KEY POINTS
- Where your body stores fat can be just as important as how much you weigh. A normal body weight doesn’t mean a lower metabolic risk.
- Excess visceral fat often has no warning signs. The first clue is often an unexpected result on a routine health screening rather than a symptom you can feel.
- Visceral fat often responds well to sustained lifestyle changes. Health improvements often begin before they’re reflected on the weighing scale.
A weighing scale tells you how heavy you are. A mirror shows how your body looks. Neither tells you where your body stores fat, and that may matter even more than the number on the scale.
Someone can appear slim yet carry unhealthy amounts of hidden fat, while another person with a larger body may have relatively little. That is because not all body fat behaves in the same way.
Hidden deep inside the abdomen is visceral fat, which surrounds organs such as the liver, pancreas and intestines. Unlike the softer fat beneath the skin that you can see or pinch, visceral fat is metabolically active. Instead of acting only as an energy store, it continually releases hormones and chemical signals that influence blood sugar, cholesterol, blood pressure and inflammation throughout the body.
This growing understanding has changed the way doctors assess metabolic health. Rather than relying on body weight or body mass index (BMI) alone, they increasingly consider waist circumference, blood pressure, blood sugar, cholesterol and other risk factors together. After all, where fat is stored can be just as important as how much fat a person has.
What makes visceral fat different
Imagine two people of the same height and weight. One stores most of their fat beneath the skin around the hips and thighs, while the other stores more fat deep inside the abdomen around the organs. Their body mass index (BMI) may be identical, but their long-term health risks may be very different.
Unlike fat beneath the skin, visceral fat sits closer to the organs and has a greater influence on how the body regulates blood sugar, cholesterol and inflammation. As a result, it’s more strongly associated with conditions such as type 2 diabetes, heart disease, fatty liver disease, stroke, and metabolic syndrome.
This is why doctors no longer rely on body weight alone when assessing metabolic health. Waist circumference, blood pressure, blood sugar, cholesterol and other health markers together give doctors a more complete picture of metabolic health. Although BMI remains a useful screening tool, it can’t distinguish muscle from fat or show where fat is stored.
The location of body fat may be just as important as the amount of fat a person carries. According to Dr Ramy Bishay, an endocrinologist, visceral fat refers to fat stored deep within the abdomen, surrounding internal organs such as the liver, pancreas, and intestines. This differs from subcutaneous fat, which is the softer layer of fat located just beneath the skin that can be seen or pinched.
This distinction matters because visceral fat is far more metabolically active. Rather than simply serving as an energy store, it can release inflammatory signals, fatty acids, and hormones that affect insulin sensitivity, blood pressure regulation, cholesterol metabolism, and vascular health.
As a result, two people with the same body weight can have very different long-term health risks depending on where their fat is stored. Visceral fat is more strongly associated with insulin resistance, type 2 diabetes, fatty liver disease, hypertension, and cardiovascular disease than fat stored under the skin.
You don’t have to look overweight
This is especially relevant in Asian populations, where metabolic complications can develop at lower BMI levels than in some other populations. Someone may notice that trousers or skirts feel tighter around the waist even though the weighing scale has changed very little. As a result, someone whose BMI falls within the healthy range may still develop conditions such as diabetes or fatty liver disease. Because appearance alone can’t determine metabolic health, routine health screenings remain important even when body weight has changed very little over the years.
Many people assume that being slim or having a normal BMI means they’re protected from metabolic disease. However, BMI is a useful population-level tool, but it’s a relatively blunt measure of individual health risk. It doesn’t reveal where fat is stored, how much muscle a person has, or whether fat is accumulating around organs.
This is particularly relevant in many Asian populations, where metabolic risk can develop at a lower BMI than is typically seen in European populations. A person may appear slim externally but still carry proportionally higher levels of visceral fat, alongside lower muscle mass, fatty liver, insulin resistance, or early metabolic disease. This phenomenon is sometimes described as being "thin outside, fat inside".
A range of factors can contribute to visceral fat accumulation despite a seemingly healthy body weight, including genetics, lower muscle mass, sedentary behaviour, diets high in refined carbohydrates, poor sleep, alcohol consumption, chronic stress, ageing, and menopause.
As a result, waist circumference can sometimes provide additional insight that body weight alone may not capture. For Asian adults, central obesity thresholds are often lower, commonly around 90 cm or more in men and 80 cm or more in women, reflecting the higher metabolic risk that can occur at a smaller body size.
How does visceral fat build up?
The body doesn't store fat in the same place for everyone. Genetics, hormones, age and lifestyle all influence whether more fat is stored around the organs or beneath the skin.
As we grow older, we naturally lose muscle and tend to gain more body fat, making it easier for fat to accumulate around the abdominal organs. Hormonal changes, particularly during menopause, also encourage fat to shift from the hips and thighs towards the abdomen. Everyday habits also influence where fat is stored. Spending long hours sitting, sleeping too little, living with chronic stress, drinking excessive alcohol and eating diets high in ultra-processed foods all increase the likelihood of accumulating visceral fat.
For many people, visceral fat builds up gradually through everyday routines rather than a single event. Desk-based work, long commutes, convenience foods, irregular sleep and limited physical activity all contribute over time. Over time, these everyday habits can lead to fat accumulating deep inside the abdomen.
Why feeling well doesn’t mean you’re healthy
Visceral fat is often overlooked because it usually causes no symptoms of its own. It doesn’t produce pain, bloating or any specific sensation that tells you it’s increasing. Instead, it gradually changes the body’s metabolism.
The first sign often isn't a symptom. It's an unexpected result on a routine health screening. Rising fasting blood sugar or HbA1c levels, elevated triglycerides, increasing blood pressure, abnormal liver function tests or fatty liver detected on ultrasound may all be early signs that important changes are already happening inside the body.
Visceral fat is only one part of the overall picture. Genetics, smoking, diet, physical activity and other medical conditions also influence long-term health. Excess visceral fat remains an important contributor to metabolic risk and often responds well to sustained lifestyle changes.
Excess visceral fat can affect the function of multiple organs, including the liver, pancreas, heart, and blood vessels. Dr Bishay explains that these effects are driven by inflammation and insulin resistance, as well as the abnormal accumulation of fat in organs where it doesn’t normally belong.
In the liver, visceral fat is strongly associated with metabolic dysfunction-associated fatty liver disease (MAFLD), elevated triglyceride levels, and increased glucose production. In the pancreas, ectopic fat accumulation and insulin resistance can gradually impair beta-cell function, increasing the risk of type 2 diabetes. Around the heart and blood vessels, visceral and ectopic fat are linked to hypertension, abnormal cholesterol patterns, vascular inflammation, atherosclerosis, and a higher risk of cardiovascular disease.
The strongest clinical associations include:
- Insulin resistance and pre-diabetes
- Type 2 diabetes
- Metabolic dysfunction-associated fatty liver disease (MAFLD)
- High triglycerides and low HDL cholesterol
- Hypertension
- Obstructive sleep apnoea
- Cardiovascular disease
- Chronic low-grade inflammation
In clinical practice, visceral fat is often viewed as an early warning sign of declining metabolic health, sometimes becoming apparent even before body weight alone suggests a problem.
Why your waistline matters
Your waistline can sometimes reveal changes that a weighing scale can’t. Someone's body weight may stay relatively stable while their waistline gradually increases because more fat is being stored deep inside the abdomen.
Waist circumference can’t measure visceral fat directly, but it’s one of the simplest ways to estimate whether excess fat is accumulating within the abdomen. Interpreted alongside BMI, blood pressure and blood test results, it provides valuable clues about metabolic health before symptoms appear.
A growing waistline doesn’t automatically mean excess visceral fat, and a normal waist measurement doesn’t rule it out. Like any health measurement, waist circumference is most useful when considered together with other health information rather than on its own.
Despite advances in imaging and metabolic testing, waist circumference remains one of the most practical and useful indicators of visceral fat risk. It’s simple, inexpensive, repeatable, and often provides additional insight into metabolic health that BMI alone may miss, particularly in Asian populations.
However, clinicians don’t rely on waist circumference alone. They typically interpret it alongside blood pressure, fasting glucose or HbA1c, lipid profiles, liver enzymes, family history, ethnicity, medication history, and features such as fatty liver identified on ultrasound.
More advanced tools such as CT, MRI, and DEXA scans can quantify visceral fat more precisely, but they’re generally not required for routine risk assessment.
There’s also growing interest in the waist-to-height ratio, with a value below 0.5 generally considered favourable and associated with a lower risk of metabolic disease. Increasingly, clinicians are also paying attention to markers of metabolic dysfunction, including fatty liver disease, triglyceride-to-HDL cholesterol ratio, pre-diabetes, insulin resistance, and cardiometabolic risk scores.
For many Asian adults, waist circumference thresholds of around 90 cm in men and 80 cm in women are commonly used to flag increased central obesity risk, highlighting the continued value of this simple measurement as part of a broader metabolic health assessment.
How to describe your concerns to the doctor
If you're concerned about your metabolic health, describing changes you’ve noticed over time often gives your doctor more useful information than saying you've gained weight.
You could mention:
Waistline: "My waist size has increased even though my weight has stayed about the same."
Health screening: "My latest health screening showed higher blood sugar, cholesterol or blood pressure than last year."
Liver health: "I've recently been told I’ve fatty liver or abnormal liver function tests."
Family history: "Several close relatives have diabetes, heart disease or fatty liver disease."
Lifestyle changes: "I've become much less active since changing jobs, or I’ve been sitting for much longer each day."
Together, these details helps your doctor build a clearer picture of your metabolic health and decide whether further assessment is needed.
Questions worth asking your doctor
Once you've shared your concerns, asking a few questions can help you better understand your health and decide on the next steps together.
Based on my waist circumference and health screening results, how concerned should I be about my metabolic health?
Which of my health screening results deserve the closest attention?
Are there any additional tests that would help assess my metabolic health?
What lifestyle changes would have the biggest impact on reducing visceral fat?
Would I benefit from seeing a dietitian, exercise professional or another healthcare professional?
How should we monitor my progress over time?
Can visceral fat be reduced?
The good news is that visceral fat often responds well to sustained lifestyle changes. Small improvements made consistently over time are usually more effective than short-term fixes. Reducing waist size is one sign of progress. Improving overall metabolic health is the bigger goal.
Regular aerobic exercise, strength training to preserve muscle, eating a balanced diet based on minimally processed foods, getting enough sleep, managing chronic stress and limiting excessive alcohol intake all help reduce visceral fat and improve metabolic health.
Visceral fat often begins to decrease before noticeable changes appear on the weighing scale. Early improvements are often happening inside the body long before they become visible on the outside.
The encouraging news is that visceral fat is often more responsive to lifestyle change than subcutaneous fat. Even modest weight loss can help to reduce visceral fat and improve insulin resistance, blood pressure, triglyceride levels, and fatty liver disease, says Dr Bishay.
Several lifestyle strategies have consistently been shown to be effective:
Maintain a sustainable calorie deficit. Extreme dieting is rarely necessary. The most effective eating pattern is usually one that can be maintained over the long term. Diets rich in protein, fibre, vegetables, and minimally processed foods can help improve satiety and reduce overall energy intake.
Engage in regular aerobic exercise. Activities such as brisk walking, cycling, swimming, and jogging can reduce visceral fat, even when overall weight loss is modest. Research suggests greater benefits are generally seen at higher levels of activity.
Include resistance training. Building and preserving muscle mass is particularly important for insulin sensitivity, glucose control, and long-term weight management.
Reduce refined carbohydrates, sugary drinks, and ultra-processed foods. These are major contributors to excess calorie intake and metabolic dysfunction, particularly when combined with low levels of physical activity.
Limit alcohol intake. Alcohol can contribute to elevated triglycerides, fatty liver disease, and abdominal fat accumulation, especially when consumed regularly or in excess.
Prioritise sleep and stress management. Poor sleep and chronic stress can adversely affect appetite regulation, insulin sensitivity, and the tendency to accumulate fat around the abdomen.
At the same time, some commonly promoted approaches are often overrated or misleading. There’s little evidence that a specific "visceral fat-burning" food, tea, detox programme, supplement, or abdominal exercise can selectively target visceral fat. While sit-ups and abdominal workouts can strengthen the core, they don’t specifically reduce visceral fat. Similarly, highly restrictive diets may produce short-term weight loss but are often difficult to sustain over the longer term.
The key message is that visceral fat is best reduced through consistent, sustainable habits rather than quick fixes. Improvements in nutrition, regular physical activity, resistance training, sleep, alcohol intake, and long-term metabolic health are likely to have a far greater impact than any single product or trend.
When should you seek medical advice?
Consider seeing your doctor if your waist circumference continues to increase despite healthy lifestyle changes, your health screening shows elevated blood sugar, cholesterol or liver enzymes, or you’ve high blood pressure or a strong family history of diabetes or heart disease.
You should also seek medical advice if you develop symptoms such as excessive thirst, frequent urination, unexplained fatigue or chest discomfort, or if you would like help understanding your health screening results and what they mean for your future health. Early assessment creates more opportunities to prevent or delay long-term complications.
Looking beneath the surface
For decades, conversations about body fat focused largely on appearance and body weight. Today, we know that where fat is stored may reveal just as much about future health as how much fat we carry.
The most important changes often happen long before they become obvious in the mirror or on the weighing scale. Understanding those changes through health screening, lifestyle and informed conversations with your doctor creates opportunities to act before chronic disease develops.
Rather than asking, "How much do I weigh?" ask: "What are my waistline and health checks telling me about my health?" That shift in perspective may be one of the most important steps towards protecting your long-term health.
Dr Ramy Bishay
Endocrinologist & Bariatric Physician
Endocrine & Metabolic Clinic, Australia
LinkedIn: @Ramy Bishay
This article was produced by Healthful For You. The views and opinions expressed throughout are those of the authors and do not necessarily reflect those of the Expert Contributor. The Expert Contributor has provided input solely for the EXPERT INSIGHT and TIP segments, based on their professional expertise. These comments are intended to offer general guidance and may not apply to all individuals. Any interpretations or conclusions beyond that section are those of Healthful For You. This article is not a substitute for personalised medical advice, diagnosis, or treatment. Please consult your doctor or a healthcare professional regarding your specific health needs.
We hope you found this article informative. Healthful For You welcomes contributions from healthcare professionals, patients, and community members. If you have a story, research, or a perspective that can enrich our dialogue, please get in touch with us at [email protected].