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Journalism of Courage
Thirty-three-year-old Riya (name changed) thought she was perfectly healthy with a body mass index (BMI) — a count derived by dividing an adult’s weight by their height in metres squared — of 21.82 kg/m2. She weighed 58 kg at 5 ft 4 inches. However, her waist circumference was 94 cm and her waist-to-hip ratio (an index arrived by dividing your waist measurement by your hip measurement) was 1.03. She was the classic case of being skinny fat, a person who has normal body weight but has a high percentage of body fat around organs and low muscle mass. Riya looked thin but had too much belly fat and weak bones.
This was the reason she had irregular periods since 21 and required infertility treatment to conceive five years after her marriage. Unfortunately, she had an abortion in the fifth month after doctors diagnosed gestational diabetes and high blood pressure. Post-abortion, her blood work showed she had high cholesterol, low vitamin D3 and vitamin B12 levels. In other words, being skinny fat had led to her developing several health complications.
Dr Vaishali Deshmukh, HOD, endocrinology, Deenanath Mangeshkar Deshmukh Clinic and Research Centre, Pune, says Riya’s body composition analysis showed that she had a poor lean muscle mass, that is sarcopenia, high visceral, that is organ-related fat, and low bone mass. “Riya reflects a classic patient of a thin-fat Asian woman who has all fat-related metabolic problems such as high cholesterol, diabetes, hypertension, polycystic ovary syndrome (PCOS) brought about by hormone imbalance, infertility and poor reproductive outcomes. She has classic sarcopenic obesity,” she adds. Unaddressed, she warns, it predisposes one to fatty liver disease, atherosclerosis, heart disease, cerebrovascular diseases and cancer .
“Treatment focusses on improving her muscle and bone mass and reducing her fat mass, especially the visceral one,” Dr Deshmukh says. Good nutrition, addiction control, exercise, sleep, and coping with mental health and stress are equally important. Her advisory includes eating more plant-based foods, which contain healthy fats, vitamins, and minerals, lean proteins like fish, poultry, low-fat dairy, whole grains and fibre-rich plant foods, like non-starchy vegetables, legumes, nuts and seeds. Eliminate fewer refined sugars, processed grains and red meat.
Building muscle is key for those with sarcopenic obesity. “Undoubtedly, there are new drugs for controlling body fat, sugar and lipids. However, building muscles is not possible with medication and requires active resistance training under supervision of experts,” says Dr Deshmukh. Try strength training and high intensity interval training (HIIT) to build muscle. Aerobic activity and cardio can burn calories.
Dr Aparna Govil, consultant bariatric and laparoscopic surgeon, Saifee Hospital, Mumbai, says people still wrongly equate fitness with thinness. “Being thin and being fit are two different things and irrespective of how one looks, exercising regularly is the key to fitness. Also our population has a genetic predisposition to a pear-shapedbody type. We are thin-fat, hence we are predisposed to developing health complications at a lower body weight than the Western population,” she says. Dr Govil also argues for higher activity levels with online conveniences limiting our mobility. “We have to make a conscious effort to move, play, exercise and work out to preserve and build muscle. We must consciously include protein-rich foods, apportioning the daily recommended allowance across three meals,” she advises.
