Skinny and Fat?

The truth about being TOFI and diabetic

Even though both are the same age, gender, have the same BMI of 25% and percentage of body fat, the person on the left has 5.86 liters of internal fat. That’s over 3.5 times the amount of internal fat of the person on the right!

For my entire life, I’ve always been very skinny.

Like BMI at 13-15%, underweight skinny.

With the exception for my three pregnancies, my weight was under 110 lbs. Despite what I ate, drank or the amount of exercise I’ve done (which I did not dedicate any time to do), I was still underweight. Based on appearance, one would think that I was not at risk of being diabetic. Even now, as I tell my type 2 diabetes story, some don’t believe that I’m even type 2. In fact, a moderator from an online diabetes support group responded that she hoped that I was not being misdiagnosed as a type 1 diabetes because of my weight.

Mainstream media outlets tend to do stories on the connection between obesity and diabetes. However, there’s very few stories that highlight this strange phenomenon of being skinny and a type 2 diabetic. The first mainstream article about this topic was written in 2006 by The Guardian’s health editor, Jo Revill, called “Are you a Tofi?”

TOFI means “Thin on the outside, fat on the inside”. This happens when one’s body has a disproportionate amount of fat stored in their abdomen. People in this category are at risk of developing insulin resistance, type II diabetes, heart disease and fatty liver due to reduced physical activity and overconsumption of sugar (carbohydrates) by inducing inflammation-associated cortisol release.

Even though people like myself are thin, we tend to carry hidden layers of fat in our bodies, which could possibly store up around vital organs and muscles, which can be extremely dangerous. This is more of a reason why we all need to make that doctor’s appointment for a check-up and test your current A1C levels.

Getting Rid of Hidden Fat

What currently works for me for the past two years is a combination of intentional exercise for 35-40 minutes a day, eating low carbohydrate/keto and some intermittent fasting. I’ve eliminated all grains, processed sugar, refined foods, starchy vegetables and fruits with high amounts of sugar from my diet. This allows me to eliminate all of the hidden fat and ultimately keep stable blood sugar levels. My diet normally consists of protein, fat and very little carb intakes.

As a result, I’m currently at a normal weight and BMI. Plus, my blood sugar levels are now stabilized.

My treatment might be a little extreme to some, but small steps like eliminating processed and refined foods and a simple intermittent fasting period (at least 8-10 hours while you sleep) would make a great difference in getting rid of the excess and hidden fat.

I’m not a doctor or medical personnel, therefore, please seek with your doctor before changing any diet to see if a similar plan would work for you. There might be other medical issues that need to be considered that needs to be prioritized before this type of lifestyle change.

There’s much more research that needs to be done on TOFI and it’s connection to metabolic diseases; however, I believe that there’s enough information from the medical community on how to prevent and treat it so we can live our best and healthier lives.

Until Next Time,

The Genetic Diabetic


“TOFI”,9 April 2021. In Wikipedia

DiNicolantonio, James J.; Mehta, Varshil; Onkaramurthy, Neema; O’Keefe, James H. (2017-12-07). “Fructose-induced Inflammation and Increased Cortisol: A New Mechanism for How Sugar Induces Visceral Adiposity”. Progress in Cardiovascular Diseasesdoi:10.1016/j.pcad.2017.12.001ISSN 1873-1740PMID 29225114.

Revill, Jo (10 December 2006). “Are you a Tofi? (That’s thin on the outside, fat inside)”. Science. The Observer. Guardian. Retrieved 2013-04-23.

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