Visceral Fat

Visceral fat is fat stored inside the abdomen, around organs such as the liver and heart. The British Heart Foundation describes it as the type of fat that sits around the internal organs, and it is the fat most closely tied to high blood pressure, raised blood sugar, high cholesterol and heart disease.

You cannot see or pinch it, and a person can carry a fair amount of it at an ordinary weight. That is why waist size, rather than weight, is the everyday measure of it.

Subcutaneous fat sits just under the skin, all over the body, and is the fat you can pinch. Visceral fat sits deeper, behind the abdominal muscles. Both are stored energy, but visceral fat is the more active of the two in the way it affects blood sugar and blood fats, which is why a large waist is a health marker and not only a matter of shape.

The same things that cause weight gain in general, with a few that push fat towards the middle in particular:

• eating more energy than you use over months or years
• too little physical activity, and in particular too little muscle-building exercise
• short or disrupted sleep
• regular alcohol, which adds energy and is often stored centrally
• falling oestrogen around the menopause, which moves fat towards the abdomen
• ageing, as muscle is lost and the body stores more fat centrally

Visceral fat has no symptoms of its own. What it produces are signs that show up on a tape measure or a blood test:

• a waist that is more than half your height
• raised blood pressure
• an HbA1c in the prediabetes range or above
• high triglycerides or low HDL cholesterol on a lipid profile
• raised liver enzymes, a sign of fatty liver

Each of these is checked in an ordinary first assessment, and together they are what the term metabolic syndrome describes.

The practical measure is your waist against your height. NICE advises keeping your waist to less than half your height: a waist-to-height ratio of 0.5 to 0.59 means increased central fat, and 0.6 or more means high. Measure halfway between the bottom of your ribs and the top of your hips, breathing out normally.

Home scales that report a visceral fat level estimate it from an electrical current, and the number varies with hydration and with the make of scale. It is useful for watching a trend on the same scale, not for a diagnosis. A scan measures it directly, but the tape measure and a blood test tell a clinician most of what they need.

Visceral fat comes off the way other fat does, and it is often among the first to go once weight starts falling. What helps most:

• a steady energy deficit you can hold, at a rate of about 0.5 to 1kg a week
• resistance training two or three times a week, so the weight you lose is fat rather than muscle
• enough protein at each meal
• enough sleep, because short sleep raises appetite
• less alcohol

Watch your waist as well as your weight. If your waist is falling, the fat that matters most is going, even in a week when the scales do not move.

No exercise takes fat off one part of the body, so there is no belly-specific workout that works on its own. Belly fat falls when overall body fat falls, through the same plan as above: a deficit you can sustain, strength training, protein, sleep and less alcohol.

If your waist has grown while your weight has stayed the same, or you have tried and nothing has moved, that is worth a clinical look. Blood sugar, thyroid function and liver tests can each show a reason, and a medical weight loss programme builds the plan around what they find.

Cortisol is the body’s main stress hormone. Very high cortisol over a long period, as in Cushing’s syndrome, does cause weight gain around the middle, but Cushing’s syndrome is rare and a GP tests for it when the pattern fits. Everyday stress works more indirectly, through poorer sleep, more eating and less activity.

Menopause is a more common reason. The NHS notes that weight gain during perimenopause and menopause often happens around the stomach and upper body, as oestrogen falls. Strength training and protein matter more at this stage, because muscle is being lost at the same time.

See your GP rather than starting a programme if your abdomen has swollen quickly, if bloating does not settle, if your waist is growing while you are losing weight elsewhere, or if weight gain comes with new tiredness, thirst or passing more urine. Those are not signs of visceral fat and they need a diagnosis first. If eating or your weight is causing you distress, speak to your GP or contact Beat.

A first assessment arranged by Medical Weight Loss London at UNTIL Soho measures your waist, weight and blood pressure, and arranges the blood tests that show what visceral fat is doing: HbA1c, a lipid profile and liver function, with thyroid function and a full blood count. First assessments at London clinics cost about £150 to £310, with tests on top (what a programme costs).

Ask what to get checked and UNTIL Health Concierge arranges the appointment with a registered clinician.