Thin, But Worried About High Cholesterol?
- Dr Chan Po Fun
- Jan 6
- 5 min read
Updated: 5 days ago
By Dr Chan Po Fun
Consultant Cardiologist | Women’s Heart Health & Preventive Cardiology
High cholesterol and heart disease can occur even in slim Asians.
A personalised assessment looks beyond weight and BMI.
Many people assume that being slim protects them from heart disease. This belief is especially common in Asia, where being slim is often equated with good health.
But in clinical practice, some of the highest cholesterol levels and earliest heart disease are seen in people who look skinny, fit, and healthy.
This article answers the most commonly-asked questions about cholesterol in slim people, explains the concept of “skinny fat”, and why this is particularly common in Asians, with clear guidance on what to do next.
Can skinny people really have high cholesterol?
Yes, very commonly.
Body size and cholesterol are not the same thing.
You can be:
Slim or skinny
Normal BMI
Active and health-conscious
…and still have high LDL cholesterol, abnormal triglycerides, or early plaque in the heart arteries.
High cholesterol usually causes no symptoms, so many slim people only discover it during a routine blood test, or after a heart attack.
Why is my cholesterol high even though I’m thin?
This is one of the most searched questions on Google, and the answer surprises many.
1. Most cholesterol is made by your liver, not from food
About 70–80% of cholesterol is produced by the liver, not directly from what you eat.
This means you can:
Avoid fried food
Eat little meat
Cook at home
…and still have high LDL cholesterol.
Diet matters, but genetics, hormones, and metabolism matter more.
2. Genetics can override body weight
Some people inherit genes that cause:
High LDL cholesterol
Poor cholesterol clearance
Early artery plaque formation
This is why slim people with a family history of heart attacks or strokes are often at higher risk than they realise.
3. “Skinny fat” is real, and common in Asians
Many slim people are what doctors call “skinny fat”.
This means:
Thin on the outside
But carrying excess visceral fat around internal organs
This pattern is especially common in Asians, even at low or normal BMI.
What does “skinny fat” actually mean?
“Skinny fat” (also known as TOFI - Thin Outside, Fat Inside) refers to people who:
Look lean
Have normal weight
But have high visceral (abdominal) fat
Visceral fat is dangerous because it:
Increases insulin resistance
Drives inflammation and plaque build-up
You cannot see visceral fat in the mirror.
Why are Asians more prone to this problem?
Research consistently shows that Asians:
Store more visceral fat at lower body weights
Develop diabetes and cholesterol problems at lower BMI
Experience heart disease earlier than Western populations
This means:
A “normal BMI” does not equal low heart risk for Asians.
Slim individuals, young adults, and even regular exercisers can still carry significant hidden cardiovascular risk.
Can exercise alone fix high cholesterol in slim people?
Exercise is important, but not always enough.
Exercise helps:
Improve insulin sensitivity
Raise HDL cholesterol
Lower triglycerides
However, LDL cholesterol is often strongly driven by genetics. This is why some slim, active people still have:
Persistently high LDL
Progressive plaque despite good habits
Lifestyle is essential, but sometimes medical treatment is needed to truly reduce risk.
How do I know if this applies to me?
You should take this seriously if you:
Are slim but have high LDL cholesterol
Have a family history of heart disease or stroke
Are Asian with central (abdominal) fat
Have pre-diabetes, diabetes, or borderline sugars
Are peri-menopausal or post-menopausal (for women)
Looking healthy is not the same as being heart-healthy.
What tests should slim people consider?
Depending on age and risk factors, evaluation may include:
Full lipid profile (LDL, HDL, triglycerides), Lipoprotein a
Blood sugar or HbA1c
Blood pressure assessment
Waist circumference (not just weight)
Imaging tests in selected individuals (e.g. coronary calcium score)
The goal is early detection and prevention, not waiting for symptoms.
Not sure if this applies to you?
A personalised consultation can help you understand your true heart risk.
Frequently Asked Questions
Q: Can thin people have high cholesterol?
A: Yes. Cholesterol is largely driven by genetics and liver metabolism, not body size.
Q: What is skinny fat and is it dangerous?
A: Skinny fat refers to hidden visceral fat in slim individuals. It significantly increases heart disease and diabetes risk.
Q: Why is this common in Asians?
A: Asians develop metabolic risk at lower BMI and tend to store more visceral fat.
Q: If I eat healthily, why is my LDL still high?
A: Because most cholesterol is produced by the liver and influenced by genetics and hormones.
Q: Do slim people ever need cholesterol medication?
A: Yes, when LDL levels or overall cardiovascular risk remain high despite good lifestyle habits.
Key takeaway
Being slim is not a shield against heart disease.
In Asians especially, cholesterol problems and heart risk can exist silently, even in people who:
Look fit
Eat sensibly
Exercise regularly
The most important step is understanding your personal risk, not relying on appearance.
Ready to get clarity?
If this article sounds uncomfortably familiar, you’re not alone.
Cholesterol and heart risk are individual, and a proper assessment looks beyond weight and
lab numbers.
👉 Get clarity, reassurance, and a prevention plan tailored to you
Because looking healthy and being heart-healthy are not always the same.
About Dr Chan Po Fun
Dr Chan Po Fun, a cardiologist in Singapore, focuses on helping patients with difficult-to-control cholesterol, familial hyperlipidaemia, and statin intolerance achieve safe, comfortable, and sustainable results.
Clinics:
Mount Alvernia Hospital
# 05-51 Medical Centre D, 820 Thomson Road, Singapore 574623
Gleneagles Hospital
Annexe Block # 03-37C, 6A Napier Road, Singapore 258500
Links:
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