Emerging Health Concerns Among Young Women in Singapore: The 'Skinny-Fat' Phenomenon

A recent study conducted by the Agency for Science, Technology and Research (A*STAR) in Singapore has unveiled alarming health risks among healthy-weight young women in their 20s and 30s. Over one-quarter of these women exhibit low muscle mass and reduced bone density, conditions typically associated with older age, but often overlooked due to standard body mass index (BMI) measurements.

The research, part of the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO), analyzed 191 Singaporean women aged 18 to 45. It was published in the JBMR Plus journal, highlighting that 26% of normal-weight Chinese women surveyed displayed a concerning combination of low muscle mass and high body fat, indicative of the 'skinny-fat' phenomenon.

Significant ethnic disparities were also noted, with Chinese women demonstrating the lowest bone density despite appearing healthy according to BMI standards. In stark contrast, women from other ethnic groups in Singapore exhibited stronger bone health. Only one-third of the Chinese women assessed had a healthy composition of muscle and body fat, with physical activity levels and dairy consumption identified as key differentiators.

This finding is particularly critical as Singapore has one of the highest rates of hip fractures globally, with Chinese women, who make up 74% of the population, disproportionately affected compared to men and other ethnicities.

Researchers have pointed out that most studies focus on bone health in middle age, whereas this research emphasizes the importance of addressing these issues in young adulthood, a stage where preventive measures can be most effective. The study revealed that women with low muscle mass had significantly lower bone density across all measured sites, irrespective of their body fat levels.

While BMI remains a popular screening method, the study underscores its limitations in detecting specific body composition-related risks. It suggests that muscle mass is a critical factor in predicting fracture risk, especially prior to menopause.

According to the senior author of the study, the findings indicate that simply having a 'healthy BMI' is insufficient to assess chronic disease risk among young Asian women. Targeted body composition screenings could identify individuals at risk who may otherwise go unnoticed due to an outwardly healthy appearance. Early identification of these risks can lead to interventions that prevent serious health issues later in life.

The research advocates for vigorous physical activity and adequate dairy consumption as essential preventive measures, emphasizing that intervention during peak bone-building years is crucial. Potential screening methods for at-risk individuals include dual-energy X-ray absorptiometry (DXA) scans, bioelectrical impedance analysis, and simple handgrip strength tests.

These findings call for healthcare strategies that consider body composition rather than relying solely on weight measurements, especially for young Asian women who may face higher metabolic risks at similar BMI levels compared to their Western counterparts.

This comprehensive study involved collaboration among A*STAR IHDP, the NUS Yong Loo Lin School of Medicine, the National University Health System (NUHS), KK Women's and Children's Hospital (KKH), and international partners from the University of Southampton and University of Helsinki.