Cutting or bulking for the “skinny fat” body type?

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By Ari Snaevarsson, Features Editor

Likely the most common dilemma anyone interested in changing their body composition arrives at is whether they should cut or bulk.  Briefly, to “cut” means to lose weight (preferably fat mass), while “bulking” denotes an attempt to increase weight (preferably muscle mass) via a caloric surplus.  Of course, answering this question is ultimately a personal decision; people at this crossroads should ask themselves what body composition they look or perform best at; whether the necessary dietary/physical regimen intervention to get to that end goal is something they can commit to; and why exactly this is important to them.

Where matters get complicated is with a class of individuals known to the scientific community as being TOFI, or “thin on the outside, fat on the inside,” or, more colloquially, skinny fat.  I should note these two terms are not exactly interchangeable, as the former has more to do with health parameters and the latter to do primarily with aesthetics.  However, it is this dichotomy I wish to address, and so for the purpose of this article, it suffices to consider these terms one in the same.

What does it mean to be skinny fat?

The skinny fat body type has a characteristically disproportionate distribution of visceral (abdominal) fat to subcutaneous fat.  In essence, these individuals likely have underdeveloped lean tissue throughout (explaining their outward “skinny” appearance), yet they have large amounts of fat in the midsection (hence the inward “fatness”).

Dr. Jimmy Bell, professor at the Medical Research Council’s center at Imperial College in London, created the aforementioned TOFI acronym to describe these individuals.  As stated earlier, this was originally highlighted in the literature to point out the poor metabolic profiles that were observed despite BMIs pointing either to normal weight or underweight.  They display high blood triglycerides, prediabetes, chronic inflammation, hypertension, and other hallmark traits typically seen in obese patients that predispose them to cardiac events.

Which do you choose?

For such individuals, I vehemently reject the push to get them to “just eat more” and lift weights in hopes that they will bulk up, effectively ignoring the dangers of their visceral fat deposits.  My word on the matter, which of course does not constitute medical advice, is that they should be treated much like obese patients with similar metabolic deficiencies.

Yes, this means “cutting.”  But, more specifically, this means a diet high in fruits and vegetables, naturally raised/farmed meats, careful attention to saturated fat intake (not all saturated fats are bad, but by in large they should not make up a large portion of one’s fat intake), plenty of monounsaturated fats, and so on.  Allow me to expand further on the importance of this.

Why is treatment of TOFI so imperative?

This is still a murky area in the literature, and so I do not mean to make the following appear to be an exhaustive, or even fully accurate, explanation.  I will only speak to the points of which I believe there to be enough grounding to warrant further observation.

The fat distribution in these individuals tends to exist around their vital organs and streaked through their underdeveloped muscles, all areas that are associated with the health risks of obesity.  In comparison to visceral fat, subcutaneous fat predisposes to virtually none of the same conditions, as elucidated by results from a 2009 review of the famed Framingham Heart Study.

For example, when visceral fat is surgically removed, plasma glucose and insulin levels drop (this is good).  Yet when subcutaneous fat is removed, glucose metabolism is not improved.

The argument could even be made that some subcutaneous fat might be protective, as posited by the ectopic fat hypothesis.  This has been shown in scientific trials.  Diabetes medications that increase fat mass have shown to improve insulin sensitivity.  And, interestingly enough, when subcutaneous fat is transplanted into visceral compartments of mice, fat mass was decreased and glucose metabolism improved.

But why?

The exact physiological mechanisms that differentiate these two types of adipose tissue are still largely unknown.  Adipocytes are a unique type of body cell, as they are responsible for paracrine, endocrine, and exocrine signaling; they may have implications for human reproductive capabilities; and they exhibit a whole host of other functions that set them apart from most cells.

One such difference, which can suffice as a tentative answer to this question, is that their gene expression may vary greatly depending on the fat type.  Visceral fat shows disturbances in this realm, an example being the overactivation of lipolysis-blocking molecules.  So, though we are far from having definitively understood pathophysiologies of the mechanisms of visceral fat, enough hypotheses, and certainly enough lab and practical observations, exist to make the case for its role in promoting obesity-related diseases.

In closing

I hope it is now clear why individuals with such a body type (and this of course encompasses obese individuals as well) need to be focusing on weight loss and not “bulking.”  I point to this specifically only because I see the advice given quite often in the lifting community and feel this is irresponsible at best.  Note that while the focus of such individuals should not be a “bulk,” in which body fat gain is expected, the retention or even increase in muscle mass should absolutely be strived for.  In sedentary individuals or those new to exercise, gaining muscle while losing weight and improving health parameters is a common reality, when prescribed the proper diet.

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Author: Ari Snaevarsson

Ari Snaevarsson '17 is a Health Sciences major and Religious Studies minor, and he is the Features Editor of The Gettysburgian. He competes in bodybuilding and powerlifting and has an immense passion for dissecting the habit psychology at play in people's dieting attempts. Outside of reading and bedroom DJ-ing, he has previously maintained a health/fitness blog that also followed nutrition news, No Fluff Strength.

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