A few months ago, Martha wrote about people who were "tofi" -- or thin on the outside but fat on the inside. The term describes a group of people who appear to be thin, but actually carry dangerous body fat around their internal organs. Because weight-related health is often assessed by measuring a person's waistline, this hidden fat can be easily missed. A CT scan can sometimes pick up the presence of the fat, but it's costly and who really wants to put themselves through an unnecessary procedure?

A new blood test may be in the works that can find hidden fat in lean patients. It screens people for a protein called RBP4, which is elevated in those who have a significant amount of abdominal fat. RBP4 has also been linked to pre-diabetes, and health experts believe that they can create a quick and inexpensive blood test to detect the protein in a patients blood. Will it someday become part of a routine screening? Who knows, but it's intriguing...especially for those who think they are at risk.

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So we know you can be thin but still have unhealthy fat on the inside, but is the opposite also true? Can you be fat on the outside, but fit and healthy on the inside?

According to this article, it is possible to weigh more than recommended for your height and still be "fit," but determining whether you fit this rule all depends on why you weigh so much. Is it due to carrying more muscle or more fat? Obviously having more muscle is better, and comes with reduced risk of many health conditions like diabetes, cancer, and stroke. Afraid it might be fat instead? Every little bit helps -- exercise can still benefit you, even if the scale is refusing to budge.

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According to research published last year, having a good BMI may not be a reliable way of judging your health. And according to a recent study from continued research, now there's even more data to support the hazards of being thin but still having an unbalanced amount of body fat. People with normal weight obese (NWO) syndrome usually have higher levels of inflammation-causing proteins, which puts them at risk for developing cardiovascular disease or obesity in the future.

The good news is that if you are "fat on the inside" you're still better off than people who are obese in the more traditional sense. People with NWO syndrome don't usually suffer from the expected side-effects of being overweight like high blood pressure, high blood sugar, and high cholesterol.

So next time you're calculating your BMI to figure your health standing, do your body fat percentage as well.

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I have a friend who, despite being a size 2, always insists that her body is fat. "I know I'm skinny," she tells me, "but trust me, I probably have 100% body fat. I never work out and I have very little muscle." I always tell her she is being ridiculous, but she may have a point. According to this, people with a certain build are called Tofis, which stands for thin on the outside and fat on the inside. It's a bit scary, actually. Tofis can have an unhealthy and frankly dangerous build-up of fat around their organs, but unlike an obviously obese person, they may not know they have a problem. Only by digging further and doing scans and tests will doctors realize just how much fat Tofis have. The article suggests that, despite their appearances, Tofis have more to worry about health-wise than the rest of us.

I'm one of those people who can gain weight just by looking at a piece of chocolate cake, and I never thought I'd say it, but that might be a good thing. I can tell when I'm consuming too much fat, and I can cut back. But Tofis don't have the warning signs that most people do -- yikes!

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