Are you Skinny Fat? The Hidden Dangers of Sarcopenic Obesity

Christina
Dec 31, 2023
6 min read

Updated: Jan 11, 2024

You could be affected despite a normal weight. One condition that often goes unnoticed is being "skinny fat", or medically called sarcopenic obesity—a combination of muscle loss and excess body fat.

Understanding what it means to be skinny fat

While you might think you are not affected by maintaining a healthy weight, your scale might lead you astray. Your weight alone doesn't give you enough indication of whether you are affected by sarcopenic obesity or not.

It occurs when muscle mass decreases while body fat increases. It creates two metabolic burdens stemming from low muscle mass (sarcopenia) and excess fat tissue (obesity).

Studies conducted over a long period have shown that their fat mass tends to increase as people age. This peaks between the ages of 60 and 75. On the other hand, muscle mass and strength tend to decline gradually with age, starting as early as 30 years old and with a more rapid loss after age 60. Dangerous visceral and intramuscular fat tends to increase, while subcutaneous fat in other body regions declines. Additionally, when fat infiltrates the muscle, it is associated with lower muscle strength and leg performance capacity.

Why is visceral fat so dangerous?

Visceral fat and subcutaneous fat are two types of body fat located in different areas, and they affect health differently. Visceral fat is stored deep inside the body, around vital organs like the liver, pancreas, and intestines. It's particularly concerning because it's linked to serious health issues like heart disease, diabetes, and increased inflammation. On the other hand, subcutaneous fat is the fat that lies just under the skin, often found in areas like the thighs, hips, and abdomen. Depending on the type of fat, even a person with a healthy weight might be at risk of severe health conditions due to visceral fat accumulation.

What causes sarcopenic obesity?

The sarcopenic obesity condition has a synergistic effect on physical disability, metabolic disorders, cardiovascular disease, and mortality. Older adults with sarcopenic obesity have a higher risk of developing coronary heart and cardiovascular diseases, as well as a higher mortality rate compared to non-sarcopenic adults. The reasons for this are:

Age-related changes

The increase in body weight and fatness is caused by decreased total energy expenditure due to reduced physical activity and energy expenditure while at rest. This decrease happens even when the caloric intake remains stable or increases, exceeding the basal and activity-related needs. Physical inactivity, hormonal changes, malnutrition, loss of muscle control in the central nervous system, low-grade inflammation, and altered gene expression can all contribute to the acceleration of muscle mass loss.

Sedentary Lifestyle

Obesity and low muscle mass may coexist in the same person due to age-related changes in body composition. However, there is evidence of a causal link between obesity and low strength. A sedentary lifestyle is a significant risk factor for weight gain. Obese individuals tend to be less physically active, which can contribute to decreased muscle strength. Muscle atrophy reduces metabolic rate both at rest and during physical activity, which may further aggravate the sedentary state, causing weight gain. Recent studies have shown that weight loss intervention combining diet and exercise among obese people improves muscle strength and muscle quality in addition to fat loss, confirming the hypothesis about the tight connection between adiposity and impaired muscle function.

Low-Grade Inflammation

Fat tissue is active, doing much more than just storing fat; it actually releases important hormones and proteins. When fat cells, or the immune cells in them, release certain substances called "pro-inflammatory cytokines" and "adipokines", it can lead to more inflammation in the body. This can then play a part in reducing muscle mass and strength. The more fat you have, the more these inflammation-causing substances are in your body and the less muscle mass you might have. People with excessive and weak muscles often have higher levels of inflammation markers than those with stronger muscles. So, this state of inflammation can be a big reason why people who are overweight or have excessive fat might find their muscle strength decreasing, creating a destructive cycle.

Insulin Resistance

Research on animals and humans shows that certain substances involved in inflammation can make it harder for the body to properly use insulin in people with excessive fat. This problem is linked to fat getting into muscles. As insulin is essential for building proteins, people with insulin resistance experience even more muscle mass breakdown. This is especially true in older people with diabetes, who tend to lose muscle strength and quality faster. Exercising strength can help the body use insulin better and control blood sugar levels.

Hormonal Imbalance

Increased adiposity is often associated with high circulating free fatty acids. Sarcopenic obese persons had depressed growth hormone secretion compared to obese persons. Similarly, obese individuals tend to have lower testosterone. Low levels of these hormones have been reported to be positively associated with low muscle strength and may, therefore, contribute to muscle impairment in obese individuals.

Malnutrition

Older persons tend to obtain too little protein in their diet, which may impair protein muscle turnover, especially during periods of weight loss, often coinciding with accelerated sarcopenia.

Identifying a Skinny Fat Body

There are various methods to assess body composition, each with different levels of ease and accuracy. Here are four common ways:

Tape Measure: A simple yet effective way to assess visceral fat is by measuring waist circumference with a tape measure. This method can quickly indicate fat accumulation around the abdomen, a key area for visceral fat. Use a measuring tape right at the top of your hip bone. Using a mirror, wrap the tape horizontally around your abdomen. Breathe normally while you measure. For men, a waist circumference greater than 40 inches (102 cm) and for women, a waist circumference greater than 34.6 inches (88 cm) is generally considered to be unhealthy. On top of that, having relatively thin limbs is a good indicator of sarcopenic obesity.
BIA Scales and Devices: Bioelectrical Impedance Analysis (BIA) scales use weak electrical currents to measure body composition. They're quick and easy to use. However, their accuracy can differ based on the body part they measure directly and what they estimate.
Clinical Tests: Procedures like hydrostatic weighing or DEXA scans in medical settings are accurate but not always easily accessible. DEXA involves a small amount of radiation.
Calipers: A popular method that involves pinching the fat under the skin to estimate internal fat. The accuracy can vary depending on the skill of the person doing the measurement.

For example, a BIA scale test result for a 6-foot (183 cm) man weighing 180 pounds (81.6 kg) showed he was within his ideal weight range with a healthy BMI of 24.4. However, his body fat percentage was 26%, well above the recommended 10-20% range for men. Despite having a normal weight and BMI, his body composition includes a higher-than-ideal amount of fat.

When using BIA devices or a tape measure, it's essential to understand the limitations and accuracy of these methods. Some BIA devices measure specific body parts and estimate the rest, while tape measurements provide a direct but limited view of fat distribution.

Prevention and Reversal Strategies: Take Charge of Your Health

Recognizing the signs of sarcopenic obesity is the first step toward proactive management. Pay attention to indicators such as unintentional weight loss, decreased strength and endurance, increased difficulty in performing daily activities, and a noticeable decrease in muscle tone. Regular check-ups and screenings can further assist in early detection, enabling timely intervention.

The good news is that sarcopenic obesity can be prevented and even reversed with lifestyle modifications. Here are some key strategies to adopt:

1. Stay Active: To counteract muscle loss and promote muscle growth, incorporate the following exercises into your routine:

Strength training exercises using body weight, resistance bands, dumbbells, or weight machines.
Balance exercises like yoga or tai chi to improve stability.
Cardiovascular exercises such as brisk walking, cycling, or swimming to boost heart health and overall fitness.

2. Fuel Your Body: To support your muscle health, focus on a balanced diet that includes:

Adequate protein sources like lean meat, poultry, fish, beans, and tofu is particularly crucial for muscle health.
Whole grains, such as brown rice and whole wheat bread, for sustained energy.
A colorful array of fruits and vegetables, providing essential vitamins and minerals.
Healthy fats from sources like avocados, nuts, and olive oil.

3. Prioritize Sleep: Quality sleep plays a vital role in muscle recovery and maintenance. Aim for 7-8 hours of uninterrupted sleep each night to support your body's natural healing processes.

4. Manage Stress: Chronic stress can contribute to muscle loss. Incorporate stress management techniques like meditation, deep breathing exercises, or engaging in hobbies that bring you joy.

5. Seek Expert Guidance: Consult with healthcare professionals, including physicians and physical therapists, who can provide personalized advice based on your needs and medical history.

Conclusion:

Sarcopenic obesity may pose challenges, but with awareness and proactive steps, you can maintain your muscle health and overall well-being. Prioritize regular physical activity, follow a balanced diet, and seek professional guidance to optimize muscle mass and reduce the risk of associated health issues. Remember, it's never too late to take charge of your health and enjoy a vibrant and fulfilling life.