What is the Deal With This Belly Fat?!
A common frustration I hear not only in patients coming to see me in the office for the first time but also amongst my social circles, is a common frustration toward the unwelcome arrival of belly fat. In more medical terms, this belly fat is known as visceral adipose tissue (VAT), commonly known as visceral fat, and is a type of body fat stored within the abdominal cavity, surrounding vital internal organs such as the liver, pancreas, and intestines. Unlike subcutaneous fat, which is the fat that lies just beneath the skin, visceral fat is hidden deeper within the body. While both types of fat serve as energy reserves, their impacts on health differ significantly.
Distinguishing Visceral Fat from Subcutaneous Fat
Subcutaneous fat is the layer of fat you can pinch between your fingers, located just beneath the skin. It acts as an insulator, regulating body temperature and providing a cushion against external impacts. Visceral fat, on the other hand, is not visible and envelops internal organs within the abdominal cavity, like our intestines, pancreas, spleen, and liver. This deep-seated fat is metabolically active and has been linked to various health complications.
Health Risks Associated with Visceral Fat
Excessive accumulation of visceral fat poses several health risks:
Cardiovascular Diseases: Visceral fat produces proteins called cytokines and the cytokines produced by visceral adipose tissue are harmful as they can trigger low-level inflammation. Chronic production of these cytokines over years can lead to tissue destruction, primarily in blood vessels. This is why low level inflammation is a risk factor for heart disease.
Type 2 Diabetes: This fat type is strongly linked to insulin resistance, the phenomenon where the body’s cells do not respond as they should to insulin, causing the pancreas to ‘panic’ and overproduce poor quality insulin. Insulin resistance is the primary cause of Type 2 Diabetes.Metabolic Syndrome: Visceral fat contributes to a cluster of conditions known as Metabolic Syndrome. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels—that together elevate the risk of heart disease, stroke, and diabetes.
Other Health Issues: An excess of visceral fat has been associated with certain cancers, sleep apnea, and premature death, even in individuals with a normal body mass index (BMI). This last point, even in individuals with a normal BMI, highlights one of the inadequacies of BMI, the fact that it is unable to report on what is making up the weight (like how much visceral fat is part of the weight).
Measuring Visceral Fat
Accurately measuring visceral fat typically requires imaging techniques:
Imaging Scans: Computed tomography (CT) scans and magnetic resonance imaging (MRI) are considered the gold standards for assessing visceral fat. However, these methods can be expensive and are not commonly used for routine evaluations.
Dual-Energy X-ray Absorptiometry (DEXA): DEXA scans provide detailed information about body composition, including visceral fat measurement, and are considered highly accurate.
Access to the imaging modalities above are limited due to the cost, however, there are highly accurate medical grade body compositions that can accurately estimate visceral fat:
Bioimpedance analysis: There are many commercial home scales available, however, their ability to accurately assess visceral adipose tissue is underwhelming. Medical-grade body composition scales often found in physician’s offices is able to accurately estimate visceral adipose tissue when combined with wait circumference measurements and can do so during an office visit.
For practical purposes (again, because the cost of medical-grade body composition scales can be cost-prohibitive for some clinics), simpler methods can offer insights into visceral fat levels:
Waist Circumference: Measuring the waistline is a straightforward method. A waist circumference over 35 inches (88 cm) for women and 40 inches (102 cm) for men is associated with higher health risks linked to visceral fat. Of note, there are ethnic variations to these measurement cut-offs and your medical provider should apply the appropriate ethnic cut-off specific to you.
Waist-to-Hip Ratio (WHR): This ratio compares the circumference of the waist to that of the hips. A higher WHR indicates a greater concentration of visceral fat.
Lifestyle Measures to Reduce and Prevent Visceral Fat
Addressing visceral fat involves consistent comprehensive lifestyle modifications:
Regular Physical Activity:
Aerobic Exercise: Engaging in activities like brisk walking (throw on a weighted backpack while you are at it!), cycling, swimming, or jogging for at least 30 minutes, five to seven days a week, is an effective way to combat visceral fat.
High-Intensity Interval Training (HIIT): This form of exercise alternates short bursts of intense activity with periods of rest and has been shown to be particularly effective in reducing visceral fat.
Strength Training: Incorporating resistance or weight training exercises helps build muscle mass, which can increase resting metabolic rate and aid in excess fat loss.
Balanced Diet:
Whole Foods: Emphasize a diet rich in fruits, vegetables, whole grains (fiber, fiber, fiber!!!), lean proteins, and healthy fats.
Reduce Added Sugars and Refined Carbohydrates: Limiting intake of sugary beverages, cereals, sweets, and refined grains can help decrease visceral fat accumulation. Learning to interpret nutrition labels can really be a super power so that foods with added sugars can be avoided and swapped for fiber-rich foods.
Healthy Fats: Incorporate sources of unsaturated fats, such as avocados, nuts, and seeds which can promote satiety and support overall health.
Stress Management:
Mindfulness Practices: Engaging in activities like meditation, yoga, or deep-breathing exercises can help manage stress levels, which, in turn, may reduce visceral fat accumulation.
Adequate Sleep: Ensuring 7-9 hours of quality sleep per night is crucial, as poor sleep patterns have been linked to increased visceral fat.
Limit Alcohol Consumption:
Moderation: Excessive alcohol intake is associated with increased visceral fat. It is remarkable how much impact avoiding any kind of alcohol intake can have on reducing visceral adipose tissue.
Regular Health Check-ups:
Monitor Health Indicators: Regular screenings for blood pressure, cholesterol levels, and insulin resistance can help detect early signs of health issues related to visceral fat.
Visceral fat is something that accumulates over time, frequently from suboptimal nutrition, sleep, and movement practices over several years. In addition, changes in fertility hormones throughout the decades also plays a role in visceral adipose tissue accumulation. By understanding the nature of visceral fat and implementing these lifestyle changes on a consistent basis, individuals can reduce visceral fat which thereby significantly reduces health risks and promotes overall well-being.