What is “Skinny Fat”?
How could skinny people gain more muscle?
Skinny people do not have to pay attention to their diet?

Written by: Ms. Sylvia Lam, Accredited Practicing Dietitian APD, Accredited
Dietitian HKDA

“You are so slim, you must be born to be thin, so envious! Look at me, I will get fat even from taking a breath of fresh air or drink a cup of water, I am destined to be fat!”

“You are so blessed as you are so slim! you can eat anything you want. My doctor just told me that my cholesterol level is high, blood sugar and blood pressure levels are also marginally high. He suggested me to lose weight and exercise. Now I can eat nothing! I am so envious of you that you can eat anything you like!”

Have you ever heard the above conversation? Often, we might judge on one’s health status based on their body size. In generally, we think that only overweight/obese people have higher chance developing some common chronic diseases such as diabetes, heart
disease, high blood pressure, cancer and so on. Although overweight is strongly related to these diseases, it does not mean that thin people do not need to focus on healthy eating and exercise. Achieving a normal weight is fundamental to a healthy body, but the
chances of getting the above-mentioned health conditions are also affected by other factors such as age, gender, genetic factors, daily eating and exercise habits, cigarette smoking, alcohol drinking and also stress.

According to a study of the 2013 cross-sectional behavioral risk factor monitoring system for 491,773 Americans, people who are underweight have a 19.7% higher risk of vascular disease than normal weight people, and overweight and obese people and 50% and 96% increased risk respectively. Thus, being thin does not mean they can be reckless in their daily eating habits.

Underweight people might have higher chance of having other diseases such as osteoporosis, muscle wasting, compromised immunity, anemia, eating disorders, in-turn increased mortality rate. Despite family history of being a thinner person, eating habits of most underweight people might have problem as well. Most often, they are picky eaters, allergic or intolerant to certain foods, having chewing or swallowing problems, anorexic or have poor appetite due to emotional distress. Underweight might also be related to other serious diseases such as cancer, liver, kidney or gastrointestinal disease which affect nutrient intake and absorption.

What is “Skinny Fat”?

According to the recommendations of the World Health Organization, the body mass index (BMI) of Asian adults is classified as follows:

BMI	Kg/m2
Underweight	<18.5
Normal	18.5-22.9
Overweight	23-24.9
Obese	≥ 25
Morbid obese	≤ 30

For Asians, a BMI of < 18.5 is defined as underweight. However, being thin does not necessarily mean a person is healthy. Some people who are thin can also have a high body fat percentage, meaning their muscle mass is inadequate. Inadequate muscle mass can lead to sarcopenia which refers to the gradual loss of body muscles due to age. It can result in weakened muscle strength, reduced physical activity and balance, increased risk of fall and fracture which consequently affecting quality of life. In addition to age, some daily habits include over-restrictive diet or excessive dieting, excessive cardio exercise and lack of muscle training can also lead to muscle loss, subsequently increase body fat percentage. And body fat does not necessarily only mean subcutaneous fat, skinny people might also have high visceral fat percentage. These people are often named as the “skinny fat” people.

How could skinny people gain more muscle?

To prevent or treat sarcopenia, a balanced diet and exercise are especially important. Skinny people and also those with poor appetite should pay more attention to whether they have adequate protein intake. They should take 1 to 1.5 grams of protein per kg of body weight. For example, a 50 kg person should consume 50 to 75 grams of protein per day, which is equivalent to 6 to 9 teals (240g to 360g) of meat. Studies have also shown that to promote muscle protein synthesis, one should consume about 25 to 30 g of protein, approximately equivalent to 3 – 4 teals (120g – 160g) of meat or fish at each meal. If one can't get enough protein from natural foods, one can consider eating whey protein-containing oral nutritional supplements. It is recommended to consult a doctor and registered dietitian before taking any oral supplements.

In addition to diet, it is recommended that people who are too thin should perform some resistance exercise or muscle training to help build muscle mass. At the same time, they should also increase the amount of foods they eat in general to increase energy intake. High quality protein should be eaten within two hours after resistance training. Consuming about 25 to 30 grams of protein (~ 120g to 160g meat) for muscle repair after exercise along with proper amount of carbohydrates is the best way to prevent muscle loss. Here are some examples of foods after resistance training:

• 2 boiled eggs or 4 boiled egg whites with a cup of low-fat milk
• 350 grams of low-fat plain Greek cheese with berries
• One sandwich with tuna (270g) or chicken (150g)
• One scoop of protein powder which contains 25 to 30 grams of whey protein with a fruit

Skinny people do not have to pay attention to their diet?

The need to increase weight does not mean that underweight people can arbitrarily eat unhealthy foods such as soft drinks, chips, chocolate, cured meats such as luncheon meat and sausages, fried noodles, fast food restaurant foods etc. to increase weight. Excessive consumption of unhealthy foods can also lead to long-term illness in people who are underweight. In order to be healthy, everyone must follow a healthy balanced diet and perform regular exercise, no matter what weight category you are in.