Why being ‘skinny-fat’ could be just as risky as being overweight

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Being overweight has long been linked to heart disease and type 2 diabetes, but even people who appear thinner may be at risk, researchers suggest.

A new study conducted by researchers at McMaster University in Ontario, Canada, explains that there is such a thing as “skinny fat”—someone who appears healthy and thin but is actually hiding fat deep within their organs.

The findings were published at: Communication Medicine, suggests that fat stored in the abdomen and liver may silently damage the arteries.

It challenges long-held reliance on body mass index (BMI) as a measure of obesity and offers new insights into how hidden fat contributes to heart disease.

Visceral fat, which surrounds the internal organs, and hepatic fat, stored in the liver, are known to increase the risk of type 2 diabetes, high blood pressure, and heart disease, but their effects on artery health are less well known.

People who appear to be a healthy weight may be at risk of heart disease, study finds (Getty/iStock)

“This study shows that even after accounting for traditional cardiovascular risk factors such as cholesterol and blood pressure, visceral and liver fat still contribute to artery damage,” said study co-leader Russell de Souza.

“The findings are a wake-up call for both clinicians and the public.”

Excess weight can cause fatty substances to accumulate in the arteries. If the vessels carrying blood to the heart become blocked, this can lead to a heart attack.

But it’s not just fat under the skin that causes problems; Fats around organs also affect how the heart and blood vessels work.

Researchers used MRI imaging and data from more than 33,000 adults in the United Kingdom and Canada and found that visceral and hepatic fat was strongly linked to thickening and blockage of the carotid arteries in the neck. These arteries supply blood to the brain, and their narrowing is a key indicator of stroke and heart attack.

Importantly, these associations persisted even after the researchers adjusted for lifestyle and metabolic risk factors.

“You can’t always tell by looking at someone whether they have visceral or liver fat,” said the study’s corresponding author, vascular disease specialist Sonia Anand.

“This type of fat is metabolically active and dangerous, linked to inflammation and artery damage even in people who are not visibly overweight. That’s why it’s so important to rethink how we evaluate obesity and cardiovascular risk.”

The researchers suggest that doctors should consider using imaging-based assessments of fat distribution because this fat is not visible and cannot be measured by BMI or waist circumference.

Alex Miras, professor of endocrinology at Ulster University, said: Independent: “Visceral fat can cause coronary artery disease even in people with normal or near-normal BMI. It is more common in certain ethnic groups, such as South Asians.”

Although this fat is not visible from the outside, it can be dissolved through diet, exercise or medication, as is the case in overweight people.

He added: “Any weight loss through behavioral interventions or obesity pharmacotherapy will likely have a positive impact on reducing cardiovascular disease. Cholesterol and blood pressures also need to be treated aggressively.”