When we think about body fat, we tend to think of the little extra cushion around our midsection.
But there’s another type of body fat that is actually way more problematic.
It’s called visceral fat, and having high levels is associated with inflammation, reduced life expectancy, chronic disease, and mortality.
This topic continues to fascinate me, which is why I had visceral fat expert Dr. Sean O’Mara on the podcast to connect the dots on what it is, what lifestyle factors contribute to it, and how to keep your levels at bay to boost your longevity and protect against chronic disease.
Today, I’m recapping everything you need to know about visceral fat.
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Visceral Fat: What Is It?
You know that belly fat around the waistline you can pinch with your fingers? That’s called subcutaneous fat, and it’s located just beneath the skin. Visceral fat, on the other hand, is located deep within the abdomen, wrapping around vital organs and tissues, including the liver, stomach, and intestines.
The problem with visceral fat is that you can’t see it with the naked eye. Therefore, it’s hard to know how much of it we have. Dr. Sean O’Mara says one proxy for understanding visceral fat stores is how much subcutaneous fat or belly fat one has because what’s happening on the outside is often a sign of what’s happening on the inside. But as you’ll see next, this is not always the case!
TOFI (Thin on the Outside, Fat on the Inside)
There’s a certain subgroup of people who have higher-than-normal levels of visceral fat on the inside without much visible subcutaneous fat.
We call this TOFI, and it impacts men and women of all ages, races, and ethnicities. If you’re a lean individual but still eat a lot of ultra-processed food, drink alcohol, don’t get quality sleep, or spend most of your time being sedentary, these are risk factors for accumulating visceral fat.
It’s Possible to be Overweight and Healthy
If I’m mentioning TOFI, I have to also quickly touch on the fact that it is possible to be visibly overweight but have little visceral fat. Dr. O’Mara describes this phenomenon as being linked to diet quality. Excess calories from minimally processed whole-food sources tend to favor gaining subcutaneous fat over visceral fat. Comparatively, excess calorie intake from ultra-processed foods results in the gain of visceral fat (1).
The Role of Visceral Fat in Chronic Disease and Longevity
Visceral fat leaks inflammatory cytokines that travel to and negatively impact all other areas of the body, including the brain, heart, liver, and gut. These cytokines create a fire of inflammation, initiating a cascade of hormonal and metabolic destruction that results in more weight gain and inflammation.
Dr. O’Mara believes many chronic conditions we see today, such as Alzheimer’s, dementia, cancer, heart disease, and stroke, can be linked to visceral fat driving systemic inflammation.
When our organs are surrounded by visceral fat, the body has to work extra hard to deliver blood, nutrients, and oxygen to our tissues. And when combined with inflammation, this takes a massive toll on our healthspan and longevity.
The harder an organ has to work, the more oxidative stress it causes. More oxidative stress means more inflammation, which winds up aging us from the inside out. Now that we know what visceral fat is, let’s talk about what causes it.
Below, you’ll find the top five contributors to visceral fat, according to Dr. O’Mara.
The Top 5 Contributors to Visceral Fat
Ultra-processed foods. Ultra-processed foods are made from refined starch, sugar, salt, and fat, making them hyper-palatable and super easy to overconsume. Excess calories from ultra-processed foods contribute to visceral fat stores. Additionally, insulin resistance from eating a diet rich in ultra-processed foods increases fat deposits inside the abdomen.
Lack of quality sleep. Not getting enough quality sleep increases the risk of overeating the next day, especially foods high in starch and sugar. A 2022 crossover study found that sleep-deprived individuals ate, on average, 300 more calories per day and gained more body fat than their well-rested counterparts (2).
But where the participants gained weight was most interesting. CT scans (i.e., the best way to measure visceral fat) revealed that visceral fat accounted for most of the weight gained. Sleep deprivation combined with overeating appears to alter the way we store fat and favors the accumulation of visceral fat.
High stress levels. Psychological stress increases cortisol levels, which can negatively affect body fat distribution, causing it to be stored centrally around the organs. Many factors, such as lifestyle, genetics, sex, and age, affect our body’s sensitivity to cortisol and can increase our susceptibility to gaining visceral fat.
Past podcast guest and professor of psychiatry at UCSF, Elissa Epel, examined this idea in her landmark study. Women who were prone to stress had higher visceral fat levels regardless of whether they were lean or overweight. And those with higher visceral fat levels were more sensitive to life stressors (3).
Drinking alcohol. There is a dose-dependent relationship between alcohol consumption and visceral fat. Studies like this one in Japanese men show that the more someone drinks, the more visceral fat they accumulate. Dr. Sean O’Mara says this is due to the metabolic impact of alcohol. The more you drink, the more your metabolism is burdened, creating more stress, more cortisol, and more hormone disruption, which impairs fat metabolism and increases its deposit in and around the liver.
Being sedentary. A sedentary lifestyle is bad for many reasons: it increases insulin resistance, the risk for sarcopenia (muscle loss), osteoporosis (weak bones), and falls and fractures and is associated with more visceral fat. Research shows that time spent being sedentary is directly correlated to visceral fat, highlighting the importance of getting in regular physical activity throughout the day (4).
Now that we know what contributes to visceral fat, here’s a list of what we can do to reduce it:
Eat a whole-food diet and feed your gut microbiome. If you listen to my podcast, you know that eating a whole-food diet and minimizing ultra-processed food consumption is key for whole-body health. Focusing on this will pay massive dividends for shifting body composition, reducing visceral fat, and optimizing metabolic health.
What you might not know is that microbiome diversity from eating a variety of whole plant and fermented foods is linked to lower levels of visceral fat too.
In one study, visceral fat was more closely related to gut microbiome diversity than BMI or waist circumference (5). This means prioritizing dietary fiber and fermented foods and greatly reducing your intake of ultra-processed foods can aid in reducing visceral fat.
Prioritize sleep. Never underestimate the power of sleep, especially when it comes to fat loss. Programming your circadian rhythm with morning and evening sunlight, addressing sleep disorders, trying mouth taping, taking a magnesium supplement, and setting a caffeine curfew can do wonders for your sleep.
Find healthy ways to manage stress. This might be the most challenging visceral fat contributor to address because it is so personal. Find an activity or outlet that works best for you that allows you to reset, release, or channel your stress into something positive.
Exercise, meditation, lifting weights, walking, yoga, journaling, or even calling a friend can help lift the burden of stress. Additionally, if you can, working under the care of a licensed therapist can be extremely helpful.
Reduce or eliminate the consumption of alcohol. If you’re someone who drinks alcohol, no shame! I’m not here to judge, but I am here to inform you of the potential dangers that come with it.
Alcohol disrupts fat metabolism and increases visceral fat stores, especially around the gut and liver, which can lead to nonalcoholic fatty liver disease and metabolic dysfunction.
Regular alcohol consumption also increases the risk of cardiovascular and neurodegenerative disease, which Dr. O’Mara suggests could be due to the impact of visceral fat on the rest of our organs.
Need tips for reducing alcohol intake? Check out this newsletter for ideas. (Note: I have stress-tested many of these myself, and they’ve worked!)
Exercise for at least 150 minutes per week. This is the minimal viable dose, according to experts, to reap the benefits of exercise. Try a combination of resistance training (2–3 days a week), HIIT workouts, and zone 2 cardio (e.g., brisk walking, biking, or jogging) to meet your weekly exercise goals.
For HIIT workouts, if you can, try incorporating some safe form of sprinting. Dr. O’Mara says he’s found this to be an extra-special type of exercise for targeting and reducing visceral fat. If you’ve never done sprints before, Dr. O’Mara further explains its benefits here and how to work your way up to incorporating sprints in your exercise regime.
If that’s not accessible to you at the moment, no worries! Engaging in some form of movement is better than none at all.
The more I learn about visceral fat, the more excited I am for it to one day make its way into standard conventional medicine practice. My hope is that in the future anyone can walk into their doctor’s office and have their visceral fat measured using MRI technology.
When matched with education, this can help the patient make changes to their diet and lifestyle early on before chronic disease develops. We’re not there yet, but that’s why it’s so important to do what we can to help spread awareness on this topic.
Here’s to your health,