Yes, you're thin but are you healthy?
There's greater awareness than ever about the health problems related to obesity, so those who are lucky enough to be thin often assume that they are not only in good shape, but in good health, too.  However, the bathroom scale alone is no reliable guage of overall health.  By Laura Twiggs

When her doctor told her that she had dangerously high levels of cholesterol which, if left unchecked, could lead to atherosclerosis (hardening and narrowing of the arteries), raising her risk of heart attack and stroke, Lucille was stunned.  "I have always thought of myself as extremely healthy," explains the 34 year old copywriter.  Weighing 56kg and measuring 1.62cm tall, her lean body toned by long-distance running and regular yoga, Lucille looks the very image of good health.  "when I was told that I needed to go on medication and that my cholesterol reading was 7.2mmol/L, way higher than the desirable levels of less than 5.0mmol/L, I thought there must be a mistake.  I had always thought that cholestrol was something that overweight people had to be concerened about, not fit people like me.  But when I told my Mom about it I learned that high cholesterol is a family trait.  Being thin and fit can't in any way compensate for that genetic inheritance

When it comes to the meaning of the word 'health' many of us are in the dark.  According to the World Health Organisation, health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.

It's a common misconception that being thin and fit, or even just thin, is some sort of indicator of good overall healthy, says Dr. Johann Viljoen, a physician at Life Knysna Private Hospital.  "in a good many cases it is, but it's certaintly not a foolproof guarantee,' he says.  "thin people can have high blood pressure, high cholesterol and the same risk of diabetes if they have a genetic predisposition to it, ' he explains. 'People imagine that these risks are linked only to obesity, but the truth is that they can remain dangerously undiagnosed in people with normal weight and thin people.'  Type 2 diabetes is more prevalent in those who are overweight, but Type 1 diagetes can affect anyone.  In addition, they may also be prone to osteoporosis, arthritis, depression and a range of other problems.What's more, the dangers related to being thin but not healthy can be even more serious, especially as these people may not be aware of their condition and therefore do not seek medical help to manage it.  A study undertaken by MaryFran Sowers, a University of Michigan obesity researcher, showed that just over half of overweight people had mostly normal levels of blood pressure, cholesteral, triglycerides and blood sugar.  However, around a quarter of those in the recommended weight range were found to have unhealthy levels of at least two of these measures.

Research like this has led to a growing awareness of what is being referred to as "skinny fat":  the sort of thin body that looks fantastic in jeans and a jersey but flabby in a swimming costume, despite being the recommended weight or even less than that, on the bathroom scale.

A  large  number of 'skinny fat' people can even have additional fat deposits around their vital organs (which increase the risk of mortality), and an overall body-fat percentage similar to someone who is obese.

'Thin looking people can actually be fat or obese inside,' explains Dr. Viljoen, 'And, if people keep their weight on the scale down by using unhealthy means to achieve this, it can actually be far worse for their health.   The sorts of people who might maintain a low weight by crash dieting, missing meals, semi-starvation, or unhealthy behaviours like smoking can also suffer from malabsorption syndrome, impair their immune systems, and are at greatest risk of osteoporosis because they do not get enough calcium.' he notes.  In addition these people are prone to vitamin deficiencies and are at higher than average risk of developing anaemia, neuropathological disorders, hair loss, infertility and depression.

Those most at risk, says Dr. Viljoen, are people without muscle tone.  'Far too many people think only about being thin and are worried about what the scale tells them, when they should rather be thinking about their fitness levels,' he observies.  'A classic scenario is the person who starts to exercise and then puts on two or three kilograms, who go down a dress size or two.  It's like comparing a kilogram of steak to a kilogram of butter.  The muscle mass in the steak takes up a far smaller area than the fat of the butter.  It is far healthier to have good muscular composition and to weight a little more than to be of a lower weight with a higher body-fat percentage.  The bottom line is that weight should never be treated as if it is only an aesthetic issue.

Dr. Daniel Schutte, a cardiologist at Life Westville Hospital in Durban, says that even though being thin (and fit) may not be a guarantee of better health, it doesn't  mean that being thin might not be good for you.  'However , many people who lose a lot of weight spontaneously may have an underlying chronic illness or malignancy.' he notes.  'And, overweight and obese people do have raised levels of risk for diabetes type 2, hypertension and obstructive sleep apnoea.' he maintains.  According to Dr. Schutte, one of the greatest physical indicators of health risk is not so much the degree of body fat or actual weight but where the body stores this weight.  'Fat distribution is important in terms of morbidity, he says, 'Intra-abdominal or abdominal subcutaneous fat, that stores around the midriff, can lead to metabolic complications such as insulin resistance (diabetes), hypertension, high blood fats and cholesterol, and polycystic ovarian syndrome in women.'  So, those who appear skinny but who carry weight around their middles should be particularly vigilant.

And, if you are tempted to think that this means you may just as well give up on you body shape and enjoy your voluptuous curves with that third helping of cheesecake, think again.

'Accepting who you are should never be an excuse not to live a healthy lifestyle,maintains a cardiothoracic surgeon, Dr. Willie Koen, at Life Vincent Palotti Hospital in Cape Town.  Dr. Koen is firm that being on a diet at all is unhealthy, and that using crash dieting as a corrective measure may create the most damage of all.  It's rather a case of consistently living a healthy lifestyle, and should be viewed as a 20 year plan,' he says.  'If you're living a healthy lifestyle, you never have to diet.


1.    Exercise regularly, for at least 40 minutes, four times a week.
2.    Avoid high-fat, processed and sugary foods;  do not fry your food;  aim for a moderate to low-fat eating plan with five portions of fruit and vegetables every day.
3.    Make sure you eat breakfast.  People who skip breakfast are more prone to obesity, according to the Heart and Stroke Foundation South Africa.
4.    Drink at least eight glasses of water every day.
5.    Never embark on fad diets (short-term 'miracles' that promise rapid weight loss).  They lower yourr metabolism and can lead to greater weight gain over time.
6.    Quit smoking, 'One cigarette does more damage than 10 fatty steaks, says Dr. Koen.


Blood pressure
If you have family history of cancer, thyroid problems or other diseases, you should have regular screenings for these.