Fooled by Phenome

Fooled by Phenome

Nurse Ruth

A Skinny-Fat Phenotype

Nobody ever accused me of being fat.  People, many of whom carried a few extra pounds, told me I was skinny.  I didn’t think I was skinny, but I knew I wasn’t overweight or obese.  At least on the outside.  In a world experiencing an epidemic of obesity, I was proud of myself. I thought I was healthy.  If people just adopted my lifestyle, they’d look better, too.

Whoa!  Not so quick!

Your phenotype (or phenome–I use the words interchangeably) is a collection of observable traits. It’s determined by your genes, environment, or the interactions between them.  Eye color and height are phenotypic traits.  As is deposition of body fat.  I was a TOFI—thin on the outside, fat on the inside.  Others call it skinny-fat. 

The author (center) celebrates getting a new pair of hiking boots from her friends in 2012. The author now realizes that she was fatter on the inside than her weight would suggest.

You could say, I was fooled by phenome. 

The first hint that all was not well came about five years ago.  A lab test showed that my average blood sugar level was at a pre-diabetic level.  I wanted to dismiss the results.  After all, many people who weighed more than me had normal blood sugars.  Certainly, I was in better shape than them.

Different people have different thresholds for making and storing fat. Being able to store fat subcutaneously may be the body’s defense against a metabolically unhealthy diet. If you have excess fat, it’s better to store it subcutaneously than viscerally and ectopically.

Where’s the fat?

Subcutaneous fat makes up about 90% of our body fat.  It’s the pinchable, jiggly fat under our skin. 

Visceral fat surrounds our organs, and includes abdominal fat and fat around the heart.

Ectopic fat is the fat stored within organs, including liver, pancreas, kidneys, heart, and skeletal muscles.

What’s the problem?

Visceral and ectopic fat are closely associated with insulin resistance and metabolic diseases. The American Heart Association describes metabolic syndrome as having three or more of the following disorders:

  • Abdominal obesity (waistline greater than 40 inches in men or 35 inches in women)
  • Triglyceride level of 150 mg/dL
  • HDL cholesterol less than 40 mg/dL in men or less than 50 mg/dL in women
  • Blood pressure of 130/85 mm/Hg or above
  • Fasting glucose 100mg/dL or greater

Unfortunately, people with metabolic syndrome have a high risk of diabetes, heart disease, and stroke.  My waistline was close to 35 inches, blood pressure was above 130/85, and blood glucose levels were high.  These observable signs contributed to my phenotype.

I had other signs and symptoms that suggested pre-diabetes or diabetes:  eyelid ptosis, rough elbows, neuropathic foot pain, skin tags, and high liver enzymes.  I didn’t take these observations seriously.  Fooled by a skinny-fat phenome. 

Why is this vitally important?

Recognizing the problem is the first step in reversing metabolic diseases.  About 20% of people who are not overweight are TOFI. Are you?

I’m grateful to the practitioners who have encouraged me to follow a metabolically healthy lifestyle.  Is it difficult?  What’s the alternative?  One practitioner put it in context.  “Changing your diet is easy.  The consequences of diabetes—kidney dialysis, blindness, pain, heart failure, and amputations—are difficult.”

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