Thin on the Outside, Fat on the Inside TOFI by dr mosley

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Thin on the Outside, Fat on the Inside TOFI by dr mosley

This topic contains 26 replies, has 9 voices, and was last updated by  QuietOne 3 years, 2 months ago.

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  • BBC journalist Dr Michael Mosley looked and was shocked by what he found.

    His body was the ultimate Trojan horse. Three years ago, Dr Michael Mosley considered himself trim and healthy. But lurking inside him, around his vital organs, were layers of fat.

    He now knows he was a TOFI: Thin on the Outside, Fat on the Inside. People identified as TOFIs often just think they are normal weight or have a bit of “middle-age spread”. Housed deep within their abdomens, however, are loads of fat around their organs, allowing their bodies to carry deadly illnesses such as diabetes and heart disease.

    Most TOFIs are blissfully unaware of their status as human ticking time bombs, but if the fat is left idle, they face higher risks of diabetes and dementia, on top of cancer and metabolic disturbances.

    Mosley, a medical doctor, BBC journalist and documentary maker who is best known in Australia for popularising the 5:2 Diet, made his TOFI discovery when he climbed into a magnetic resonance imaging (MRI) machine in the name of work. He saw the fat on the MRI and thought about upping his exercise and tweaking his diet, but “didn’t really do anything about it” until a trip to his GP to check a suspicious mole made him face reality, 18 months later.

    “I had some blood tests done [at the behest of the GP] and my doctor told me that at that point I was diabetic, with incredibly high cholesterol,” Mosley says.

    Mosley, aged in his mid-50s, then had a second MRI and was astounded at how many extra tubes of fat lay around his organs. He is medically trained, his wife is a GP and he knows about the dangers of being overweight, but he says until his blood tests showed his diabetes and he had the second MRI, he hadn’t heeded the warning.

    “I think I was really in a state of shock [when he learnt he was a TOFI] because I’d seen my father die of diabetes-related illnesses,” Mosley says. “I had assumed I was healthy and suddenly I was discovering I wasn’t, and had to take this visceral fat situation seriously.”

    Mosley says he plainly wasn’t obese and had thought his diet and exercise patterns were reasonable. He quickly started investigating intermittent fasting, trying fasting for several days at a time, before settling on a regime of eating normally five days a week and cutting his kilojoule intake for two. He made a documentary about it and co-wrote the best-selling Fast Diet book. The diet suggests women eat 2100 kilojoules on each fast day, while men consume 2500.

    Mosley says he is passionate about alerting people to the dangers of visceral fat and advises anyone who fears they may be a TOFI to measure their waists. He speaks about the TOFI phenomenon in his documentary The Truth About Exercise, which is showing on the BBC Knowledge channel as part of the What’s Your Body Hiding? series starting next month.

    “The first thing people can obviously do is just get a tape measure and measure themselves and be honest about it,” he says. “And they can certainly go to their GP, to have their cholesterol measured and their blood glucose measured.”

    Mosley combined diet with exercise to cut his abdominal fat in 10 weeks, losing about 0.9 kilograms each week, and says he now fasts one day per week to maintain his weight loss and keep the visceral fat at bay.

    “The good thing about visceral fat,” he says, “is that when you get rid of it – and you can get rid of it relatively easily – then all the other markers [such as blood sugar and cholesterol levels] improve.”

    “He now knows he was a TOFI: Thin on the Outside, ”

    Thin on the Outside, shouldn’t that be called TOTO?


    I re-read the article and understand the TOFI acronym better as:

    Thin on the Outside, Fat on the Inside -> TOFI

    Got it.


    LOL πŸ˜€ LOL πŸ˜€

    I have exactly this problem. I have the added complication of taking a lot of meds, so I will be coming off a couple of them in order to start this 5.2 diet. I was hoping to find others in a similar position in order to buddy-up with them but can’t seem to find anyone at the moment.


    Me too!
    I am 5’5″, 143lb and body fat 36%. 55yo and going through peri menopause.

    I have been concerned about my high body fat for a few years now and have tried weight training with a personal trainer (working hard), cardio, every way of eating that’s out there but to no avail.

    I am starting the 5:2 on Monday and I’m hoping this might be the answer. It’s so funny that everyone always tells me how I don’t need to lose weight, but if they could only see how floppy I am and how little muscle I have underneath my clothes!! I am about to take my measurements for the online tracker.

    What is your story?

    Well I’m not thin anywhere, yet.

    I typed out my whole story from my teens until I slide down in my early thirties and my near deaths in my 40’s I clipped it all.

    To change we have to do, just make up your mind and throttle it. This is IT. No if, no because, no well just… We are what we do. So just do! If I have to true fast half the month at a stretch to keep my health benefits you know what I’m doing!

    You have no idea how great your life is until it isn’t. Seriously. Your heart beat is the background noise of your entire life and you never hear it. When it stops, yeah you know it, loudest sound you never heard.

    So what does this have to do with being TOFI? I think this may be just stretch a bit to far. Is it true? Sure has snakes in a basement in a flood. But you KNOW, I KNOW, your Dr. KNOWS, your wife KNOWS, your husband KNOWS, your significant other KNOWS, and again you KNOW! If you aren’t listening there is something more wrong than visceral fat. LISTEN.

    I don’t know what you are trying to say Quietone I’m afraid. There is such a thing as a tofi for sure. Ask Michael Mosley as he IS one. I definitely do not need to lose weight. Yeah my diet was never perfect but not bad. I don’t eat meat and don’t have much of a sweet tooth. My fat goes straight to the visceral organs instead of to the slightly safer areas such as the hips in a lot of other people. It explains all this in the 5:2 book. It used to be called metabollic system. I have always had negligible HDL levels which are the lipids needed to sweep the veins of fat. No one really knows why, although there is a suspected genetic link. I also have raised blood pressure and low thyroid levels, typical metabolic syndrome. I’m 5′ 3″ and 161 kilos. not sure what that is in pounds sorry. Are you a troll quiet one? If so get off here now. In answer to kateij61. As above and I’m 63 years old was diagnosed with type 2 diabetes in my 50’s and it was a shock to everyone including myself as I was not large. I did however adjust my diet and increased exercise which helped and I was on diet control for a number of years until about a year ago when my levels suddenly shot up and I was forced to take meds. I also walk several miles a day, briskly with my dog but going to increase the exercise. Unfortunately nothing has gone to plan since I started this diet and I contracted a nasty bout of cystitis just beforehand and felt so ill that I had to delay diet. I had to have 2 courses of antibiotics and still not sure if it’s gone. I also stopped 2 meds after consultation with dr before starting diet. I’ve been forced to reinstigate the blood pressure tablets as my blood pressure started to rise, hardly surprising really. I’m also having a new kitchen installed so it will make things difficult for a week or too, but still want to do the diet. It’s the only way of changing my fat storage problem and reversing the diabetes as far as I can see. Went to see a lipids specialist recently who admitted that there is very little the medical proffession can do about this except to offer statins, which I am intoloerant of ( I take an alternative). And there is no guarantee as to how effective they would be anyway. I like the idea of the fasting too for the other possible benefits mentioned in the book. I’m surprised at how little response there was to my post. Thank you for those who have replied though. x

    What I am saying is there is TOFI but most of these people know. Inside it’s not a surprise. If your Dr isn’t telling you full details of your present condition twice a year you need a new Dr.

    if your Drs first thing is to write a script for Statins find a new doc. High blood sugar and he wants to give you Metformin, find a hew Doc.

    I’d love to go to Ontario and sign on with Jason Fung for 8 weeks in house 5+ weeks fasting. 2 weeks feeding and a week just being there.

    Hello all,

    I’ve just started Fast Diet and I have a question: On β€˜Fast Days’, do you need to consume the calories (600) or can you skip the whole day without eating?

    As far as I can tell the number of calories is nominal. Some people do fast completely. However if you are on meds or have any health issues check with your doctor first. I would find it better personally to have the 500 cals as I am more likely to succeed that way. The important thing, apart from the reduced cal intake is the length of time between eating. It’s important to have at least 12 hours or more at least once in that day between meals. More if poss.

    Hi I and welcome:

    You can eat 600 calories or less. You don’t ‘need’ to eat to 600.

    This thread will answer most of your questions:

    Good Luck!

    Hi onne:

    5’3″ and 161 kilos and you definitely don’t need to lose weight? And you are worried about internal fat?

    And you call QuietOne a troll?


    161 kilos = 355 pounds, yes?

    Yes I stand by it. I do have visceral fat issues and low HDL those are proven points. And to boot I know lots of other TOFI’s too. We are quite offended by this attitude of diabetics thinking that it’s all about weight loss. That is only the tip of the ice berg. I can see that this site is full of them and I will have to think about leaving the site. I did not come on here for this. I came on here to exchange info with others in the same situation. Perhaps if you read the book you would understand.

    Tofi is merely a nick name for those that have problems with fat storage and lipids, which can lead to diabetes amongst other problems and is a harder issue to address than just reversing diabetes as there is very little weight to lose so there are limitations. I can see that there is a lack of knowledge by some of these replies.

    If some of those with silly replies had read the whole of my account that would have helped, rather than rush is with offensive replies.

    Hi onnecar:

    You are a newbie here. It is clear you have not taken the time or expended the energy to find out who knows what on this site. Calling people that know a lot more than you do and who are trying to help you ‘trolls’ is simply bad form. I’m pretty sure all of the information you seek is here, and that there are several people that can help you. It is up to you whether you get any benefit from the knowledge on this site.

    I’m afraid you need more than just good luck.

    I was not seeking information but moral support which I most certainly have not received from some people. I stand by what I have said. I am not querying peoples knowledge in general either. But I do know what I am talking about when I refer to my issue of being a Tofu so no do not try to tell me that I have not taken the time to find things out. That is not an issue. If telling me that I am not overweight and do not need to diet is considered helpful what is this place? I am trying to reverse my diabetes and my lipids issue which puts me at risk of many illnesses. So no this is not bad form from me. And I feel that those who have replied to me have not read everything that I have said and therefore do not understand the issue at hand. This is not what I expected. I am not trying to tell others what is wrong with them, but I am expected to accept this from others. That is ludicrous. I am not the one who has not taken the time and trouble to read about stuff. I was simply asking for support and communication. I know what my problem is.

    And also it would seem that being a Newbie means that I must EARN my place here and accept offensive remarks it seems. Some policy lol

    Ho onnecar:

    Nice chatting with you.

    Good bye.

    Hi Onnecar,

    you say you are low weight diabetic. Did you mean actually 163 pounds instead of kgs? It would have been around 80 kgs. But in any case, I follow every other day fasting and also in 5:2 it was said diabetics must be extremely careful with fasting diet at all. There is some risk of hypoglycemia, because your blood sugar is not consistent, so you should be under doctor’s supervision and must get advice from him/her. Otherwise fasting is actually very effective in removing visceral fat according the stories in Dr. Varady’s book and the same this was the reason why Dr. Mosley tried with fasting at first place.

    If your doctor approves the fasting, then you loose water first before starting to loose fat, so you can loose more in the beginning, then it slows down. Actually visceral fat problem has everyone who has apple shaped body form. With 5:2 you can loose 0,5 kg each week, so it’s not very fast weight loss.

    Heaven be praised Truemirror. At last someone who understands what I am talking about. Thank you thank you. I am being made out to be a monster and I can assure you that I am not. I am 61 kilos and don’t know what that is in pounds. I do need to lose a few pounds as my BMI is not low – forget what it is off hand. I have consulted my doctor who agreed that I could stop taking two of my tablets as long as I self-monitored. I have had to reintroduce the blood pressure one, but it was worth a shot. May have another shot at that later on in the diet. I will also monitor weight loss as I don’t want to lose too much and will swap to 6:1 if I go too low. I want to be sensible about this. I have seen doctors and consultants about the lipids issue and I’ve even been told by a consultant that there is not real medical progress in this area and that I had as much or more chance of addressing this by doing this diet. You are absolutely right, one of the diabetic tablets that I had to stop could have given me a hypo on a fasting diet, so I had to stop that one. So far my glucose levels have been unaffected by this though. I am also splitting my fast days up as I think that will be less of a risk. Just looked up 61 kilos it equals 134 lbs . How long have you been doing it? You have obviously read the book or similar info as me. πŸ™‚

    I have an apology to make. I’ve just realised that a typing error put me at 161 kilos in stead of 61 kilos. No wonder everyone thought I was weird. lol. Just to clarify again I’m actually 61 kilos and 5′ 3″. I blame the constant conversions I’ve had to make for ending up typing the wrong figure.

    That equated too approximately 134 lbs. I couldn’t understand why everyone was saying such strange things. lol


    I was thinking it must have been typo on your weight, I recognized it from the context. I am not doing 5:2, but every other day fasting and doing it since mid of January. I need to loose much more, but I am aware I am the type who keeps visceral fat as well. So if you are now aware of risk and consulted with doctors, you can go ahead. Fasting is healthy approach and many people are doing it not for weight loss, but just for health.

    As I understood the goal of fasting is to get the body into healthy mode, not just to loose weight, also according Dr. Varady’s book you loose more fat than muscles unlike daily cal restriction. So the best approach is stay off of the food as long as possible. 500 Kcal is manageable way with minimum cal to fast as long as possible. I eat once a day all my 500 cal intake, sometime even less. I read the Dr. Varady’s book and look for relevant information on net rather than here. Here I like to read those success stories of people, it’s nice motivation for me. It’s better to google some fasting benefits on goolge. If you don’t want to loose than keep your cal intake slightly over TDEE the other non fasting days, because you will loose otherwise. If you have no other limitation some exercise would help, because once you loose visceral fat, kgs will go down, maybe try to do bodybuilding of your legs and arms. There is a lot of info out there how to keep your weight stable. So good luck, I hope fasting will help you with diabetes.

    I don’t get into arguments on a board. I just don’t. I have been TOFI. Now I’m just fat all over.

    I do what I do. I never said that TOFI didn’t exist or wasn’t real. What I am saying is that too many people use it. “well I thought I was fit” no it doesn’t work that way. Be HONEST and open with yourself.

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