Recent updates to the U.S. food pyramid have sparked renewed conversations about the role of healthy fats in our diets. There are widespread misconceptions surrounding terms such as ‘fat but fit’ and ‘skinny fat.’ Medical News Today consulted experts to explore whether all fats are detrimental to health and to determine the implications of different body types and fat compositions on well-being.
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For many years, body fat has been seen merely as a “storage depot” for energy and warmth. However, recent research indicates that fat functions more like an organ, producing hormones and sending signals to the brain and immune system.
While people often focus on the pinchable fat on their bodies, studies have shown that “hidden” fat, or visceral fat, poses a greater health risk and can lead to organs aging prematurely. This harmful fat surrounds vital organs and contributes to chronic illnesses.
Traditionally, health guidelines have encouraged reducing all forms of fat intake, particularly saturated fats found in butter, full-fat dairy, and red meat, with recommendations to limit them to 10% of daily caloric intake.
However, recent studies cast doubt on these limits, suggesting that individuals with low cardiovascular risk and cholesterol levels may not be significantly affected by saturated fat intake.
Nevertheless, the type of fat replacing saturated fat is essential.
Medical News Today consulted three specialists: Michelle Routhenstein, MS, RD, CDCES, CDN, a dietitian in preventive cardiology at Entirely Nourished; Kristin Kirkpatrick, MS, RDN; and Hector Perez, MD, a bariatric surgeon at Renew Bariatrics, to gain insights into the healthiest fat sources, recommended intake amounts, and the relationship between appearance and health.
All three experts agreed that the notion of low-fat diets and stringent fat limits is no longer relevant.
“The push for minimal fat consumption is outdated. Research has adjusted guidelines to emphasize overall dietary patterns and the quality of fat consumed rather than merely cutting fat,” Routhenstein explained.
“In my view, low-fat advice is obsolete and simplistic. Many ‘fat-free’ products are often loaded with sugar as a substitute,” added Perez.
“Total fat intake is generally regarded as acceptable within the range of 20 to 35 percent of daily calories. Saturated fat should ideally comprise less than 10% of total calories, depending on cardiovascular risk.”
— Michelle Routhenstein, MS RD CDCES CDN
“We spent 40 years removing fat from food and replacing it with refined starches and sugars, then acted surprised when obesity and type 2 diabetes rates soared. What makes ‘low-fat’ suggestions especially outdated is modern evidence indicating that the type of fat is far more important than the total fat intake,” Perez elaborated.
“Diet quality should be the focal point when determining the best dietary patterns. In fact, a recent study published in the Journal of the American College of Cardiology found that the quality of the diet is more significant than the specific macronutrient ratio,” Kirkpatrick noted.
However, she emphasized that individuals with conditions like type 2 diabetes, fatty liver, or insulin resistance might find a moderate- to lower-carbohydrate approach more beneficial for managing blood sugar levels.
Current research supports replacing saturated fats with polyunsaturated and monounsaturated fats, which can help reduce LDL or ‘bad’ cholesterol levels.
Kirkpatrick highlighted that these healthier fats, which are essential for brain and heart health, can be found in foods such as extra-virgin olive oil, avocados, nuts, seeds, and fatty fish like salmon.
Meanwhile, Routhenstein reminded that completely eliminating saturated fat is often impractical for many individuals.
“I recommend evaluating where saturated fats are sourced in your diet and purposefully swapping them for unsaturated fats. This approach is generally more effective than outright elimination,” she advised.
Perez further emphasized the importance of making the right substitutions and avoiding heavily processed alternatives.
“If you’re reducing saturated fat, choose monounsaturated and omega-3 fats from sources like olive oil, nuts, and fatty fish instead of refined carbohydrates. Swapping steak for sugary cereal isn’t a smart choice,” he cautioned.
Routhenstein also urged individuals to focus on whole foods rather than fixating solely on fat content.
“For instance, full-fat dairy, which contains saturated fat, also provides protein and calcium, promoting satiety and supporting bone and muscle health,” she explained.
“Instead of obsessing over fat content, it’s time for people to educate themselves on which nutrients are genuinely beneficial versus harmful. I’ve seen individuals cut out saturated fat only to replace it with bagels and low-fat snacks, which doesn’t resolve the underlying issue,” Perez added.
“Absolutely. That’s why I tell my patients not to rely solely on BMI as a health indicator. I’ve encountered patients weighing just 120 pounds with fatty liver, insulin resistance, elevated triglycerides, and metabolic syndrome,” Perez said.
He elaborated on the distinction between appearing ‘thin’ and having healthy body fat.
“We have identified a phenotype known as ‘TOFI—Thin Outside, Fat Inside,’ where visceral fat accumulates despite a normal external appearance. Just because you look good on the outside doesn’t imply your internal health is in order,” he explained.
“Someone may appear slender but still possess elevated visceral fat levels or other metabolic risks. The scale doesn’t always provide an accurate picture of overall health or chronic disease risk,” added Kirkpatrick.
This phenomenon has also been referred to as “skinny fat” on social media.
Excess body fat is a leading cause of metabolic syndrome, heightening the risk of various conditions, including type 2 diabetes, cardiovascular disease, and high cholesterol.
“Metabolic disease can manifest prior to visible weight gain, especially in individuals with inactive lifestyles, poor diets laden with sugar and refined starches, or genetic predisposition,” Perez noted.
“Just because someone appears lean doesn’t mean they are safeguarded from cardiometabolic diseases. Evaluating cardiometabolic markers, such as waist circumference, blood pressure, cholesterol, glucose, and insulin levels, is a more accurate method than simply relying on weight,” Routhenstein advised.
Research consistently indicates that visceral fat, which surrounds vital organs, is more harmful to metabolic health.
Kirkpatrick noted that the location of stored fat can be crucial for long-term health outcomes.
“The area where fat is stored is a better predictor of health than the total amount of fat. A lean BMI doesn’t protect you from fat-related health issues if that fat is centrally located,” Perez pointed out.
“A slender individual with visceral belly fat is at greater metabolic risk than a heavier person with predominantly subcutaneous fat around their thighs or buttocks,” he said.
The experts elaborated on the differences between visceral and subcutaneous fat and the biological mechanisms associated with both.
“Visceral adipose tissue is located deep within the abdomen, releasing pro-inflammatory cytokines that exacerbate insulin resistance and contribute to heart disease. Conversely, subcutaneous fat is more like an insulator, being bulky but less biochemically harmful,” said Perez.
“Visceral fat is strongly linked to a higher risk of chronic illnesses like heart disease and diabetes, whereas subcutaneous fat, which resides just beneath the skin, carries a lower metabolic risk,” Kirkpatrick added.
“Thus, waist circumference and other metabolic markers are often more useful for assessing health risk than relying solely on BMI or weight,” Routhenstein concluded.
