When skier Lindsay Vonn referred to models as “skinny-fat,” saying that “they have more cellulite than most people,” she did more than solidify a new term: She brought into question a health issue that’s perhaps been overlooked in the midst of an obesity epidemic.

“I see these people all the time,” Dr. Daniel Neides, medical director at Cleveland Clinic’s Wellness Institute, told Time. “On the outside they look incredibly healthy, but on the inside they’re a wreck.”

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The more technical term, normal-weight obesity, refers to people with a normal body mass index but a high percentage of the most dangerous type of body fat. People classified as “skinny-fat” usually don’t exercise much and eat unhealthy diets. They face the same issues associated with obesity: type 2 diabetes, high blood pressure and high cholesterol. And new research suggests that these people are at the highest risk of metabolic problems and even death from cardiovascular diseases, Time reports.

“When you’re eating a diet high in sugar and processed foods, it causes visceral fat storage, and that can lead to all sorts of risk factors of being overweight,” Dr. Mark Hyman, author of “The Blood Sugar Solution 10-Day Detox Diet,” told Time.

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The take-away message, experts say, is that weight should be just one piece of the puzzle. Just as overweight people can be fit, underweight people can be sick.

“It’s sexy and beautiful to be strong,” Vonn said in her interview with Self magazine.

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