The 30-second article
• TOFI individuals are ‘thin on the
outside, fat on the inside’
• These clients may have inadequate
nutrition, lack muscle and have poor
cardiorespiratory fitness, leading to
high levels of fat around their visceral
organs
• This ‘hidden’ fat puts them at higher
risk of heart disease, type 2 diabetes,
cancer, stroke and other conditions
• By focusing so much of our attention
on overweight clients, we often
overlook TOFI clients and their
health risks
• You can help TOFI clients reduce their
metabolic risks by prescribing
moderate intensity exercise, and
gradually introducing resistance
training, HIIT and functional training,
as well as directing them towards a
healthy eating plan.
we tend to miss this population of people
that are dying, or at least very sick, despite
appearing healthy.
The scientific relationship between body
fat and risk for illness and death is not well
understood by most people, including
doctors who were educated before more
recent scientific findings became available.
Lavie encourages us to look more closely
and change our long-held convictions about
fat as he stirs up debate about the value – or
confusion – surrounding BMI.
How to recognise the TOFI client
So, who is the TOFI client? This is the client
who focuses on weight loss or maintaining
a ‘skinny’ frame through diet alone, such
as the bride who starves herself before
the wedding. They can appear generally
skinny (but not anorexic), but may have a
little ‘pudge’ around their bellies and even
under their chin. They tend to have very poor
physical fitness. So, while they appear to
be a healthy weight or underweight by BMI
standards, their body is ‘acting fat’ on the
inside because they have excess fat around
their visceral organs. They are lacking
muscle and that muscle is what uses the
energy and keeps visceral fat levels at bay.
Is TOFI a metabolic time-bomb?
Who cares if the TOFI client has fat around
their visceral organs as long as they have a
low BMI? You should care, and so should
they. By focusing so much of our attention on
overweight clients, we often overlook TOFI
clients and their health risks. The fat around
the visceral organs is the worst type of fat
to have, because it enters the portal system
of blood vessels and heads straight towards
vital organs. Welcome heart disease, type 2
diabetes, cancer, stroke and more.
One of the many other reasons these clients
suffer, without realising it, is the resultant
increase in insulin resistance. We often
associate insulin resistance with overweight and
obesity, but this phenomenon occurs in TOFI
people too. A lack of a sound exercise program,
combined with too few calories consumed, can
cause muscles to start to waste away, and
it doesn’t take long before insulin resistance
steps in. When insulin levels are high, other
hormones can be thrown off balance, either
by getting revved up or turned down. All of this
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60 | NETWORK AUTUMN 2016