher risks for developing diabetes type 2 and insulin resistance.
What’s worse is that if you are a TOFI, unlike outwardly fat individuals, you will not promptly realize that you are morbidly fat inside.
Also, while TOFI is not necessarily a metabolic syndrome, it is highly associated with the development or existence of metabolic syndrome.
What Are The Signs Of TOFI?
Some of the most common signs of TOFI are an increased waist-to-hip ratio and waist circumference, high triglyceride levels, abnormal insulin and blood sugar levels, low muscle mass, and high blood pressure.
However, most of these signs are not so specific to being TOFI.
You might need more complex medical examinations or investigations to rule out or confirm TOFI.
Here are some of the measurements/investigations you and/or your doctor can do:
- Body Fat Percentage Measurements.
The most accurate way to determine whether you are a TOFI is to measure your body fat percentage.
Bioelectrical impedance analysis, dual-energy X-ray absorptiometry (DEXA), and skinfold measurements can be used for this purpose.
If your body fat percentage is high, even if your weight is in the normal range, it could indicate that you are a TOFI. - Blood Tests.
Certain blood tests can also give clues as to whether you are a TOFI or not.
For example, elevated levels of triglycerides, insulin, and glucose in your blood can indicate excess fat storage in your body, even if you appear thin. - Waist-to-Hip Ratio.
Measuring the ratio of your waist circumference to your hip circumference can also provide insights into whether you are a TOFI.
If your waist-to-hip ratio is high, it can indicate that you are carrying excess visceral fat even if you don’t have much subcutaneous fat.
The normal waist-to-hip ratio (WHR) varies by gender and age, but generally, a WHR of less than 0.90 for men and less than 0.85 for women is considered normal - Imaging Tests.
Imaging tests such as CT scans, DEXA, and MRI scans, can give a detailed picture of the amount and distribution of fat in your body.
These tests provide a clear picture of what’s going on but are not typically used for diagnostic purposes unless other methods have failed to provide a clear answer. - Physical Examinations.
Your doctor can also perform a physical examination to assess your overall health and look for signs of metabolic problems, such as high blood pressure or insulin resistance.
Whether you found out you are a TOFI or not, it is important to take appropriate measures to reverse or prevent it.
The following section will help you with that.
How To Cure Or Prevent TOFI.
The following are 5 practical tips on how you can cure, reverse, or prevent TOFI:
- Adopt a Healthy Diet.
A healthy diet is crucial in preventing or managing TOFI.
Focus on consuming a variety of nutrient-dense foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats.
Limit your intake of processed foods, sugary drinks, and trans fats. - Get Active.
Exercise can help you prevent or manage TOFI by reducing visceral fat.
Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, jogging, cycling, or swimming. - Reduce Stress.
Chronic stress can lead to increased cortisol levels, which contributes to TOFI.
Incorporating stress-reduction techniques such as meditation, yoga, deep breathing exercises, can help you manage stress and cortisol levels. - Get Enough Sleep.
Sleep plays a critical role in maintaining a healthy weight and reducing the risk of metabolic problems associated with TOFI.
Aim for at least 7-9 hours of quality sleep per night. - Frequently Monitor Your Health.
Regular health check-ups with a healthcare professional can help detect and manage TOFI.
Your doctor may recommend blood tests, body composition measurements, and other assessments to identify potential problems.
TOFI – Take Away.
Your weight and outward appearance may not always accurately reflect how healthy you are.
Assessing visceral fat levels through the methods highlighted in this article can provide a more accurate picture.
If you find out that you are TOFI, you should reduce the risk of health problems by engaging in regular physical activity, maintaining a healthy diet, and managing stress levels.
