Why Thin Fat Indians Are at Higher Diabetes Risk Than They Think

Add as a preferred source on Google

In a pan-India registry of nearly 38,000 people with Type 2 diabetes, over a third of men and almost 42 per cent of women had a high body fat percentage despite a completely normal BMI. On paper, none of them should have qualified as overweight. In reality, their bodies were carrying a hidden metabolic risk that no weighing scale would ever have caught.

Photo Credit: Canva

This pattern has a clinical name: TOFI, short for "Thin Outside, Fat Inside" - and according to Dr Prudwiraj Sanamandra, Consultant - Endocrinologist and Diabetologist, Arete Hospitals, Gachibowli, it's increasingly common in his own clinic. He says he routinely diagnoses elevated blood sugar in people who look perfectly healthy on the outside - young professionals, regular gym-goers, people with entirely normal body weight. "I don't eat sweets," "I walk every day," "I'm not overweight" are lines he hears often, right before a test confirms otherwise.

Why Indians Are Built This Way

Dr Sanamandra points to genetics as a major piece of this puzzle. Family history plays an outsized role in Indian patients, he explains, and a person can maintain a perfectly reasonable weight while still developing insulin resistance because of inherited metabolic tendencies. Many South Asians, he notes, accumulate fat around internal organs - visceral fat - even when they look nowhere near overweight externally.

The research backs this up. Studies comparing Asian-Indians with Caucasians at the same BMI have found that Indians consistently carry more central and visceral fat, a pattern researchers call the "thin-fat phenotype." That internal fat isn't passive - it's metabolically active, releasing hormones and inflammatory substances that interfere with insulin signalling and gradually push blood glucose upward over time.

It's Not Just About Genes

Photo Credit: Magnific

Dr Sanamandra is clear that lifestyle compounds the genetic risk, and often in ways that look healthy on the surface but aren't. "Long work hours, poor sleep, chronic stress, irregular meal timings, a heavy reliance on packaged "healthy" foods, and a lack of muscle-building activity all add up - even in people who consider themselves disciplined," he said.

Diabetes, he stresses, is not simply a disease of sugar intake or body size. It involves insulin function, liver metabolism, pancreatic health, muscle activity, sleep and hormones together.

Signs People Tend to Ignore

According to Dr Sanamandra, the body often gives subtle warnings long before a diagnosis - though sometimes it gives none at all:

Photo Credit: Canva

• Increased thirst
• Fatigue after meals
• Frequent urination
• Difficulty losing abdominal fat
• Recurrent infections
• Darkening around the neck or underarms
• Sudden fluctuations in weight

Why Screening Matters More Than Appearance

This is why Dr Sanamandra advocates for preventive screening over waiting for symptoms. "A fasting blood sugar test, HbA1c, and periodic health check-up can flag abnormalities long before complications set in - complications that, left undetected, can silently affect the eyes, kidneys, nerves and heart," explained Dr Sanamandra. India's own clinical guidelines now use Asia-specific BMI and waist circumference cut-offs precisely because Western thresholds tend to underdiagnose Indians.

Bottomline

Dr Sanamandra's message is simple: health cannot always be judged by appearance. A person can look healthy externally and still carry significant metabolic stress internally. The goal isn't to "look diabetic" or "not look diabetic" - it's to know your actual numbers, through awareness, lifestyle balance, and timely screening.

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.