Is it possible to be overweight and metabolically healthy? Or normal weight and metabolically unhealthy?
In short, yes. But an important factor in an unhealthy metabolism is so-called visceral fat. In other words, more critical than the amount of fat we carry is where the fat is located.
The fat you see at first glance on someone is the fat right below the skin, called subcutaneous fat. On the other hand, if the fat is stored inside and between the organs, it is called visceral fat. The latter contributes to metabolic problems and causes our liver and pancreas (pancreas) not to function properly. Interestingly, visceral and subcutaneous fat do not always occur together. While it is entirely possible to have both, it is also possible to have mainly one type of fat!
Image from https://doi.org/10.1038/oby.2011.142, E. L. Thomas et al.: The Missing Risk: MRI and MRS Phenotyping of abdominal adiposity and Ectopic Fat.
Many people belong to the second phenotype called TOFI (thin on the outside, fat on the inside) or normal weight metabolically obese. It even occurs in high-performance athletes, who can become metabolically obese and develop diabetes from years of carb-loading, even though they are still muscular and very lean. This is also prevalent in Asian populations because the predominant phenotype tends not to put on subcutaneous fat as easily. However, with rising sugar consumption in Asian countries like India and China, the prevalence of diabetes has reached rates similar to those in the United States. In 2019, 10.4% of people in the U.S. had diabetes, compared to 9.2% of the population in China, even though the obesity rate in China is five times lower than in the U.S.
So if you know someone who can seemingly eat anything, all the junk food, all the sugary food, and still be very slim - while you seem to gain weight just by looking at food, don’t be jealous. If you can see the fat you're gaining, at least you realize you need to change your diet. You can tackle the problem and protect your metabolic health early.
If, on the other hand, you can't put on subcutaneous fat as easily, you also don't have that first line of defense for your metabolic health, that buffer where excess sugar can be deposited in a relatively harmless storage. Without this warning sign, many people don't realize they have a problem until quite late in life, namely, when a disease has already been diagnosed. In other words:
Even for slim people, it is essential to look at the quality of their diet and the amount of carbohydrates they consume daily!
Image from FOOD FOR HEALTH