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<blockquote data-quote="Grateful" data-source="post: 1616998" data-attributes="member: 438800"><p>A summary of generalities on this topic, from various sources.</p><p></p><p>First, a couple of acronyms:</p><ul> <li data-xf-list-type="ul">Thin Outside, Fat Inside (TOFI)</li> <li data-xf-list-type="ul">Metabolically Obese but Normal Weight (MONW)</li> </ul><p>Some seemingly thin people carry proportionately large amounts of fat compared to muscle. Even with a "healthy" BMI they may harbor larger quantities of "visceral fat" deep in the abdomen. Certain groups are more likely to be normal/thin weight at diagnosis, including Asians and the elderly.</p><p></p><p>There is, it seems, no easy way to detect TOFI except with a particular kind of MRI scan. It seems to me this is totally impractical as a way to screen the general population, given the expense and time required. So, perforce, TOFI goes undetected and therefore those people are not informed that their risk of Type 2 diabetes may be greater.</p><p></p><p>For those like me who did have a bulging waistline on an otherwise thin frame, the waist-to-hip ratio could be used. In my case, that measure indicated that I was "obese" (!) at diagnosis although my BMI was 21.7. My doctor did not use such a measure and even today, states that I was "not overweight."</p><p></p><p>Some have advocated using the waist-to-hip ratio as a warning sign for predisposition to Type 2 diabetes, or even a simpler metric such as "40 inches" being the danger level for men's waists. But as the Wikipedia article on TOFI points out, "indirect methods such as waist circumference are not suitable as individuals with an identical waist circumference can have vastly different levels of internal fat." (<a href="https://en.wikipedia.org/wiki/TOFI" target="_blank">https://en.wikipedia.org/wiki/TOFI</a>.)</p><p></p><p>These relatively crude measures are in any case useless for those slim/normal "body types" who have not put on any weight around the waist.</p><p></p><p>Genetic factors may also, in part, explain why normal/thin weight people develop diabetes. As well as the usual associated lifestyle factors such as lack of exercise, stress, lack of sleep, and poor diet (which apply to all people with T2D regardless of body type).</p><p></p><p>I hope this is a fair summary and I invite anyone who finds gaps or inaccuracies to poke holes in it! Thank you!</p></blockquote><p></p>
[QUOTE="Grateful, post: 1616998, member: 438800"] A summary of generalities on this topic, from various sources. First, a couple of acronyms: [LIST] [*]Thin Outside, Fat Inside (TOFI) [*]Metabolically Obese but Normal Weight (MONW) [/LIST] Some seemingly thin people carry proportionately large amounts of fat compared to muscle. Even with a "healthy" BMI they may harbor larger quantities of "visceral fat" deep in the abdomen. Certain groups are more likely to be normal/thin weight at diagnosis, including Asians and the elderly. There is, it seems, no easy way to detect TOFI except with a particular kind of MRI scan. It seems to me this is totally impractical as a way to screen the general population, given the expense and time required. So, perforce, TOFI goes undetected and therefore those people are not informed that their risk of Type 2 diabetes may be greater. For those like me who did have a bulging waistline on an otherwise thin frame, the waist-to-hip ratio could be used. In my case, that measure indicated that I was "obese" (!) at diagnosis although my BMI was 21.7. My doctor did not use such a measure and even today, states that I was "not overweight." Some have advocated using the waist-to-hip ratio as a warning sign for predisposition to Type 2 diabetes, or even a simpler metric such as "40 inches" being the danger level for men's waists. But as the Wikipedia article on TOFI points out, "indirect methods such as waist circumference are not suitable as individuals with an identical waist circumference can have vastly different levels of internal fat." ([URL]https://en.wikipedia.org/wiki/TOFI[/URL].) These relatively crude measures are in any case useless for those slim/normal "body types" who have not put on any weight around the waist. Genetic factors may also, in part, explain why normal/thin weight people develop diabetes. As well as the usual associated lifestyle factors such as lack of exercise, stress, lack of sleep, and poor diet (which apply to all people with T2D regardless of body type). I hope this is a fair summary and I invite anyone who finds gaps or inaccuracies to poke holes in it! Thank you! [/QUOTE]
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