Fat is not simply passive storage

It is easy to think of body fat as somewhere the body stores excess energy.

But adipose tissue is biologically active.

It releases signalling molecules and interacts with systems involved in:

• energy regulation
• inflammation
• insulin sensitivity
• lipid metabolism
• hormone signalling

Visceral fat is particularly relevant because of its location and metabolic activity.

Higher levels are associated with patterns such as:

• insulin resistance
• raised triglycerides
• lower HDL cholesterol
• raised blood pressure
• increased risk of type 2 diabetes
• increased cardiovascular risk

This does not mean that visceral fat itself is the sole cause of these conditions.

Metabolic disease is multifactorial.

But visceral adiposity can be an important part of the overall risk picture.

Why can visceral fat matter more than body weight?

A set of scales tells us total body weight.

It does not tell us what that weight is made from.

Body weight includes:

• muscle
• fat
• bone
• organs
• body water

Nor does BMI tell us precisely where fat is being stored.

Two people can have the same BMI but very different levels of muscle, subcutaneous fat and visceral fat.

That is why current UK guidance also considers central adiposity, not BMI alone, when assessing health risk.

For many adults with a BMI below 35, NICE recommends using waist-to-height ratio alongside BMI to help assess central adiposity.

A simple public-health message is:

keep your waist circumference to less than half your height.

This is a screening tool rather than a diagnosis, but it can add useful information to the wider picture.

Why does visceral fat affect metabolic health?

One important difference between visceral and subcutaneous fat is where it drains.

Visceral fat is closely connected to the portal circulation, which carries blood towards the liver.

This means fatty acids and signalling molecules released from visceral adipose tissue can have particularly direct effects on liver metabolism.

Higher visceral fat is associated with:

• increased release of free fatty acids
• changes in inflammatory signalling
• altered lipid metabolism
• reduced insulin sensitivity

Over time, these processes can form part of the pattern seen in metabolic dysfunction.

This is one reason I do not look at abdominal weight gain purely as a cosmetic issue.

The health significance depends on the whole picture.

Visceral fat and insulin resistance

Insulin helps move glucose out of the bloodstream and into cells where it can be used or stored.

When cells become less responsive to insulin, the pancreas may need to produce more insulin to achieve the same effect.

This is known as insulin resistance.

Visceral adiposity and insulin resistance often occur together.

Higher visceral fat can contribute to a metabolic environment associated with reduced insulin sensitivity, while insulin resistance itself can also influence how energy is stored.

That relationship is not always one-directional.

It is part of a wider metabolic pattern involving:

• liver
• muscle
• adipose tissue
• physical activity
• diet
• genetics
• sleep
• hormones
• overall energy balance

[Explore: What is insulin resistance? →]

Why does visceral fat become particularly relevant in midlife?

Many women notice that fat distribution changes through perimenopause and menopause.

They may say:

“I haven't gained much weight, but everything seems to have moved to my middle.”

That observation has physiological support.

Research across the menopausal transition has found increases in central and visceral fat, alongside broader changes in body composition. Meta-analysis has also shown increases in waist circumference and visceral fat between pre- and postmenopausal groups.

More recent research continues to report greater central adiposity after menopause.

Importantly, this does not mean menopause is the only explanation.

Ageing, movement, muscle mass, nutrition, sleep and overall energy balance also influence body composition.

A more accurate way to think about it is:

menopausal hormonal change occurs within a wider midlife metabolic transition.

Oestrogen and fat distribution

Oestrogen appears to have a role in body-fat distribution.

Before menopause, women are more likely to store a greater proportion of fat subcutaneously around the hips and thighs.

As ovarian oestrogen production declines, fat distribution can shift towards a more central pattern.

But this should not be reduced to:

“Low oestrogen causes belly fat.”

The real picture includes:

• hormonal change
• ageing
• muscle loss
• physical activity
• sleep
• diet
• alcohol
• stress
• genetics
• total energy balance

That is why a woman experiencing abdominal body-composition changes does not automatically need a hormone test or a restrictive diet.

She needs context.

[Explore: Perimenopause and metabolism →]

Muscle belongs in this conversation too

If the goal is healthier body composition, we cannot focus only on fat.

We also need to think about muscle.

Skeletal muscle is an important site for glucose uptake and contributes to metabolic health.

Resistance training can help maintain or increase muscle while also supporting body composition and function.

So rather than thinking:

“How do I get rid of belly fat?”

I prefer to widen the question:

How can we reduce excess fat while protecting or building muscle?

That leads to a very different strategy.

It shifts the emphasis away from increasingly restrictive dieting and towards:

• adequate protein
• resistance training
• everyday movement
• appropriate overall energy intake
• sleep
• metabolic health

[Explore: Protein and muscle through midlife →]

Can you tell if you have visceral fat by looking?

Not reliably.

Someone can appear relatively slim and still carry more visceral fat than expected.

Another person may carry considerable subcutaneous fat but have a different metabolic profile.

That is why appearance alone is not a useful clinical assessment.

There are several ways central or visceral adiposity may be estimated or measured.

Waist circumference

Waist circumference is one of the simplest ways to assess central adiposity.

It does not measure visceral fat directly.

However, because it provides information about abdominal fat distribution, it can be a useful practical marker alongside other health information.

Changes in waist circumference over time can sometimes be more informative than changes on the scales alone.

Waist-to-height ratio

Waist-to-height ratio compares your waist measurement with your height.

Current NICE guidance recommends it alongside BMI in certain adults as a practical way of assessing central adiposity.

The simple calculation is:

waist circumference ÷ height

using the same units for both.

A ratio below 0.5 is generally used as a public-health target.

In plain language:

aim to keep your waist smaller than half your height.

This is not a diagnostic test, and it should not be interpreted in isolation.

Body-composition measurements

Some body-composition devices estimate visceral fat.

These can sometimes be useful for tracking broad trends, but results vary according to the technology used and conditions at the time of testing.

Hydration, recent food intake and other factors can affect some measurements.

I therefore prefer to use body-composition data as one source of information, rather than treating a single number as an absolute truth.

Imaging

CT and MRI can measure visceral adipose tissue much more directly and are often used in research.

They are not routinely required simply to assess visceral fat in everyday nutritional practice.

Again, more sophisticated testing is not automatically more useful.

The question should always be:

Will this information change what we do?

What health markers do I look at alongside central adiposity?

Waist or body composition becomes more meaningful when considered alongside metabolic markers.

Depending on the individual and what information is already available, I may be interested in results such as:

• fasting glucose
• HbA1c
• triglycerides
• HDL cholesterol
• wider lipid profile
• blood pressure
• liver markers
• relevant thyroid results

No single one of these tells us whether someone is metabolically healthy.

The pattern matters.

How can visceral fat be influenced?

Visceral fat is responsive to changes in energy balance and lifestyle.

There is no food, supplement or exercise that selectively “melts” visceral fat from the abdomen.

Spot reduction is not how human physiology works.

Instead, we look at the behaviours and metabolic factors that influence overall and central body fat.

Resistance training

Resistance exercise deserves a place in almost every midlife body-composition conversation.

It helps provide the stimulus needed to preserve and build muscle.

That matters because the goal should ideally be:

improve fat mass while protecting lean mass.

Body weight alone cannot tell us whether we are doing that successfully.

Aerobic activity and everyday movement

Walking, cycling, swimming and other aerobic activity can contribute to overall energy expenditure and cardiovascular health.

Everyday movement matters too.

A person can exercise several times each week and still spend most of the remaining day sedentary.

For metabolic health, I am interested in the whole week — not simply formal exercise sessions.

Nutrition

There is no special “visceral fat diet”.

A useful nutritional strategy usually considers:

• overall energy intake
• adequate protein
• fibre
• vegetables and fruit
• wholegrains and pulses where appropriate
• minimally processed foods
• dietary fat quality
• alcohol
• meal structure
• sustainability

The appropriate balance will vary from one person to another.

What I would avoid is responding to abdominal weight gain with progressively more restrictive eating without considering muscle, nourishment or long-term sustainability.

Protein

Adequate protein can be particularly useful when someone is trying to improve body composition while maintaining muscle.

Protein itself does not specifically burn visceral fat.

Its role is part of a wider nutritional strategy that supports:

• muscle maintenance
• satiety
• recovery from resistance training
• overall diet quality

[Explore: Protein and muscle through midlife →]

Fibre and plant foods

Fibre-rich foods can support digestive, cardiovascular and metabolic health as part of the wider diet.

Useful sources include:

• vegetables
• fruit
• beans
• lentils
• wholegrains
• nuts
• seeds

Again, variety and overall dietary pattern matter more than finding one particular “fat-burning” food.

Alcohol

Alcohol can be relevant to body composition for several reasons.

It contributes energy, may affect food choices and appetite, and can also influence sleep.

For someone concerned about central weight gain, it can therefore be worth looking honestly at both quantity and frequency.

That does not automatically mean eliminating alcohol.

It means including it in the overall assessment.

Sleep

Sleep belongs in the visceral-fat conversation.

Persistent poor sleep can influence:

• appetite regulation
• food choices
• glucose regulation
• energy
• motivation to exercise

For women in perimenopause, sleep disruption may be particularly relevant because night sweats and other menopausal symptoms can make good sleep harder to achieve.

This is a good example of why simply telling someone to “eat less and move more” can miss important parts of the picture.

Stress

Stress is another area where health messaging can become exaggerated.

Stress does not automatically “cause belly fat” simply because cortisol exists.

But chronic stress can influence:

• sleep
• appetite
• alcohol consumption
• eating behaviour
• activity
• recovery

Those behavioural and physiological effects can influence body composition over time.

So stress deserves consideration — without blaming cortisol for everything.

What I look at in practice

When a client is concerned about abdominal weight gain or visceral fat, I do not start with the assumption that she needs a stricter diet.

I want to understand the wider pattern.

What has changed?

Has weight increased, or has body shape changed despite relatively stable weight?

When did that change begin?

Where are you in midlife?

Has the change coincided with perimenopause, menopause or another life transition?

What is happening with muscle?

Are you resistance training?

Has strength declined?

Has activity changed?

What does your diet actually look like?

Are you eating enough protein?

How much fibre?

How much alcohol?

Are meals satisfying?

Are repeated attempts at calorie restriction affecting the overall pattern?

How are you sleeping?

Poor sleep can affect both behaviour and metabolic physiology.

What health information do we already have?

Waist measurements and existing GP blood results may already tell us a great deal.

Additional testing is only useful if it answers a meaningful question.

Jo's perspective

When women tell me that their middle has changed through midlife, I think it is important not to dismiss the experience as simply “getting older” — but equally important not to blame everything on hormones.

I want to know what has changed across the whole picture.

Hormones matter.

But so do muscle, sleep, movement, food, alcohol, glucose regulation, health history and genetics.

And I rarely think the best answer is simply to make the diet smaller and smaller.

The more useful goal is:

less emphasis on weighing less, and more emphasis on building a healthier body composition.

That means thinking about what we want to reduce and what we want to protect.

For many women, that means reducing excess central fat while protecting muscle, strength and nourishment.

What can you realistically focus on?

For many people, useful foundations include:

• resistance training regularly
• remaining active throughout the day
• eating enough protein
• building meals around whole, nutrient-dense foods
• including plenty of fibre-rich plant foods
• reviewing alcohol intake
• supporting sleep
• avoiding repeated extreme diets
• looking at waist and body composition alongside weight
• reviewing metabolic health markers where appropriate

The best starting point will depend on the individual.

When should you speak to your GP?

Changes around the abdomen are common, particularly through midlife, but unexplained or rapid changes should not automatically be attributed to visceral fat or menopause.

Speak to your GP if you have:

• unexplained or rapid weight change
• persistent abdominal swelling or bloating
• abdominal pain
• symptoms of diabetes
• concerns about blood pressure or cholesterol
• abnormal blood-test results
• symptoms that are new, severe or concerning

Nutritional therapy should complement appropriate medical assessment rather than replace it.

Connect the dots

Perimenopause and metabolism

Why hormonal change, ageing, muscle, sleep and activity all influence the wider metabolic picture.

[Read the guide →]

What is insulin resistance?

Understand how glucose, insulin, muscle and adipose tissue interact.

[Read the guide →]

Protein and muscle through midlife

Why body composition is about protecting muscle as well as reducing excess fat.

[Read the guide →]

Understanding blood glucose and HbA1c

What these markers can tell us about glucose regulation.

[Read the guide →]

Want to understand your own body-composition picture?

Your Body Library can explain the science.

But it cannot tell you why your body composition may be changing.

If you would like personalised support, I can help you look at your nutrition, movement, muscle, sleep, health history and relevant results together and identify where attention may be most useful.

[Explore nutritional therapy →]

[Book a discovery call →]

This page is for educational purposes and is not a substitute for medical diagnosis or treatment. If you have symptoms or health concerns requiring medical assessment, please speak to your GP or another appropriate healthcare professional.

References & further reading

• NICE. Overweight and obesity management (NG246). Guidance on identifying and assessing overweight, obesity and central adiposity.
• NHS. Overweight and obesity in adults.
• NHS. Waist-to-height ratio calculator.
• Ambikairajah A et al. Fat mass changes during menopause: a meta-analysis. Menopause. 2019.
• Abdulnour J et al. The effect of the menopausal transition on body composition and cardiometabolic risk factors. Menopause. 2012.
• Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiological Reviews. 2013.
• Neeland IJ et al. Research examining visceral and abdominal subcutaneous adipose tissue and cardiometabolic risk.
• Szeliga A et al. The impact of the menopausal transition on body composition. 2026.