Visceral fat has become somewhat of a buzzword your patients may ask you about during routine appointments or follow-up discussions if they are on a weight-loss journey. Although visceral fat is a familiar concept, patients may ask about its risks and ways to reduce it. Understanding this can help you support their wellness goals.

Providing a Definition to Patients 

Viscera are internal organs, so visceral fat is fat tissue that surrounds internal organs, such as the intestines, kidneys, and heart. 

“More than 80% of the fat tissue in our bodies is subcutaneous, or under the skin. Only a small portion of the fat mass in our bodies is visceral fat,” said Max Petersen, MD, PhD, assistant professor of medicine, WashU Medicine in St Louis. 

Despite this, he continued, it’s been known for decades that visceral fat is more strongly associated with diabetes and cardiovascular disease than subcutaneous fat. 

“Although it makes intuitive sense that the fat directly surrounding our organs might more directly promote disease than the fat stored in our thighs, the specific mechanisms involved are still being intensely studied,” Petersen added.

Informing Patients About Causes of Visceral Fat 

Visceral fat builds up when calorie intake consistently exceeds physical activity. Other factors also affect fat storage build-up and the accumulation of visceral fat. These include:

Genetics: Some patients have a genetic predisposition to accumulate fat surrounding their abdominal organs.

Sex: Men generally have a high risk of accumulating visceral fat compared to premenopausal women.

Hormonal changes: Menopausal hormonal shifts in females can raise visceral fat levels.

Low birth weight: Some studies have revealed this may increase the risk of developing visceral fat later in life.

Lifestyle patterns: Behaviors such as heavy alcohol consumption, chronic stress, and poor sleep contribute to the risk of visceral fat. As a primary care physician, you can guide patients in managing visceral fat more effectively.

How Does Age Impact Visceral Fat? 

Visceral fat mass does tend to increase with age but so does subcutaneous fat. A variety of hormones can affect visceral fat, including estrogen and cortisol. The clinical link is important to discuss with patients. 

“The age-related accumulation of visceral fat can accelerate after menopause in women, and some evidence supports a role for hormone replacement therapy in preventing this,” Petersen said. “However, hormone replacement therapy does not significantly affect total body weight in women.”

Moreover, men with low testosterone tend to have more visceral fat, and although testosterone levels do decrease with age, they don’t undergo the sharp drop seen with estrogen levels after menopause, Peterson said. “Testosterone replacement in men with low testosterone does reduce visceral fat,” he said.

As adults enter middle age and extending though early aging — up to 65 years — the amount of visceral fat increases, which plays an important role in the pathogenesis of metabolic disease, said David A. Harris, MD, assistant professor of surgery and director of MIS Research, WiSLiM Lab, and affiliate member of the Division of Endocrinology, Diabetes, and Metabolism at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin.

“It is also around this time that muscle mass declines,” Harris said. “These changes, for many, can lead to sarcopenic obesity, which portends a worse prognosis.”

While the exact mechanisms behind these changes are not completely understood, he cited some factors to consider. “There appears to be multiple contributory insults responsible, including a reduction in global metabolism, a change in the hormonal landscape, increased adipocyte hypertrophy, a change in the adipogenic potential of fat cells, increased cellular senescence within adipose depots, and chronic inflammation,” he said. 

Visceral fat tissue is associated with a myriad of conditions — dyslipidemia, metabolic-associated fatty liver disease, insulin resistance, heart disease, and multiple cancer subtypes—Harris said.

Further, accumulation of visceral fat tissue and insulin resistance are “major drivers of Alzheimer’s disease and related dementias and accelerate aging phenotypes, frailty, and hasten mortality,” Harris said. 

What Are Interventions to Suggest? 

Studies have shown dietary and lifestyle changes remain reliable recommendations in major practice guidelines for managing obesity and type 2 diabetes. During your discussions, consider advising patients to boost protein and fiber, cut carbohydrates, and get their heart pumping through regular exercise. You may even suggest they consult with a registered dietitian for a tailored nutrition plan.

“Weight loss can be achieved through behavioral, dietary, medical, or surgical therapies depending on the patient, and improved physical fitness can be achieved by progressively increasing exercise,” said Petersen. “Both exercise and weight loss will reduce visceral fat and will also positively impact many other factors at the same time to improve overall health.”

Peterson is a sub-investigator for Viking Therapeutics. Harris serves on the board of the Wisconsin Obesity Society.