The body positive very overweight women need to stop pointing out that thin people have heart attacks in an attempt to validate obesity.

This is like saying that smoking is okay because nonsmokers get lung cancer!

When a fat person insists they’re healthy because thin people have heart attacks, this is truly a “WTF” line of logic.

Yes, we all know that skinny people can drop dead from a heart attack.

What the body positive women (and the men who endorse this way of thinking) fail to do is differentiate between three kinds of “thin.”

1) Skinny Fat
2) Lean Toned
3) Lean Muscular


Shutterstock/Sorn340 Images


When a so-called thin person has a heart attack, they almost always fall into category one: skinny fat.

Skinny-fat is very unhealthy, but “fat fat” can be far worse in some cases.

Obesity Is Tons Worse than Lean Toned/Muscular

There are lean toned people, and certainly lean muscular people, who’ve suffered cardiac events. But they are rare – too rare to use as an excuse for obesity.

In fact, the heart attack deaths of skinny-fat individuals, though much more common than in lean toned/muscular, should never be used as an excuse for staying obese.

And when the lean toned or lean muscular person does suffer a cardiac event, keep in mind that there are causes for heart problems OTHER THAN CLOGGED ARTERIES.

• For example, that lean toned person might have been born with a predisposition towards an aortic aneurysm.

• They may have been born with an undiagnosed hole in their heart or some other structural abnormality that remains asymptomatic until they reach their 30s.

• The heart problem could be due to steroid use, a viral infection or an autoimmune disorder.

• Lean toned/muscular people can also develop a heart arrhythmia that’s NOT related to diet or body composition.

But by and large, thin people who have heart attacks are of the skinny fat variety.

An obese person with a normal EKG and normal blood pressure is NOT healthy just because the skinny person before her was told by her doctor, “You have prediabetes and your EKG indicates coronary artery occlusion.”

Fair question: Where are all the body positive obese women over age 50?

Skinny Fat Explained

“There is a condition called TOFI — thin on the outside, but, fat on the inside — meaning that the arteries are clogging up even if the person is not overweight or obese,” explains Dana S. Simpler, MD, an internal medicine physician with Mercy Medical Center in Baltimore, MD, who specializes in helping patients treat disease with diet and exercise.

Keep in mind that the term “skinny fat” also applies to people who are of a so-called normal weight. They are not thin or lanky in appearance, but have a more proportionate look.

An example would be a woman who stands 5’4” and wears a size 8 rather than a size 2. Even a size 10 woman can be deemed skinny fat. Absent is a chubby look, but inside she’s loaded with fat.

Skinny-fat is often used to describe a particular look. But medically it means that despite having a small clothing size, the individual’s organs are coated with visceral fat – a very dangerous form of fat – far worse than subcutaneous (below the skin) fat — which is what creates the so-called thunder thighs.

That 115 pound woman’s heart and liver may be surrounded by visceral fat, putting her at risk for conditions like hypertension, type 2 diabetes, stroke, heart disease and heart attack.

That size 4 woman never exercises, perhaps smokes and has very poor metabolic health. She has poor “body composition,” and this can be determined simply by appearance.

But people who are lean toned or lean muscular, by definition, do not have poor metabolic health that puts them at risk for related illness!


Shutterstock/ Vadym Wedmov


Shutterstock/ Lyashenko Egor

The skinny-fat condition is driven by lifestyle choices, namely SAD: standard American diet.

And of course, right up there is lack of efficient cardio and especially strength training workouts. Sorry, housework and the walking you do at work do not count.

“Even children who are eating the standard American diet have fatty streaks in their arteries when autopsied after fatal accidents,” says Dr. Simpler.

“The bottom line is that the American diet of highly processed, sugared and fat-laden foods causes heart disease, cancer, diabetes, AND causes overweight/obesity,” explains Dr. Simpler.

“The more you eat the standard American diet, the higher likelihood of being ill. The safest diet is the Whole Food Plant Based diet as recommended by many doctors including Dr. Caldwell Esselstyn,” a Fellow of the American College of Cardiology.

Pointing out that an obese person can be healthy just because thin people die of heart attacks is one of the weakest arguments out there.

An overweight woman (and man) can dramatically improve their metabolic health by taking up compound strength training and high intensity interval training.

dana simpler, MD

Dr. Simpler received her medical degree from University of Maryland School of Medicine and has been in practice for over 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.