When we talk about weight, we often focus on what we can see.
The number on the weighing scale.
Our waist size.
The way our clothes fit.
But not all body fat behaves in the same way. Some fat sits just beneath the skin. This is known as subcutaneous fat. Other fat accumulates deeper inside the abdomen, surrounding organs such as the liver, pancreas and intestines. This is visceral fat. And when it comes to metabolic health, where fat is stored may matter as much as how much we have.
Visceral fat is metabolically active. Unlike simply being an energy store, visceral adipose tissue releases signalling molecules that can influence inflammation, insulin sensitivity and metabolism. Excess visceral fat has been associated with:
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Insulin resistance
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Type 2 diabetes
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Cardiovascular disease
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Fatty liver disease
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Chronic low-grade inflammation
This helps explain why two people with the same body weight or BMI can have very different metabolic health profiles.
Our bodies have a remarkable ability to store excess energy. But when energy storage in subcutaneous fat becomes overwhelmed, excess fat may begin accumulating in places where it is less well tolerated, including around internal organs and within organs themselves. Fat accumulation in the liver and pancreas is particularly relevant to type 2 diabetes. Excess liver fat can contribute to hepatic insulin resistance, while excess fat in the pancreas has been linked to impaired insulin secretion.
One of the most important connections is between visceral fat and insulin resistance. Insulin helps move glucose from the bloodstream into cells where it can be used or stored. When cells become less responsive to insulin, the pancreas needs to produce more insulin to maintain normal blood glucose levels. Over time, this compensation may become insufficient. Blood glucose begins to rise. And eventually, type 2 diabetes may develop. Visceral fat is one of the factors that can contribute to this process through changes in fatty acid metabolism, inflammatory signalling and insulin sensitivity.
But here's the good news. Visceral fat is not necessarily permanent. Lifestyle changes can reduce it. Research has shown that even modest weight loss can lead to a significant reduction in visceral fat. This means that relatively small changes in body weight can still bring meaningful improvements in metabolic health. This is one reason why we should not focus exclusively on reaching a particular number on the scale. A change in waist circumference, blood glucose, triglycerides, blood pressure or HbA1c may tell us something important about what is happening beneath the surface.
So how do we reduce visceral fat?
Nutrition
Prioritising minimally processed, nutrient-dense foods while reducing excessive energy intake and refined carbohydrates.
Movement
Combining regular aerobic activity with resistance training can improve insulin sensitivity and body composition.
Sleep
Poor sleep can disrupt appetite regulation, glucose metabolism and hormonal balance.
Stress management
Chronic stress can influence eating behaviour and metabolic physiology.
Consistency
Perhaps most importantly, these behaviours need to be sustainable. The goal is not a short-term reduction in weight. It is creating an internal environment that supports metabolic health over the long term.
At Remisi, we believe that weight is one piece of the metabolic health puzzle. We consider the bigger picture:
What is happening to blood glucose?
What is happening to insulin sensitivity?
What is happening to waist circumference?
What is happening to cardiovascular risk?
And ultimately, what is happening to the person's health?
Because the goal isn't simply to become lighter. It is to become metabolically healthier.
References
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Després JP, Lemieux I. (2006). Abdominal obesity and metabolic syndrome. Nature.
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Neeland IJ, Ross R, Després JP, et al. (2019). Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease. Journal of the American College of Cardiology.
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Taylor R. (2013). Type 2 diabetes: etiology and reversibility. Diabetes Care.
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Lean MEJ, et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT). The Lancet.
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World Health Organization. Obesity and overweight.
