You don’t need to be overweight to be inflamed, fatigued, or at risk for a heart attack. That’s the uncomfortable truth behind visceral fat — a type of body fat most people have never heard of, yet almost everyone carries to some degree. Unlike the fat you can pinch under your skin, visceral fat is stored deep in the abdominal cavity, wrapped around vital organs like the liver, pancreas, and intestines. And it’s more than cosmetic — it’s metabolically dangerous.
“Visceral fat is like a furnace pumping out low-grade inflammation,” says Dr. Eric Westman, a physician and obesity researcher at Duke University. “It’s not just about weight. This type of fat raises your risk of heart disease, stroke, and insulin resistance — even if you’re not visibly overweight.”
In fact, many people with high visceral fat levels look perfectly normal on the outside. This has led to the acronym TOFI, or “Thin Outside, Fat Inside” — describing those who appear lean but are metabolically compromised. These individuals often struggle with unexplained fatigue, brain fog, high blood pressure, or prediabetes despite having a so-called “healthy” weight.
What’s the Difference Between Visceral and Subcutaneous Fat?
Subcutaneous fat sits just beneath the skin and is what most people associate with body fat. It’s what jiggles, what gets pinched, and what you lose visibly when dieting. Visceral fat, by contrast, hides beneath the abdominal muscles and builds up internally around your organs.
This deep fat layer is particularly harmful because it secretes inflammatory molecules — including cytokines like interleukin-6 and tumor necrosis factor-alpha — that can disrupt everything from hormone regulation to cardiovascular function. Over time, visceral fat is linked to atherosclerosis (hardening of the arteries), fatty liver, insulin resistance, and cognitive decline.
In Vermont, where many meals lean heavily on starches — from potatoes to homemade bread and pantry grains — the quiet buildup of visceral fat often goes unnoticed. According to national dietary trend data, carbohydrates (particularly refined starches and sugars) remain the leading source of calories in New England, especially among older adults. That matters, because visceral fat tends to accumulate most in response to high-carb, high-insulin lifestyles — not necessarily high-calorie ones.
Signs You Might Be Carrying Hidden Visceral Fat
Because visceral fat hides beneath the surface, it doesn’t always show up as a large belly. However, a widening waistline is one of the strongest indicators. Doctors often rely on waist circumference as a proxy for visceral fat, with thresholds around 40 inches for men and 35 inches for women considered high-risk.
Other clues include:
- Skin tags or darkened skin folds (acanthosis nigricans)
- Elevated fasting blood glucose or triglycerides
- Irregular menstrual cycles (in women), especially when linked to PCOS
- Restless sleep or obstructive sleep apnea
- Poor exercise recovery or increasing stiffness with age
Dr. Westman notes that even in lean patients, subtle signs like skin tags or persistent fatigue often point to metabolic dysfunction below the surface.
Another indicator, popularized by researcher Dr. Sean O’Mara, is deep subcutaneous fat in the lower back, also known as “love handles.” Pushing (not pinching) the tissue around the lower flanks can sometimes reveal firm, deep fat deposits that correlate with visceral fat seen on MRI scans.
Fatty Liver Rarely Stands Alone
While fatty liver disease has become increasingly recognized, it rarely occurs in isolation. Dr. Ken Berry, a Tennessee-based physician and author, often reminds patients that a fatty liver usually signals fat buildup elsewhere — including the pancreas, heart, kidneys, and even skeletal muscle. These infiltrations, known as myosteatosis, are linked to declining strength, insulin resistance, and faster aging.
“If you’ve got fat in your liver, chances are good it’s in other organs too — it’s just not being measured,” Berry says.
That systemic infiltration may explain why so many people over 40 report feeling older than their age. The loss of energy, resilience, and clarity often blamed on “just getting older” may, in fact, be a sign of internal inflammation driven by visceral fat.
How to Get Rid of Visceral Fat
The good news is that visceral fat responds quickly and consistently to dietary intervention — especially when insulin levels drop.
The most evidence-supported approach? A low-carbohydrate or ketogenic diet. Dr. Westman has used this method in his clinic for over 15 years.
“In head-to-head trials, low-carb diets either outperform or match low-fat diets for fat loss, and they work particularly well at reducing visceral fat,” he explains. “The hunger suppression is a big part of that — people eat less without even trying.”
Other helpful strategies include:
- Cutting processed foods, especially refined grains and seed oils
- Time-restricted eating or intermittent fasting
- Fermented foods, which support gut health and reduce systemic inflammation
- Avoiding sugar-sweetened beverages and frequent snacking
You don’t need to run marathons — in fact, long-duration cardio may preserve visceral fat more than it burns, according to some recent imaging studies. The key is to stop feeding the fire with carbs, ultra-processed oils, and constant insulin spikes.
Dave Soulia | FYIVT
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