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We have had several cases in Australia of very fit amateur's running marathons in hot weather.I am quite lucky with my belly, 1m87 and 72 kg. Whatever I eat or drink!
Some 10 years ago I was participating at an international judo competition for veterans (next doors for me, in The Southern Netherlands) and we could get a free health check-up.
I went to the doctor to get my results and he told me: "you have one problem, you are below the minimum limit of fat level"
I asked: "So, what's the problem?"
He: "Well, you are below the lower limit!"
Me: "Yess, I understood, but what's the problem for my health?"
He: "Euh, well, that you will burn your muscles instead of your fat when you are doing a lot of effort!"
Me: "So, no health problem?"
He: "Not really"
They have very low fat levels and as your doctor said they start to burn their muscles instead of fat.
They keep going until they actually start to damage and destroy the muscles.
This damage is not reversible.