What “Skinny Fat” Looks Like—and Why It’s Harder to Fix Than Obesity

If you’ve managed to stay around the same weight you were in college but notice your belt holes need loosening every couple of years, it’s likely you’ve traded some of that youthful muscle for body fat. Losing some muscle as you age is normal, but being “skinny fat,” as the look is often called, can also be a health risk.

The body type that looks like thin arms and legs with a thicker middle is pretty common. About one in four men with a normal BMI actually carry enough body fat to qualify as obese, according to a study of over 3,000 adults. A Mayo Clinic analysis found men with a normal BMI who store their body fat around their midsection had double the risk of dying compared to men who were overweight or obese but carried their weight in other places. Turns out, BMI isn’t all that reliable in the first place.

To find out what causes skinny fat and how to fix it, we talked to a sports cardiologist, a registered dietitian, and a physician.

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What Is “Skinny Fat”?

“Skinny fat” isn’t a diagnosis, but doctors have a few names for what it describes. “Clinically, we often describe this as normal-weight obesity or, when accompanied by metabolic abnormalities, metabolically obese normal weight,” says Marius I. Chukwurah, MD, FACC, a sports and performance cardiologist at MedStar Health Cardiology Associates. You’ll also hear TOFI, short for “thin on the outside, fat on the inside.”

Whatever you call it, when someone is “skinny fat,” it means their BMI is in the normal range (18.5 to 24.9), but they’re carrying too much body fat, especially visceral fat (deep fat that packs in around the liver and other organs), along with too little muscle. 

“Two men can have identical BMIs but dramatically different cardiovascular risk profiles depending on their muscle mass, fat distribution, insulin sensitivity, and lipid metabolism,” Chukwurah says. In other words, you could look like you’re in a healthy weight range, but your body might struggle to clear sugar from your blood or have high cholesterol and triglycerides. 

Related: What 4 Different Body Fat Percentages Look Like on Real Men

What Does It Look Like?

Being “skinny fat” typically looks like having a softer midsection or a belly that stands out from your otherwise slimmer frame. It comes with thinner arms and legs without a whole lot of visible muscle, and less strength than you’d expect for a guy that size, according to Luciana Soares, DCN, MS, RDN, professor and director of the Nutrition and Dietetics Department at Johnson & Wales University.

“A lot of these guys tell me their shirt size hasn’t changed in years, but they keep moving to a new hole on the belt,” says Haleem Mohammed, MD, MBA, chief medical officer at Gameday Men’s Health.

Instead of just judging by your looks, you can grab a tape measure and wrap it around your waist at the belly button. For men, a measurement over 40 inches points to excess visceral fat, but you can also divide your waist by your height for a better indication. The number you get should be under 0.5, which means your waist is less than half your height. This ratio predicts diabetes and heart disease risk better than BMI alone. 

What Causes Someone to Be “Skinny Fat?”

Mohammed describes the typical patient with this body type as a guy who never lifted, or who lifted in college and quit when he got a desk job. “Ten or fifteen years later he weighs about the same, and he’s swapped a good amount of muscle for fat,” he says.

Starting in the thirties, men lose about three to eight percent of their muscle mass per decade, and it speeds up with age.  “Skeletal muscle is one of our largest sites of glucose disposal,” Chukwurah explains, meaning muscle is where a lot of the sugar from your meals ends up. “When muscle mass declines, the body’s capacity to regulate glucose efficiently can diminish, contributing to insulin resistance,” a state where your cells stop responding well to insulin and blood sugar creeps up.

Diet is also a culprit. If you restrict your eating and don’t get enough calories or protein, it makes it hard to hold onto muscle, Soares says, but so does eating plenty of food with little nutrition in it. “A diet made mostly of refined carbohydrates and nutrient-poor ultra-processed foods can provide enough energy but may not provide enough protein, fiber, and other nutrients for optimal muscle maintenance,” she says.

One thing that might surprise you is that exercise alone won’t protect you. If you mostly (or only) do cardio and not a lot of lifting, you could still develop the classic skinny fat body type, says Chukwurah. Sleep, genetics, and hormones play a role too.

Related: Carrying Excess Body Fat in These Areas Speeds Up Brain Aging, Study Says

Risks of Being “Skinny Fat”

Having too much visceral fat can cause chronic low-grade inflammation, insulin resistance, high blood pressure, and the kind of cholesterol pattern (high triglycerides, low HDL, lots of ApoB particles) that leads to plaque buildup in the arteries. Over time, those changes make you more likely to develop type 2 diabetes, fatty liver disease, and heart disease. 

Soares says not every man with a normal BMI and higher body fat percentage will develop these conditions, but long-term research found normal-weight men with central obesity had an 87 percent higher risk of death than men with the same BMI and a smaller waist, and the worst survival of any group in the study.

One of the biggest risks of being “skinny fat” is that your doctor may be less likely to check on your health. “His doctor sees a normal weight and moves on,” Mohammed says. “So these men often find out they’re prediabetic or have fatty liver years later than a heavier guy would.” If you’re worried about your health even though your weight is normal, push for some blood work. Chukwurah keeps a particular eye on triglycerides, HDL cholesterol, and ApoB, a protein that counts the number of cholesterol-carrying particles capable of building plaque in your arteries, and Soares also checks A1C, a measure of your average blood sugar over the past three months.

How to Fix Being Skinny Fat

To turn things around, you have to change your body composition with training and diet. “One of the biggest mistakes is focusing exclusively on losing weight rather than improving body composition,” Chukwurah says. Cutting calories and adding more cardio can just make things worse. 

Building muscle is your best bet for both your appearance and your health. Chukwurah recommends resistance training at least two to three times a week, hitting every major muscle group, with progressive overload. Mohammed recommends focusing on compound movements like squats, hip hinges, presses, rows, and pull-ups with sets taken close to failure. Still aim for 150 minutes of cardio per week, but save time for your muscles. 

Mohammed says a lot of guys with this problem are eating too little protein to build muscle, but you need it to help you build and maintain muscle mass. Both Chukwurah and Soares suggest 1.2 to 1.6 grams per kilogram of bodyweight per day as a starting point, which works out to 100 to 130 grams for a 180-pound man. Spread your intake across three or four meals, Soares says, and don’t neglect the rest of your diet. “Protein is important, but so are vegetables, fiber-rich carbohydrates, healthy fats, and adequate hydration,” she says.

Whether you should increase or decrease your calories depends on how much fat you have to lose. If you’re new to lifting, you can build muscle while eating about 200 to 300 calories under maintenance to lose some fat. If you’d rather put all of your energy into building muscle, you can eat at maintenance or a little more, says Soares. It’s also important to sleep seven to eight hours and watch your alcohol intake since they both affect recovery and where your body stores fat.

After about two to three weeks, you should be stronger, and your blood markers like triglycerides will likely be improved, says Mohammed. More noticeable body composition changes will happen in about 8 to 12 weeks. Track your progress by how strong you’re getting, your measurements, and photos instead of the scale, which may not change all that much.

Soares says a label like “skinny fat” can do a number on body image, so focus on the positives like getting stronger and being consistent so you can move and feel better as you age. “This is very fixable,” Mohammed says. “I’ve watched men in their fifties put on real muscle and get their labs back to normal within a year.”

Related: This Diet Helped People Lose 2x More Weight Without Cutting a Single Calorie

This story was originally published by Men’s Journal on Oct 28, 2026, where it first appeared in the Health section. Add Men’s Journal as a Preferred Source by clicking here.