‘Skinny but Unhealthy’: The Hidden Problem of Normal Weight Obesity

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For years, body weight has dominated conversations around health. If someone appeared thin or maintained a "normal" weight on the weighing scale, they were usually assumed to be healthy. Increasingly, however, that assumption is proving to be misleading. We spoke to Dr Prudwiraj Sanamandra, Consultant - Endocrinologist and Diabetologist, Arete Hospitals, who explained the hidden problem of normal weight obesity.

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When Weight Doesn't Tell the Full Story

In endocrinology clinics, a pattern that comes up quite often now is people who do not appear overweight externally, yet show several markers of poor metabolic health internally. "Blood sugar may be borderline high, cholesterol levels abnormal, fatty liver changes visible on scans, or body fat percentage significantly elevated despite a normal Body Mass Index (BMI). This is often referred to as "normal weight obesity" - a condition where body weight appears acceptable, but body composition and metabolic function tell a different story," said Dr Sanamandra.

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The issue is especially relevant in Indian populations because metabolic risk tends to appear at lower body weights compared to Western populations. Someone may wear smaller clothing sizes, not visibly carry excess weight, and still have unhealthy fat accumulation around abdominal organs. "This visceral fat behaves differently from fat under the skin. It is metabolically active and closely linked with insulin resistance, inflammation, and increased cardiovascular risk," added Dr Sanamandra.

What makes this difficult to identify is that many people do not feel unwell initially. They are often surprised when routine health checks show elevated sugars or triglycerides despite looking lean. A common response in clinics is, "But I'm not overweight."

The Lifestyle Shift Behind It

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Lifestyle patterns play a major role here. Sedentary routines have become increasingly common, even among people who appear physically slim. Long hours sitting at desks, poor sleep, chronic stress, irregular eating habits, and diets high in refined carbohydrates or ultra-processed foods can all contribute to metabolic dysfunction without necessarily causing obvious weight gain.

"One aspect that often doesn't get enough attention is low muscle mass. Some people stay light on the weighing scale not because they are particularly fit, but because their muscle stores are quite limited. Since muscle helps the body handle blood sugar more efficiently, lower muscle levels combined with a sedentary routine can gradually affect metabolic health. In many cases, body fat starts increasing quietly even though overall weight may not change very much," explained Dr Sanamandra.

This is also one reason why crash dieting or aggressive calorie restriction can sometimes backfire. Weight may reduce temporarily, but if muscle loss accompanies it, metabolic health does not necessarily improve in a meaningful way. In some cases, people become lighter but not metabolically healthier.

Why Younger Adults Are Being Affected

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"Younger adults are increasingly falling into this category. It is not unusual now to see people in their late 20s or early 30s with early insulin resistance, fatty liver disease, or prediabetes despite not fitting the stereotypical image of obesity. Much of this is linked to reduced movement through the day rather than food intake alone. Many people exercise briefly but remain sedentary for most of their waking hours," said Dr Sanamandra.

The larger concern is that relying only on appearance can delay diagnosis. When someone looks thin, symptoms like fatigue, poor stamina, disturbed sleep, or abdominal weight gain are often brushed aside. Screening also tends to happen later because neither the individual nor those around them perceives a risk.

What The Expert Says

Dr Sanamandra concluded, "The conversation around metabolic health needs to move beyond weight alone. Waist circumference, muscle strength, sleep quality, activity levels, blood markers, and body composition often provide far more useful information than the number on the scale by itself."

"Being thin does not automatically mean being metabolically healthy, just as being heavier does not always reflect poor health in isolation. The body's internal health is often far more complex than outward appearance suggests," he added.

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.