Health
‘Skinny fat’ warning issued as study finds hidden obesity behind normal BMI
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For decades, BMI (body mass index) has been the go-to number doctors use to decide whether someone is underweight, “normal,” overweight or obese.
But new global research suggests it’s possible to have a normal BMI, look thin in clothes and still meet the medical definition of obesity.
A large study published in JAMA Network Open based on World Health Organization (WHO) survey data examined health data from more than 471,000 adults across 91 countries.
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The researchers looked at people whose BMI fell in the normal range (18.5–24.9) but who carried extra fat around their midsection, measured by waist circumference.
The results showed that roughly 1 in 5 people with a normal BMI had abdominal obesity, a large waistline linked to serious health risks.
Many people who appeared thin still met criteria for obesity, the study found. (iStock)
These so-called “skinny fat” individuals weren’t necessarily healthy just because the scale said they were.
Compared to people of normal BMI and smaller waists, those with belly fat had 29% higher odds of high blood pressure and 81% higher odds of diabetes. They were also significantly more likely to have unhealthy cholesterol and triglyceride levels.
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In short, their metabolism looked more like that of people with obesity, even if their weight didn’t.
The findings seem to expose a blind spot in how obesity is measured. BMI only considers weight and height but says nothing about where fat is stored.
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Fat that sits deep in the abdomen and surrounds vital organs is particularly dangerous, fueling inflammation, insulin resistance and cardiovascular problems, according to experts. Someone can be “thin outside, fat inside,” a concept the researchers call TOFI.
Compared to people of normal BMI and smaller waists, those with belly fat had 29% higher odds of high blood pressure and 81% greater risk of diabetes. (iStock)
Lifestyle also plays a role, the researchers noted. People with normal BMI who had belly fat were more likely to be inactive, eat fewer fruits and vegetables and have desk jobs or unemployment.
That combination of little muscle and lack of movement makes it easier to accumulate visceral fat even without gaining much overall weight.
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The latest research suggests that waist size may be just as important to track as weight.
For most adults, a waist above roughly 32 inches for women or 37 inches for men signals excess abdominal fat and higher health risks.
People with normal BMI who had belly fat were more likely to be inactive, eat fewer fruits and vegetables, and have desk jobs or unemployment. (iStock)
The researchers noted several limitations. Because the study was cross-sectional, it can’t prove cause and effect, only associations.
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Data also came from many countries and time periods, and high-income nations were underrepresented, which may affect how widely the results apply.
The study didn’t include actual body fat scans and instead depended on people’s own reports about their habits, which can make the results less reliable. However, the WHO’s survey methods are generally well-validated.
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Just four minutes of daily strength exercises can dramatically improve mobility, balance and leg strength in older adults, per new research from the Penn State College of Medicine.
Standard public health guidelines recommend at least 150 minutes of moderate exercise per week. However, the study suggests that fewer than one in five older adults meet the recommended muscle-strengthening guidelines.
The research team designed a home-based program called Functional Activity Strength Training, or FAST-2. They evaluated 97 sedentary participants 65 and older, with an average age of 74.
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Before entering the study, these individuals were averaging just 18 minutes of total physical activity each week.
The older adults were randomly split into two groups, with one group performing the daily exercise routine and the other serving as a control group that received no intervention, according to the study’s press release.
Just four minutes of daily home strength training can significantly improve mobility, balance and leg strength in older adults, according to a Penn State College of Medicine study. (iStock)
Participants performed four basic movements for 30 seconds each, separated by 30-second rest intervals. The entire routine lasted exactly four minutes. The circuit consisted of push-ups, chair stands, two-arm resistance-band rows and stair stepping.
To keep the routine accessible, researchers provided written explanations and simple modifications. For example, participants could perform push-ups against a kitchen counter or wall, or use their hands on their knees for support during chair stands.
Participants were also given four elastic resistance bands and an adjustable step platform.
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“Exercise is actually really complicated, because you have to decide how many repetitions, how far, how many sets, how much rest and how many times per week,” co-author Smita Dandekar, associate professor of pediatrics at Penn State College of Medicine, said in the press release.
“It’s hard work … so if we can make it short, we’re part [of the] way there.”
The program consisted of four basic movements: push-ups, chair stands, resistance-band rows and stair stepping. (iStock)
As the participants grew stronger, they were encouraged to progress to higher levels of difficulty, such as transitioning away from modifications or increasing the height of the stepper.
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After 12 weeks, the results suggested that a tiny dose of regular exercise could yield noticeable physical benefits. In a 30-second chair-stand test, the exercise group performed an average of 4.2 more repetitions than the control group.
“These indicators … give you a sense of whether or not you’re going to be able to be active in the future.”
The adults doing the exercises also shaved 2.3 seconds off their time during a test measuring how they could stand up and sit down five times consecutively. Furthermore, they extended their one-legged balance time by an average of 3.6 seconds.
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The researchers emphasized that these specific measurements are critical medical indicators of an older adult’s future health.
By keeping the routine ultra-short, researchers eliminated common barriers like time constraints and exhaustion, resulting in an exceptionally high 81% workout completion rate. (iStock)
“These indicators predict your future ability to go into a nursing home, your future likelihood of falling and of developing difficulty walking,” noted lead author Christopher Sciamanna, professor of medicine and of public health at Penn State College of Medicine, in the press release.
“They give you a sense of whether or not you’re going to be able to be active in the future.”
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While traditional home exercise programs generally see low engagement, the participants in this study successfully completed their workouts on 81% of the tracked days, according to the researchers.
After 12 weeks, exercising seniors gained the ability to complete an average of four more chair-stand repetitions than those who did not exercise. (iStock)
The study had several noted limitations. As it tracked a relatively small sample size of fewer than 100 individuals over a brief 12-week time frame, it is unknown whether these mobility gains can be sustained long-term.
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Additionally, the researchers did not specify the exact dropout rates or detail how the routine might affect seniors who already relied on assistive devices like walkers or canes.
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Because the final trial results reflected a specific group of participants who met the entry criteria, further investigation is required to determine whether the short routine can safely benefit older adults facing more severe physical limitations or cognitive decline.
The study was published in the journal PLOS One.
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Jill Smokler, founder of Scary Mommy, has died at age 48 after a battle with glioblastoma, an aggressive form of brain cancer.
The popular “mommy blogger” had been fighting the disease for the past two years, according to an announcement posted on ScaryMommy.com on Monday.
The stay-at-home mother of three launched the blog in 2008 as a place to share the “joys and pitfalls” of parenting, according to the article.
As Scary Mommy expanded from a personal blog into a major parenting brand, Smokler built a following with her honest, often self-deprecating take on motherhood. She went on to speak at blogging conferences, author bestselling books, appear on national television programs and earn three Webby Awards, her biography states.
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“Jill spent her life telling the truth about motherhood — that it could be wonderful and impossible in the very same breath — and in doing so, she gave millions of women permission to stop pretending and feel a little less alone,” her family shared in a statement following her passing.
Jill Smokler, founder of Scary Mommy (pictured in 2018), has died at age 48 after a battle with glioblastoma, an aggressive form of brain cancer. (Lloyd Fox/Baltimore Sun/ZUMA Press Wire / Shutterstock)
“She was funny, fearless, generous and entirely herself. More than anything she built, Jill was proudest of her three children, Lily, Ben and Evan. We are heartbroken to lose her, and endlessly proud of the mark she left on the world.”
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Smokler’s first sign of the disease was in April 2024, when she experienced a sudden seizure. She then underwent surgery to remove a brain tumor, after which she didn’t recognize her own children, she previously shared with Today.
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“I am definitely grateful that I don’t remember the looks on their faces when I didn’t recognize them,” she said. “That must have been gutting.”
Smokler was diagnosed with glioblastoma, the most common malignant primary brain tumor in adults and one of the deadliest forms of brain cancer. There is currently no cure.
About 13.9% of all brain tumors are glioblastomas, according to the American Brain Tumor Association. (iStock)
Following surgery, the blogger underwent radiation and chemotherapy, during which she was open about her treatment side effects, including fatigue and hair loss. Additional surgeries and clinical trials followed, according to previous interviews.
“Thank you, Jill, for everything. May you rest in peace,” the Scary Mommy post concluded.
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About 13.9% of all brain tumors are glioblastomas, according to the American Brain Tumor Association. More than 12,000 new cases are diagnosed in the U.S. each year.
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Median survival is approximately 12 to 18 months after diagnosis, even with treatment. Only about 5% to 7% of patients survive five years after diagnosis, data shows.
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