Not all adipose (fat tissue) is created equal

belly fat vs sub-cutaneous fat

Despite their frequent use by doctors and healthcare providers, weight and Body Mass Index (BMI) are outdated, poor markers for overall health. As we have written before, individuals who are overweight but fit tend to have better health outcomes than those who are normal weight and less fit.

In addition, it is well accepted that overweight individuals whose adipose is mostly subcutaneous have better health outcomes than those who have more visceral adipose (also referred to as liver fat, “belly” fat, or the dreaded “apple shape”).

Now, a new study suggests some of this may be under genetic control, and those genes may help determine our risk for disease.

Science Daily: Genetic factors tied to obesity may protect against diabetes

The study used genetic sequencing combined with MRI quantification of visceral fat to help determine risk of diabetes, hypertension and heart disease in over 500,000 subjects. They found seven specific genes that were associated with increased risk of obesity but with higher subcutaneous fat and lower visceral fat. These individuals consequently had better health outcomes with lower risk of disease.

The authors concluded, therefore, that where we carry our fat is more important than the absolute amount, and much of that determination is under genetic control.

This gives us even more reason to pay less attention to the scale and more attention to our overall healthy lifestyle habits. And remember, just because our genes may make it more or less likely that we have visceral fat, that does not mean it is all beyond our control. Healthy lifestyle practices including low-carb diets (with or without intermittent fasting) and regular exercise can help reduce visceral fat and improve our overall health.

So throw out your scale, hit the gym, and cook up one of our delicious low-carb recipes!

Thanks for reading,
Bret Scher MD FACC


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  1. Catheryn
    The BMI was mathematically incorrect from its very inception. The volume of a shape (and hence its mass) scales with the cube of its length, not the square. Any physicist or engineer can explain the consequences of this basic fact when it comes to designing structures in the real world. Living things, of course, are more complicated than simple geometric shapes (there are some other considerations that come into play when you look at the scaling of the skeletal structure, for example), but the principle is still the same. This is one of the reasons why many taller men are erroneously classified as obese/overweight by the BMI. (Another reason is that fat, muscle and water mass are all treated exactly the same in the formula.)
    Reply: #4
  2. Mudder
    I thought the science showed there was no correlation between exercise and weight loss? Yes exercise is good for you, but doesn’t help in weight loss?
    Reply: #6
  3. Simon
    Mudder, Bret is encouraging fitness- hence exercise. Every smart person acknowledges fitness as being important for health.
  4. Evi
    Well said Catheryn, this is so true, but many doctors still refer to a BMI for measure. I've argued this for a long time. You can have a short muscular body builder, whose weight is higher than normal because of his muscle mass, but have none to little body fat, and will be deemed obese because of his weight to height ratio according to his BMI.
    I am 157cm tall, by rights my weight is supposed to be between 48 to 52 kg. I can tell you right now that at my lowest ever at 54kg I looked sickly. 48 to 52 would likely have my BMI looking good, but not physically looking good. My best weight for me has been between 57 to 60kg, though that would put me in a category of overweight to obese. I will stick with what I think feels and looks right to my body. Health is more important than measures to try to live up to.
    Reply: #10
  5. Katherine
    BMI is routinely ignored for pregnant women and bodybuilders/weightlifters. At best it is but a "rule of thumb" for nonmedical people to get an idea of where they stand vis-à-vis height vs weight as compared with other humans. Similar to those growth charts that are published for parents to judge how well they're doing in raising their kids. You will find that as one ages, one's BMI changes. Many older people find themselves unable to keep the weight they have. This my situation. I spent most of my life fighting to keep the weight off only to find that now I have to fight to keep it on. Mother Nature has a wry sense of humor. I am 5' 9" and hovering around 144 lbs.
  6. Loobyloo
    I’m sorry I don’t agree. If this is the case how come I’ve lost almost two stones in weight, increased my lean muscle mass, lost a percentage in body fat, lost measured inches and dropped two clothes sizes since I upped my game and took up more exercise? The fat didn’t disappear of it’s own accord. It took time and effort. And I’m so pleased with the outcome. 😁
  7. Wendy
    In my experience medical staff constantly use BMI to judge lifestyle. I have Lipoedema, an adipose tissue abnormality where the abnormal fat does not respond to diet, yet my BMI is used to justify their comments.
  8. Margaret
    This is the first I have read these insights on BMI, etc. and it answers questions I've had all my life. I am now 70 years old, have the classic pear shaped body, and have always weighed more than I was "supposed" to. Even as a youth, I had decided different people must have different types or shapes of body fat, because if I were to weigh what I was told I should weigh for my height, I would be a rack of bones. Even now at my age, my BMI says I classify as "obese," and there is no way that I either look or feel obese!
  9. Åsa Helander
    BMI does not work for me either. I have short legs. I tell the doctor, who looks confused at the fact that I come out as overweight, that I am 10cm taller when I sit down:)
  10. MelD
    Exactly my situation, Evi - same height, same results. Yes, I am now older and overweight (working on it!) but I would never even want to conform to what those tables tell me - my best weight range was 58-63 kg. I have way bigger wrists, for instance, than my petite friend of the same height, they measure almost half more so obviously we aren't going to have the same healthy weight range!! In addition, I keep seeing skinny older women and it's not really attractive, I think some subcutaneous fat is also aethetically more pleasing :o Something to keep in mind as we age!

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