Not All Body Fat Is the Same
When most people think about body fat, they think about one number.
Body fat percentage.
Body weight.
Or perhaps the number on the bathroom scale.
But human body fat is much more complicated than that.
Two people can weigh the same amount, have similar body mass index values, and even have similar percentages of total body fat while having very different metabolic risk.
Why?
One important reason is where the body stores fat.
Fat stored directly underneath the skin does not behave exactly the same way as fat stored deep within the abdomen around internal organs.
The first is known as subcutaneous fat.
The second is known as visceral fat.
Both are normal components of the human body. Neither is inherently bad. We need adipose tissue for energy storage, insulation, hormone signaling, and numerous other biological functions.
The problem occurs when excessive amounts accumulate, particularly in the visceral compartment.
Research has consistently associated excess visceral fat with insulin resistance, type 2 diabetes, abnormal blood lipids, cardiovascular disease, metabolic syndrome, and other forms of cardiometabolic dysfunction.
Understanding the difference between these two types of fat helps explain why metabolic health cannot be determined simply by stepping on a scale.
What Is Subcutaneous Fat?
Subcutaneous fat is the fat located directly beneath the skin.
It is the soft fat you can usually pinch around areas such as the abdomen, thighs, hips, buttocks, and arms.
When someone notices that their clothes fit differently after gaining or losing weight, much of what they are noticing is a change in subcutaneous fat.
Subcutaneous fat serves several useful biological purposes.
- It stores energy.
- It helps insulate the body.
- It cushions tissues.
- It participates in hormone and cellular signaling.
Most importantly for this discussion, subcutaneous fat can provide the body with a relatively appropriate location to store excess energy.
That does not mean unlimited amounts of subcutaneous fat are harmless.
Excess total body fat can still be associated with health problems.
But subcutaneous fat, particularly fat stored around the hips and thighs, does not appear to carry the same metabolic risk as excess visceral fat.
Some research even suggests that lower body subcutaneous fat may be associated with a more favorable metabolic profile when compared with abdominal visceral fat.
The location of fat matters.
What Is Visceral Fat?
Visceral fat is located deeper inside the abdominal cavity.
Instead of sitting directly beneath the skin, it surrounds internal organs.
This means you cannot simply grab visceral fat between your fingers.
Someone can have a relatively firm, enlarged abdomen and carry significant visceral fat even if there is less soft fat available to pinch.
Visceral adipose tissue is biologically active.
It participates in the release of fatty acids, hormones, inflammatory mediators, and signaling molecules that can influence metabolism throughout the body.
Excess visceral fat is associated with metabolic abnormalities involving glucose regulation, insulin sensitivity, triglycerides, cholesterol patterns, blood pressure, and inflammation.
A major position statement published in The Lancet Diabetes and Endocrinology concluded that visceral and ectopic fat are important contributors to cardiometabolic disease and that excess fat in these locations can help explain why individuals with similar levels of overall obesity sometimes have very different health risks.
In other words, fat distribution matters.
Think About Fat as a Storage System
One way to understand this is to think about adipose tissue as the body’s energy storage system.
When energy intake exceeds energy expenditure, some of that excess energy can be stored as triglycerides inside fat cells.
Subcutaneous adipose tissue can act as a storage compartment.
Ideally, excess energy is stored safely within this tissue.
But storage capacity differs between individuals.
Genetics, sex, hormones, age, ethnicity, physical activity, and other factors influence where each person tends to accumulate fat.
When the ability of subcutaneous adipose tissue to appropriately store excess energy becomes limited, fat may increasingly accumulate in less desirable locations.
This includes visceral fat.
Fat can also accumulate in tissues that normally contain relatively little fat.
This is known as ectopic fat.
What Is Ectopic Fat?
Ectopic fat is fat stored in or around organs and tissues where excessive accumulation can interfere with normal function.
Examples include excess fat within the liver, skeletal muscle, pancreas, and around the heart.
Fat accumulation in the liver is particularly relevant to metabolic health.
Metabolic dysfunction associated steatotic liver disease, sometimes abbreviated MASLD, is closely associated with obesity, insulin resistance, type 2 diabetes, and other cardiometabolic abnormalities.
This helps explain an important concept.
The health consequences of excess energy storage are not determined only by how large someone’s fat cells become.
They are also influenced by where excess energy ultimately gets stored.
Why Is Visceral Fat More Concerning?
Visceral adipose tissue has several biological characteristics that help explain its relationship with metabolic disease.
It is more metabolically active than many subcutaneous fat depots.
Visceral fat can release fatty acids into circulation and is associated with altered secretion of adipokines and inflammatory signaling molecules.
Excess visceral fat is also strongly associated with insulin resistance.
When insulin sensitivity declines, the body’s tissues do not respond to insulin as effectively.
The pancreas may compensate by producing additional insulin.
- Over time, glucose regulation can become increasingly difficult.
- Fasting glucose may begin to rise.
- A1C may increase.
- Triglycerides may rise.
- HDL cholesterol may decrease.
- Blood pressure may increase.
Eventually, the person may develop the collection of abnormalities known as metabolic syndrome.
This is why visceral fat should not simply be thought of as stored calories.
It is metabolically active tissue that can influence the rest of the body.
Visceral Fat and Insulin Resistance
The relationship between visceral fat and insulin resistance is particularly important.
Insulin normally helps regulate glucose and energy storage.
When tissues become resistant to insulin, the pancreas must produce increasing amounts of insulin to maintain normal glucose levels.
For a while, this compensation can work.
Someone can therefore have insulin resistance even while their fasting glucose appears relatively normal.
Eventually, the pancreas may no longer be able to compensate sufficiently.
Glucose begins rising.
Prediabetes may develop.
For some individuals, the process eventually progresses to type 2 diabetes.
Excess visceral and ectopic fat are closely associated with this metabolic progression.
This does not mean every person with abdominal fat will develop diabetes.
Genetics, muscle mass, physical activity, nutrition, sleep, medications, hormones, age, and many other factors influence individual risk.
But visceral adiposity is an important part of the picture.
Visceral Fat and Metabolic Syndrome
Visceral obesity is also closely connected with metabolic syndrome.
Metabolic syndrome refers to a cluster of cardiometabolic risk factors that tend to occur together.
These include:
- Increased waist circumference
- Elevated blood pressure
- Elevated fasting glucose
- Elevated triglycerides
- Low HDL cholesterol
When several of these abnormalities occur together, they signal increased metabolic and cardiovascular risk.
This is why waist circumference can provide information that body weight alone cannot.
A person does not necessarily need to have severe obesity to develop visceral adiposity and metabolic syndrome.
Someone with a moderately elevated body weight but substantial abdominal fat may have greater metabolic risk than the scale suggests.
Why Waist Circumference Matters
Body mass index, commonly called BMI, can be useful for evaluating weight relative to height across populations.
But BMI has an important limitation.
It does not tell us where body fat is located.
It also cannot distinguish muscle from fat.
A muscular person and a person carrying excess body fat can sometimes have similar BMI values.
Waist circumference gives us additional information because it provides a simple clinical estimate of abdominal adiposity.
A major consensus statement published in Nature Reviews Endocrinology concluded that waist circumference provides information about cardiometabolic risk beyond BMI alone and recommended that waist circumference be routinely incorporated into clinical assessment.
The combination of BMI and waist circumference can identify higher risk patterns of obesity more effectively than either measurement alone.
This does not make waist circumference a perfect measurement.
It is a screening tool.
But it can tell us something important that the bathroom scale cannot.
Can You Have Visceral Fat Without Looking Obese?
Yes.
This is one reason appearance is an unreliable measure of metabolic health.
Some people accumulate a relatively large amount of visceral or ectopic fat without developing the degree of overall obesity that might immediately raise concern.
A person can therefore have a relatively normal or only moderately elevated BMI while still having an unfavorable pattern of fat distribution.
Conversely, another person with a higher BMI may store a greater proportion of excess energy in subcutaneous tissue and have less visceral fat than expected.
This helps explain why two people with the same BMI can have dramatically different metabolic profiles.
One may have normal glucose, favorable triglycerides, normal blood pressure, and good insulin sensitivity.
The other may have elevated glucose, high triglycerides, low HDL cholesterol, hypertension, and fatty liver.
Body size matters.
Body composition matters.
But fat distribution matters too.
Men and Women Often Store Fat Differently
Hormones and biological sex influence fat distribution.
Before menopause, women often have a greater tendency to store subcutaneous fat around the hips, thighs, and buttocks.
Men are generally more likely to accumulate abdominal visceral fat.
These patterns are not universal, but they help explain some differences in metabolic risk.
Fat distribution can also change during menopause.
As estrogen levels decline, some women experience a shift toward greater abdominal fat accumulation.
This can occur even without dramatic changes in total body weight.
Age itself can also influence body composition.
Someone may gradually lose muscle while gaining visceral fat without seeing a major change on the scale.
That is another reason body weight alone becomes increasingly incomplete as we age.
The Scale Can Stay the Same While Your Body Changes
Imagine someone who weighs 170 pounds at age 35.
At age 55, that person still weighs 170 pounds.
It would be easy to assume that very little has changed.
But suppose that over those twenty years the person lost ten pounds of muscle and gained ten pounds of fat, including additional visceral fat.
Body weight remained identical.
Body composition did not.
Metabolic health may not have either.
This phenomenon becomes particularly relevant with aging because skeletal muscle tends to decline unless we actively work to preserve it.
That means maintaining the same body weight throughout adulthood does not automatically mean maintaining the same health.
The scale is one measurement.
It should never be the entire evaluation.
How Do You Know How Much Visceral Fat You Have?
The most precise methods of directly measuring visceral adipose tissue generally involve imaging techniques such as computed tomography or magnetic resonance imaging.
These methods are useful in research and selected clinical circumstances, but they are not necessary for routine assessment in most people.
Dual energy X ray absorptiometry can also provide useful body composition information and, depending on the technology, estimates related to regional adiposity.
In routine clinical practice, waist circumference is much simpler.
Body composition measurements can provide additional information when appropriate.
Physicians may also look at the metabolic consequences associated with visceral adiposity.
These include:
- Blood pressure
- Fasting glucose
- A1C
- Triglycerides
- HDL cholesterol
- Liver enzymes
- Waist circumference
- Body composition
- And other cardiovascular or metabolic markers when clinically appropriate
No single measurement tells the entire story.
The pattern matters.
Can You Specifically Burn Visceral Fat?
You cannot choose exactly where your body removes fat.
Doing hundreds of abdominal exercises will not selectively remove visceral fat from your abdomen.
Abdominal exercises can strengthen abdominal muscles.
They do not allow you to control where fat loss occurs.
Fortunately, visceral fat can respond to lifestyle intervention.
Research has shown that exercise can reduce visceral adipose tissue, including in situations where the change in total body weight is relatively modest.
Dietary interventions that create appropriate energy balance and reduce excess body fat can also reduce waist circumference and visceral adiposity.
The important point is that improving abdominal adiposity does not require finding a special “belly fat” exercise.
It requires improving overall metabolic health and energy balance.
Exercise Is Particularly Important
Regular physical activity is one of the most valuable strategies for addressing visceral fat and cardiometabolic risk.
Aerobic activity can help increase energy expenditure and improve cardiovascular fitness.
Walking is an excellent starting point.
Cycling, swimming, jogging, rowing, and other forms of cardiovascular exercise can also be effective depending on physical ability.
Resistance training deserves attention as well.
Why?
Because weight loss should not simply be about becoming smaller.
We want to reduce excess body fat while preserving or building skeletal muscle.
Muscle contributes to strength, mobility, glucose utilization, insulin sensitivity, and long term physical function.
A healthy body composition strategy should therefore focus on both sides of the equation.
Reduce excess fat while protecting muscle.
Nutrition Matters
There is no single diet that selectively removes visceral fat.
A sustainable nutrition strategy should help improve overall diet quality, support appropriate calorie intake, provide adequate protein, and make long term weight management possible when weight reduction is needed.
A practical approach often emphasizes:
- Vegetables
- Fruits
- Lean protein
- Fish
- Legumes
- Nuts and seeds
- Whole foods
- Fiber rich carbohydrate sources
- Healthy fats
- Minimally processed foods
At the same time, reducing excessive consumption of sugary beverages, refined foods, highly processed foods, and excessive alcohol can help reduce unnecessary calorie intake.
Protein becomes especially important during weight loss because we want to preserve lean tissue.
Combine adequate protein with resistance training whenever appropriate.
Sleep and Stress Should Not Be Ignored
Body composition is not determined by diet and exercise alone.
Poor sleep can influence appetite, glucose regulation, food choices, physical activity, and hormonal signaling.
Obstructive sleep apnea is also closely associated with obesity and metabolic disease.
Chronic stress can affect sleep, appetite, alcohol consumption, eating behaviors, and physical activity.
This does not mean stress automatically causes visceral obesity.
It means metabolic health is influenced by the entire environment in which someone lives.
Successful long term strategies usually address more than one behavior.
Do Not Chase a Perfect Body Fat Percentage
The objective of improving body composition should not be achieving an arbitrary appearance.
The goal is better health.
- Is waist circumference decreasing?
- Is strength improving?
- Are triglycerides improving?
- Is blood pressure improving?
- Is glucose regulation improving?
- Is A1C moving in the right direction?
- Are you maintaining muscle?
- Are you becoming more physically active?
Those outcomes may tell us more about health than whether someone reaches a particular clothing size.
Visceral fat matters because of what it represents metabolically, not because of how someone’s abdomen looks in a photograph.
Healthy Aging Requires Looking Beyond Body Weight
As we age, body composition becomes increasingly important.
We want to preserve skeletal muscle.
We want to preserve bone.
We want to maintain strength.
We want to minimize excessive visceral and ectopic fat.
And we want to maintain good insulin sensitivity and cardiovascular health.
That means healthy aging should not simply be about weighing less.
Someone can lose significant weight while also losing muscle.
Someone else can maintain the same body weight while gaining muscle and losing visceral fat.
The second person may have experienced a meaningful improvement in body composition without producing a dramatic change on the bathroom scale.
That is why the question should not always be:
How much do you weigh?
Sometimes the better question is:
What is that weight made of, and where is the excess fat being stored?
Take a More Complete Approach to Body Composition
At Vita Nova AntiAging and Rejuvenation Center, we believe body composition should be evaluated as part of the larger picture of metabolic and healthy aging.
Body weight alone cannot tell us how much muscle someone has.
It cannot tell us where body fat is stored.
And it cannot tell us whether glucose, blood pressure, triglycerides, insulin sensitivity, and other metabolic markers are moving in the right direction.
A more complete evaluation may consider waist circumference, body composition, muscle mass, blood pressure, fasting glucose, A1C, cholesterol, triglycerides, lifestyle, nutrition, physical activity, sleep, hormone health, family history, and other individual risk factors.
The goal should not simply be to make the number on the scale smaller.
The goal is to improve what that number represents.
Preserve muscle.
Reduce excess visceral fat.
Improve metabolic health.
Become stronger.
Remain active.
And build a body that supports the life you want to continue living as you age.
When it comes to body fat, location matters.
And understanding that difference can change the way we think about weight, metabolism, and healthy aging.
Related Reading
Learn more about medical weight loss programs at Vita Nova AntiAging and Rejuvenation Center.
References
- Neeland IJ, Ross R, Després JP, et al. Visceral and Ectopic Fat, Atherosclerosis, and Cardiometabolic Disease: A Position Statement. The Lancet Diabetes and Endocrinology. 2019;7:715 to 725.
- Ross R, Neeland IJ, Yamashita S, et al. Waist Circumference as a Vital Sign in Clinical Practice: A Consensus Statement From the IAS and ICCR Working Group on Visceral Obesity. Nature Reviews Endocrinology. 2020;16:177 to 189.
- Powell Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143:e984 to e1010.
- Ibrahim MM. Subcutaneous and Visceral Adipose Tissue: Structural and Functional Differences. Obesity Reviews. 2010;11:11 to 18.
- Fox CS, Massaro JM, Hoffmann U, et al. Abdominal Visceral and Subcutaneous Adipose Tissue Compartments: Association With Metabolic Risk Factors in the Framingham Heart Study. Circulation. 2007;116:39 to 48.
- Després JP. Body Fat Distribution and Risk of Cardiovascular Disease: An Update. Circulation. 2012;126:1301 to 1313.
- Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The Clinical Importance of Visceral Adiposity: A Critical Review of Methods for Visceral Adipose Tissue Analysis. British Journal of Radiology. 2012;85:1 to 10.
- Tchernof A, Després JP. Pathophysiology of Human Visceral Obesity: An Update. Physiological Reviews. 2013;93:359 to 404.
- Ross R, Soni S, Houle SA. Negative Energy Balance Induced by Exercise or Diet: Effects on Visceral Adipose Tissue and Liver Fat. Nutrients. 2020;12:891.
Medical Disclaimer
This article is intended for general educational purposes and should not be considered individualized medical advice, diagnosis, or treatment. Body weight, waist circumference, body composition, and metabolic risk should be interpreted within the context of a person’s age, sex, medical history, medications, laboratory results, physical examination, family history, and individual risk factors. Discuss concerns about abdominal obesity, weight, diabetes risk, cardiovascular health, or significant changes to your nutrition or exercise program with a qualified healthcare professional.