Abdominal fat is not all the same
When people talk about "belly fat", many first think of the visible padding around the waist. In medicine, however, two very different types of adipose tissue in the abdominal area are distinguished: subcutaneous fat directly beneath the skin, and visceral fat, which lies deeper in the abdomen and surrounds the internal organs. Both fat depots fulfil important functions – they store energy, cushion organs and are involved in hormonal processes. Yet not every form of fat distribution is of equal significance from a health perspective.
In recent years, research has shown that an increased proportion of visceral fat in particular has been linked to various metabolic changes. Those wishing to reduce their abdominal fat therefore benefit from understanding the underlying mechanisms and how to make a rough assessment of their own situation.
Subcutaneous and visceral fat compared
Subcutaneous fat – the fat beneath the skin
Subcutaneous adipose tissue lies directly beneath the surface of the skin and is the fat that can be seen in the mirror or felt between the fingers. It serves as an energy store, as thermal insulation and as mechanical padding. In moderate amounts it fulfils important roles and is considered metabolically active, but less problematic than the deeper abdominal fat.
Visceral fat – the fat surrounding the organs
Visceral fat is located within the abdominal cavity and surrounds organs such as the liver, pancreas and intestines. It is not directly visible or palpable from the outside. Even slim people may have an increased proportion of visceral fat – a situation sometimes described as "TOFI" (thin outside, fat inside). Conversely, there are people with a higher body weight whose visceral fat depot is comparatively small.
Visceral adipose tissue is hormonally very active. It releases messenger substances – known as adipokines – as well as inflammatory mediators, which can affect metabolism and blood vessels to varying degrees.
Why fat distribution matters for health
An increased proportion of visceral fat has been associated in the scientific literature with various changes. These include, among others:
- Changes in insulin sensitivity, which in the long term are associated with an increased risk of type 2 diabetes
- Unfavourable changes in blood lipid levels, such as elevated triglycerides or lower HDL cholesterol
- Elevated blood pressure
- Low-grade, chronic inflammatory processes in the body
- A higher statistical risk of cardiovascular disease
When several of these factors occur together, doctors refer to this as the metabolic syndrome. This does not mean that every person with a slightly larger waist circumference will automatically fall ill – the relationships are complex and are additionally influenced by genetics, physical activity, diet, sleep and stress. A more favourable fat distribution can, however, be an important building block for long-term health.
Apple and pear types
Colloquially, a distinction is often drawn between the "apple type" (fat accumulation mainly around the abdomen) and the "pear type" (fat more on the hips and thighs). The apple type statistically more often goes hand in hand with a higher proportion of visceral fat. This classification is simplified, but can serve as initial guidance in everyday life.
Waist circumference and health: a simple measurement with meaningful insight
While a precise determination of the visceral fat content is only possible using imaging methods such as MRI or computed tomography, waist circumference can easily be measured at home. Waist circumference is considered a practical indicator of fat distribution and complements the body mass index (BMI), which alone does not adequately reflect body composition.
How to measure correctly
- Measure in the morning, on an empty stomach and while standing
- Place the tape measure horizontally around the abdomen, roughly halfway between the lower edge of the rib cage and the upper edge of the iliac crest
- Breathe out calmly and do not pull in your stomach
- The tape should sit snugly but not constrict
Reference values
The World Health Organization (WHO) gives the following reference values for adults:
- Women: slightly increased risk from 80 cm, markedly increased risk from 88 cm
- Men: slightly increased risk from 94 cm, markedly increased risk from 102 cm
These values are points of orientation, not rigid thresholds. They do not replace an individual medical assessment, but can be a reason for a conversation with your general practitioner.
In addition, the waist-to-height ratio is often used: a value below 0.5 is generally considered favourable.
Reducing abdominal fat: what the research shows
Those who wish to reduce their visceral fat content should have realistic expectations. Quick promises or one-sided "miracle diets" rarely deliver what they claim. However, studies suggest that visceral fat often responds particularly well to lifestyle changes – frequently even before changes become clearly visible on the scales.
Well-evidenced approaches that can contribute to the reduction of abdominal fat include:
- Regular physical activity: A combination of endurance and strength training is generally recommended. Everyday activity such as walking and taking the stairs is also helpful.
- A balanced diet: Plenty of vegetables, pulses, wholegrain products, fruit in moderation, healthy plant-based oils, fish and moderate amounts of animal products – similar to the Mediterranean diet. Highly processed foods, sugary drinks and excessive alcohol consumption should be reduced.
- Sufficient and regular sleep: Lack of sleep can have an unfavourable influence on metabolism.
- Stress management: Chronic stress is linked to changes in hormone balance, which can also affect fat distribution.
- Avoiding smoking: Smoking has been associated with a less favourable fat distribution.
Targeted exercises for the abdominal muscles do strengthen this muscle group, but they do not lead to the selective breakdown of fat at precisely that location – a phenomenon known as "spot reduction", which has not been scientifically confirmed. Body fat is generally reduced holistically.
When medical assessment is advisable
An increased waist circumference is not in itself a disease, but it can be a reason to review further values such as blood pressure, blood sugar and blood lipids together with your doctor. Regular check-ups are particularly recommended for people with a family history of diabetes or cardiovascular disease. Those who notice no changes despite lifestyle adjustments should also seek advice in order to clarify individual causes.
Conclusion
The distribution of body fat is often more informative for health than overall weight alone. In particular, visceral fat in the abdomen is the focus of research, as it is metabolically active and is associated with various risk factors. Waist circumference provides a simple, practical point of orientation. Anyone who focuses on a balanced diet, regular physical activity, sufficient sleep and a mindful approach to stress is laying a good foundation for reducing abdominal fat in the long term and supporting their health.
This article does not replace medical advice.