TOFI – Is Your Child Thin on the Outside, Fat on the Inside?

January 15, 2016

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As parents we see it all the time, the kid who can eat whatever he wants without putting on a single pound. From ice cream to cake, your little one continues to be skinny as a toothpick. As we watch this we think “if only I can eat like that?”

But there may be more going on inside our slender child’s body than we may think.

One-third of children in the United States are overweight or obese. However, the other two-thirds may not all be in the clear. Your skinny son or healthy-looking daughter may actually have fat on the inside, but not be showing it.

This syndrome has a few names: It is called “skinny/fat” or “thin on the outside, fat on the inside” (or Tofi) and it is a real problem that needs more media attention.

There is a good chance your slender child is unhealthy on the inside.

If your child is primarily sustaining themselves on junk food, then this is something you will want to check out with your doctor.

What is TOFI?

Thin outside/fat inside is characterized as someone who appears to be thin, but within his or her body there are layers of fat that are not visible. Whether this fat is wrapped around his stomach or hidden around vital organs, like the liver, pancreas or heart, this accumulation of fat is dangerous and can even be more detrimental than being noticeably overweight (1).

This hidden fat is hard to detect, and someone who not only looks thin but who has even gotten their BMI tested, can be a Tofi. That is where the danger lies—in not knowing.

As Professor David McCarthy, a childhood obesity expert from the London Metropolitan University said to the Daily Mail, “There’s a raft of children who have been overlooked because they have a ‘healthy’ BMI. This matters because the more fat you have compared to muscle, the more likely you are to develop type 2 diabetes and coronary heart disease in later life.”

As with children who are overweight, if this issue is left unchecked, the risk for heart disease and diabetes is higher (2).

Who it Affects

For the past few decades’ diabetes has been on the rise as American portion sizes have grown and the amount of sugar consumed has increased.

With all of this hidden sugar in many of our foods, no wonder why obesity is on a rampage and diabetes is statistically becoming more prevalent!

A recent survey showed that 13 percent of children who were of a normal weight are pre-diabetic. That’s one in seven normal-weight children who are diabetic (3)!

Even more so, as the Huffington Post reported, a staggering number of children with seemingly normal weights are 37 percent more likely to have cardiovascular diseases ranging from high blood pressure to high cholesterol to elevated sugar levels.

Why is this so prevalent among normal-weight children? Because they’re thin outside/fat inside.

Why Do Kids Have This Hidden Fat?

As with obesity, being thin/fat comes from eating unhealthy foods.

Ever see someone devour cake, candy, drink tons of juice or soda and consume lots of unhealthy foods without ever seeming to gain an ounce of weight?

This is where thin/fat comes from. It comes from these unhealthy eating habits. Your child may not just burn through those calories, they may store them around their organs, hidden from sight.

With the addition of all of these added sugars hidden in plain sight, like cereals, breakfast bars and yogurt it makes it even easier for your child to consume unhealthier foods than ever. That’s why it is so important for you to foster healthier eating habits with your kids.

How do you know if your child is Thin Outside/Fat Inside?

This is where things can become a little tricky. There’s no easy way to test the ratio of fat within the body. That’s partly why doctors still use the BMI chart.

BMI or Body Mass Index is a generalized test, where a doctor uses your child’s weight and height to come up with a ratio that determines whether your child is within the right weight range. Being thin outside/fat inside won’t show up on a BMI chart (2).

The best way at detecting this problem is to, of course, consult your child’s physician. As we always suggest before taking any part in addressing your child’s potential weight issues, please be sure to talk to your doctor.

Your doctor will run tests. Some of these tests include:

Blood test for cholesterol level
Blood test for insulin levels
A full body scan to check for hidden fat (4).

And of course there’s never any harm in focusing on creating a healthy lifestyle for you and your family. As we stated in our article on Dieting with Kids, you must focus on creating a non-shaming, positive environment that focuses on a lifestyle change as opposed to a diet change.

As with obesity, the best solution to solving this problem is to focus on changing the way you eat, the way you exercise and the way you think about food.

How to Fix It

In essence, the solution to this issue is very similar to the solution to help with obesity, which is diet and exercise. It is suggested children need to consume healthier foods, from vegetables to fruits; from complex carbs like lentils and whole wheat pastas to drinking enough water and eating more greens.

Consuming healthier fats, like the omega-3 fatty acids found in fish and avocados, can help reduce bad cholesterol and clean up the unhealthy build up around the organs (4).

And of course, mealtime with your family is the place to start creating healthier eating habits. It is mealtime where you can introduce newer, healthier foods for your kids to eat.

So the time is now to start focusing on changing and resolving this issue. Feel empowered because the solution is one that the whole family can benefit from.

A great reference on this subject of food, sugar and the fat/thin issue is the film FedUp created with Katie Couric and Laurie David. The film is available on Netflix or you can rent or buy if off Amazon. It’s eye opening. Check it out!