Are Your Kids TOFI?

A new acronym has emerged in the fight against obesity and other metabolic risk factors for heart disease: TOFI, which stands for thin on the outside and fat on the inside.  

Obesity researchers have discovered that many normal weight children (about 15%) have an inordinate amount of visceral fat. That's fat surrounding their internal organs. As you may know, this finding is associated with metabolic derangements like diabetes and has been shown to increase the risk for heart disease.  

This is in line with a current paradigm shift in how we look at the origins of obesity and why there is a growing need for easy weight loss programs. We used to believe that obesity was the cause of all the health problems that ensue. Now we are coming to discover that for many people, this is completely backwards. These metabolic disorders, which are signaled by the presence of excess visceral fat, could lead to hormonal changes that then lead to weight gain.  These metabolic disorders are often mediated by a process known as “insulin resistance.”  

Something happens in people who suffer from this condition that makes the insulin in their bodies less effective; their bodies actually become resistant to the effects of insulin.  As a result, they have to produce greater levels of insulin to control blood sugar.  Insulin is a hormone with many functions, one of which is to help our bodies accumulate fat.  As a result of having higher levels of insulin, people with insulin resistance gain weight more quickly and easily and have a more difficult time losing weight.  

It's not certain what triggers insulin resistance or what has led to this sudden rise in metabolic disorders in children. Some theories include a change in our digestive flora because of the overuse of antibiotics in humans and within the food chain.  Another leading theory is that the higher levels of hidden sugar (mainly fructose) are leading to the metabolic derangements that trigger insulin resistance.  

Currently, precise tools for the diagnosis of insulin resistance are not available.  There are, however, blood tests that can estimate the presence of insulin resistance using fasting blood sugar and insulin levels.  There are also imaging tests available at affordable rates that can quantify the amount of visceral fat. 

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