Dire warnings about the risks of being overweight might have left some slim people feeling rather complacent — only last week, for example, a review by the World Health Organisation linked eight additional cancers to excess weight.
But the fact is that ‘fat’ conditions usually associated with obesity, such as heart disease and diabetes, can also affect the healthily slim.
One theory for why slim people could be at risk from these diseases is that we each have our own personal fat thresholds — based on diet or genes — that determines how fat someone can be before problems such as type 2 diabetes kick in.
Here we talk to people who all have a normal body mass indexes (BMIs) — between 18 and 25 — but suffer from so-called ‘fat’ conditions. These are usually associated with obesity, such as heart disease and diabetes, can also affect the healthily slim
Complicating matters further is the issue of TOFI — being thin-outside-fat-inside — a term used to describe slim people with a disproportionate amount of fat stored within their abdomen and around their organs, which also raises the risk of type 2 diabetes.
This fat is thought to pump out toxic chemicals that raise the risk of inflammation and disease.
Here we talk to people who all have a normal body mass indexes (BMIs) — between 18 and 25 — but suffer from so-called ‘fat’ conditions.
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HEART ATTACK
Becks Breslin, 38, a data manager, lives in Melton Mowbray, Leicestershire, with her husband Liam, 38, an engineer.
Height, 5 ft 6in; weight, 8½ st; BMI, 19.
One morning in March 2012 Becks Breslin woke up feeling sick and hot and felt a strange pushing sensation on her chest
I never imagined I’d be a candidate for a heart attack — I was slim, young, exercised regularly, didn’t smoke and drank alcohol only socially.
But one morning in March 2012 I work up feeling sick and hot and felt a strange pushing sensation on my chest.
My husband was away and I thought I must be coming down with a bug, so tried to go back to sleep.
But a couple of hours later the pain in my chest was intense, almost suffocating. I also had a strange tingling sensation in my jaw and my left arm.
I was pretty scared, so I called my sister — her partner came round, took one look at me and rang for an ambulance. Apparently I was white as a ghost and sweating.
At hospital a scan revealed I had a form of heart disease called spontaneous coronary artery dissection (SCAD), known as the ‘widow-maker’, since it has a low rate of survival.
Bascially the inner layers of one of the coronary arteries is torn away from the outer layer.
Blood is able to flow into the space between the layers and a clot forms, cutting off blood supply to the heart muscle and triggering a heart attack. I was absolutely shocked.
I stayed in hospital for 18 days while they monitored me and got my medication right (this included aspirin to prevent clots forming). I’m still taking medication, I’ll need that for life.
These days I do only light exercise — such as walking the dogs for less than an hour a day — to avoid over- exerting myself.
I go to Pilates, too, but I do get tired as my heart is having to work harder. Slim people need to know that heart disease can affect them, too.
Becks Breslin had a form of heart disease called spontaneous coronary artery dissection (SCAD), known as the ‘widow-maker’, since it has a low rate of survival
EXPERT VERDICT
Dr Glyn Thomas, a consultant cardiologist at the Bristol Heart Institute says: ‘Spontaneous Coronary Artery Dissection (SCAD) is an unpredictable form of heart disease.
‘It isn’t related to conventional heart disease risks such as being overweight — though raised blood pressure can be a risk factor. It’s far more common in women, in particular during or soon after pregnancy, all of which suggests a hormonal link causing a weakness in the arterial walls.
‘Sadly some cases are fatal, which is why it’s vital to act swiftly, even if you don’t believe you’re a “candidate” for a heart attack.
‘It’s also important to be aware that heart disease can be hereditary, even if you’re slim. One Swedish study found that women whose mothers had heart disease were at a 43 per cent greater risk of the same problem.’
TYPE 2 DIABETES
John Nicholson, 63, a management consultant, lives in Hampshire with his wife, Jane, a counsellor.
Height, 5 ft 10in; weight, 11 st; BMI, 22.
I’ve always been slim and even though I travel a bit for work and would sometimes find myself grabbing fatty fast- food lunches, I’ve never had a weight problem.
John Nicholson, 63, was diagnosed with type 2 diabetes after feeling tired for months
I also went to the gym or swam two or three times a week.
But a few years ago I started feeling really tired, as if my energy had been sapped. Over a couple of months I also lost half a stone, without trying.
I thought I was a bit run down. Then I started feeling unusually thirsty and my wife insisted I saw our GP.
My blood sugar test was sky high — the reading was 17, it should be around 5 — and to my absolute astonishment I was diagnosed with type 2 diabetes.
My GP was also surprised, but said it was probably genetic: my mother was diagnosed with it in her mid-60s (and she was by no means overweight), but because I’d looked after myself it never crossed my mind I could get it, too.
I had this sense of real disappointment this hadn’t been enough to protect me.
I was given metformin, a drug that controls blood sugar, and saw a dietitian, who said I should include more slow-energy-release carbs, such as wholegrains, to keep my blood sugar regular.
Beforehand, my diet probably was a bit too fatty, so although I was slim, I was eating the wrong things.
Once I’d got over the shock, something inside me decided to fight back. I started running and exercising most days.
If I book into a hotel for work, I always choose one with a gym. I still have diabetes and take medication but my readings are what they should be and, ironically, I feel fitter than ever.
EXPERT VERDICT
Natasha Marshland, a senior clinical adviser with Diabetes UK, says: ‘Although type 2 diabetes is associated with being overweight, some people have a genetic pre-disposition.
‘If your mother or father has type 2 diabetes, it increases your risk by 15 per cent, irrespective of your weight.
‘But another problem becoming increasingly apparent is relatively slim people being diagnosed with type 2 as a result of visceral fat, hidden fat that lies around the heart, liver, kidneys and pancreas.
‘This fat can lead to insulin resistance — when insulin is not used effectively — which, in turn, can lead to type 2 diabetes. So if John had a fatty diet before, even if he was slim, this may have had an impact.
SNORING
Karen Danville, 55, lives in Hull with her husband, David, 56, and their son.
Height, 5ft 6in; weight, 9½ st; BMI, 21.
Karen Danville, 55, started snoring terribly after a ‘mini stroke’ in 2013
On Valentine’s Day 2013 I was sitting on the sofa at home when I suddenly felt dizzy. I must have blacked out for a moment because the next thing I remember is sitting there with my right arm feeling strangely numb.
After a couple of minutes the feeling returned but the episode really frightened me. I went to my GP the next day and he concluded that I’d momentarily fainted but it was nothing to worry about.
I wasn’t entirely convinced and started thinking about other aspects of my health. For several months I’d been terribly tired and even after a full night’s sleep I’d wake up exhausted.
My husband, David, had also started complaining about my snoring — he said it would be terribly loud, then I seemed to stop breathing for a moment.
I thought it was just overweight old men who snored, not slim women like me so I went on the internet: the symptoms pointed to sleep apnoea, where the walls of your throat relax during sleep.
I read that it can be linked to stroke and I realised that the blackout and numbness in my arm might have been a mini stroke.
Really worried, I went back to my GP who referred me to the local sleep clinic. But since I’m very slim I was told that it was unlikely I had sleep apnoea and they sent me away.
My instinct told me not to accept this and I pushed my doctor for a second opinion and several weeks later I was sent to another sleep clinic.
They tested me using a breathing device and diagnosed sleep apnoea.
The consultant also said that it was likely I had suffered a mini-stroke.
My sleep apnoea was probably down to the fact that I’m petite and therefore the airways in my nose are small.
I now use a continuous positive airway pressure therapy (CPAP) machine at night — it’s a mask that blows air into your throat to stop your airway collapsing.
The results have been amazing. I sleep well and have so much more energy.
EXPERT VERDICT
Michael Oko, a consultant ear, nose and throat surgeon and head of obstructive sleep apnoea services at United Lincolnshire Hospitals NHS Trust, says: ‘Obstructive sleep apnoea is a potentially life-threatening sleep disorder which affects 4 per cent of middle-aged men and 2 per cent of middle-aged women.
Sleep aponea is more common overweight patients, because when fat is deposited around your upper airway it can exert a strain around the throat
‘It happens when the upper airway walls relax, collapse and narrow during sleep, so the patient repeatedly stops breathing.
‘Left untreated, it can lead to heart disease, stroke and diabetes because the body responds to the dropping levels of oxygen by releasing adrenaline which, among other things, increases blood pressure and heart rate.
‘It’s more common in those who are overweight, because when fat is deposited around your upper airway it can exert a strain around the throat.
‘But 20-25 per cent of sleep apnoea patients aren’t overweight. Since Karen is very slim, it’s possible she has naturally narrow airways — internal anatomy is one of the main reasons it happens to slim people.
‘Luckily, Karen had the presence of mind to seek a second opinion as untreated sleep apnoea can be dangerous.’
ACID REFLUX
Phil Salter, 58, who works in IT, lives in Manchester with his wife Maxine, a credit controller. The couple have a daughter, Hannah.
Height, 5f t 10in; weight, 12 st; BMI, 24.
Phil Salter, 58, was diagnosed with an ulcer in his throat, caused by acid from his stomach splashing into his oesophagus
When I started suffering with a scratchy sore throat in May last year, I just presumed I was coming down with a cold.
It wasn’t terribly painful, but after three weeks it was still bothering me. A friend who works as an administrator in the ENT department at a local hospital insisted I got checked out.
I got an appointment within a couple of weeks and when the consultant examined my throat, he told me that he could see an ulcer which had been caused by acid from my stomach splashing into my oesophagus.
I’d never suffered with indigestion or heartburn type symptoms. I don’t drink or smoke and have never been overweight — it just didn’t make sense.
The consultant told me there was nothing to worry about so long as I had the ulcer removed, which I did with a laser, under general anaesthetic.
After the operation the sore throat magically vanished. I already had a pretty healthy diet, but the consultant suggested cutting back on dairy as it can aggravate reflux.
I’m also on daily medication called Lansoprazole which reduces the amount of stomach acid produced.
EXPERT VERDICT
Dr Steven Mann, a consultant gastroenterologist at the Royal Free London NHS Trust, says: ‘People associate reflux with being overweight, but while it can be caused by this (possibly because extra fat around the belly increases the pressure on the stomach, forcing fluid up into the oesophagus), there are other reasons.
‘These include a hiatus hernia which prevents the sphincter, the valve at the bottom of the oesophagus, working properly.
Dr Steven mann of the Royal Free London NHS Trust says fatty foods can also aggravate acid reflux, as the stomach takes longer to digest fatty meals, so producing more acid
‘Fatty foods can also aggravate the condition, as the stomach takes longer to digest fatty meals, so producing more acid. Smoking, drinking and having too much caffeine can also relax the sphincter, making the condition worse.
‘As Phil’s had an ulcer his reflux should be monitored, although the medication should keep it in check.’
GALLSTONES
Kerry Freedman, 42, a teacher, lives in Manchester. She is divorced with two children.
Height, 5 ft 7in; weight: 10 st; BMI, 21.
When Kerry Freedman, 42, was pregnant with her daughter, she started suffering with really bad griping pains in her stomach
When I was pregnant with my daughter Charlie, now 15, I started suffering with really bad griping pains in my stomach, which would happen every week or so.
On one occasion, I was in London for a meeting and it was late so I grabbed a takeaway pizza to eat in my hotel.
At 2am I woke up doubled up with pain so bad that the hotel called an ambulance. Doctors suspected an inflamed appendicitis, but scans were clear.
I put it down as one of those things but every couple of weeks it would happen again for up to 40 minutes and I’d catch my breath with the pain.
My main worry was the baby, but scans kept showing everything was fine.
When Charlie was about five months old it was still happening every two weeks so I went to see a specialist privately and scans showed I had gallstones.
The specialist said he was surprised since I seemed so slim and healthy — it was often older, overweight people who got them.
I had my gallbladder removed and was also put on a strict, low-fat diet which I still follow.
However, every six months or so my stomach will go into spasm and I get the griping pains which can last about half an hour. I just wait for it to pass — I couldn’t face more surgery.’
EXPERT VERDICT
Dr Steven Mann, a consultant gastroenterologist at the Royal Free London NHS Trust, says: ‘Gallstones are usually made of cholesterol.
‘Although common in the overweight — obesity can raise your cholesterol level and make it harder for the gallbladder to empty completely — they can affect slim patients, too.
‘They affect more women than men and can be the result of a low-fibre diet.
‘Other factors include being pregnant as raised levels of oestrogen can increase the risk.
‘However, the fact that Kerry is still suffering now should be investigated. In around ten per cent of cases, stones can form in the bile duct, which carries bile from the liver.
‘This can affect anyone who’s had gallstones, regardless of their weight.’