We all carry fat, but it is not how much fat you carry but where you carry it that determines its threat?  Fat in and around your vital organs often leads to serious health issues.  Even if you are “thin” on the outside.

Fat storage has been a blessing throughout human history: our caveman ancestors stored excess calories during the abundance of summer to ensure survival during the scarcity of winter.  Women store fat around the hips to use during times of increased demand in pregnancy and lactation.

Excess calories can be stored as fat in the subcutaneous tissue (under the skin).  This healthy fat, stored in the right place, constitutes a strategic energy reserve.  However, fat accumulation in the abdomen (belly fat) alters your metabolism and hastens the development of metabolic syndrome, which is common among both outwardly obese and slim people.

Studies have confirmed that 40% of thin people have metabolic syndrome – these are usually described as Thin from the Outside and fat from the Inside (TOFI).

Belly fat is a warning sign that your health is in jeopardy.  Starting out as a metabolic dysfunction, belly fat becomes the cause of high blood pressure, high cholesterol, diabetes, and dementia.  It’s a common feature in patients suffering from heart attack and stroke.

In this blog, we will discuss how the human race’s survival trick has turned into a disease trap.  We will explain what foods and other lifestyle choices can wreak havoc with your metabolism, resulting in central obesity and increasing your risk of serious health issues.  We shall explore what you can do to eliminate belly fat, avoid metabolic problems, and decrease your disease risk.  

Andy, a 45-year-old gentleman, was in good health, apart from mild symptoms of indigestion.  However, he was very concerned about recent blood tests arranged by his GP that reported abnormal liver function and borderline sugar and cholesterol levels.  Andy has a family history of early death: his father died of a heart attack at the age of 46, and his mother died of liver cirrhosis in her 50s, although, strangely, she did not drink alcohol.

Andy admitted his diet was high in carbohydrates.  He also found it very difficult to do any exercise due to a busy job, working from home.  Being at home also made him more aware of his family’s daily tribulations, causing stress.  Therefore, he frequently worked very late, negatively impacting his sleep.  He did not drink alcohol but regularly snacked on crisps, cakes, and chocolate.  He is not on any medication that could cause liver damage.

On examination, his body weight was 75kg, and his BMI was 24.5 (normal), but with a waist of 41.5 and hip of 40, his WHR (waist-hip ratio) was very high at 1.05 (normal is less than 0.9 in men.)  This indicated fat accumulation in the abdomen, and further evaluation with an abdominal ultrasound scan confirmed fatty liver.

Routine blood tests showed abnormal liver function with high liver enzymes – ALT at 73 (normal under 40) and AST at 99 (normal under 40); blood sugar was prediabetic at 6.2 (normal is less than 6), but haemoglobin A1 C reflects that blood sugar control over the last three months was 5.9 (normal is under 5.5), high fasting insulin level at 21 (normal is under 5), low HDL (the good guy) at 0.95, triglyceride (another risk factor for vascular disease) was significantly high at 3.3 (normal is under 1.7.)

Shifting our focus on fat storage

Jean Vague, a French physician 1947, made the first observation that central obesity led to the development of diabetes, heart disease and gout.  Advising a low-carb diet, she helped her patients improve their diabetic control and lower triglycerides and cholesterol levels.

Her research shifted our focus from how much fat is stored in your body, reflected in body weight, to where the fat is stored.  Fat accumulation in the abdomen (belly fat) alters the body shape.  An expansion in the waistline results in Android (male-type obesity) or Apple body configuration.

Calories from complex carbs, high in fibre and nutrients, are generally stored in the subcutaneous tissue (under the skin) without any adverse effects.  However, the wrong calories, like sugar and refined carbs, are stored in the abdominal cavity (belly fat) with serious health consequences.

One study confirmed that central obesity and low HDL (the good guy cholesterol) were the earliest signs of metabolic dysfunction.  High blood pressure and blood sugar occur later in the process.

Causes of central obesity

The Western diet of energy-dense food – sugar, processed carbs (bread, rice, pasta, pizza) – low in fibre and nutrients – stimulates sugar spikes and crashes, resulting in excessive craving and frequent hunger, with no sense of fullness, leading to larger portions.  This results in belly fat accumulation, particularly if combined with a sedentary lifestyle and low physical activity.  Also to blame is the excessive consumption of commercial fruit juice and soda, particularly those sweetened with high fructose corn syrup (HFCS).  There is also enough evidence to implicate fried food and trans-fat.

Alcohol consumption is very well known to cause belly fat accumulation.  “Beer belly” is, in fact, a medically sound term!  Alcohol contains a high 7 calories per gram, increasing cortisol (stress hormone) and compromising sleep.  One study reported that an intake of over four litres of beer per week is associated with a higher degree of abdominal obesity, particularly among men.

Chronic stress, a common feature of modern life, triggers comfort eating.  It stimulates the appetite for processed energy-dense, palatable food causing central obesity.  Again, activation of the stress response and release of cortisol also leads to the accumulation of visceral fat.

How belly fat increases the risk of chronic diseases

Fatty liver occurs when fat builds up there, often directly from the consumption of high fructose corn syrup (HFCS).  HFCS triggers lipogenesis (fat synthesis) to deposit fat in the liver.  A normal-weight person transports fat that is within their liver’s capacity to process.  However, having excess visceral fat, you continue sending large amounts to the liver, leading to fat accumulation and the development of non-alcoholic fatty liver disease (NAFLD).

Mild fatty liver does not show any symptoms in the early stages.  It starts to cause significant effects when the liver fat content exceeds 5% of its weight.  The condition affects 30% of the population, but worryingly, 10% of children in the UK have mild fatty liver disease.

Symptoms can include fatigue, fluctuations in energy, particularly feeling sleepy after a meal, a significant afternoon dip, Gynecomastia (man boobs), pain or discomfort in the right upper quadrant of the abdomen, and in the later stages, liver palms (red palms), prominent veins under the skin, jaundice, enlarged spleen and swollen ankles.

The condition progresses from simple inflammation of liver cells to liver damage and scarring.  With extensive scarring, it progresses to fibrosis and, later, the more serious liver cirrhosis.  The latter stages can be associated with high mortality.  Liver cirrhosis can be complicated by liver failure or even liver cancer.

Having a fatty liver would also imply having fatty muscles, which can also interfere with insulin signalling, negatively impacting muscle function.

Your muscles and the liver are the biggest consumers of glucose.  As both become insulin resistant, insulin levels are raised, leading to high blood pressure and high blood glucose (two components of the metabolic syndrome.)

With the two biggest consumers of glucose effectively shutting down, most of the glucose will be converted into the standard type of fat, triglyceride, raising its level (another metabolic syndrome risk factor.)

By contrast, subcutaneous fat releases fat more slowly into the general circulation, reaching the liver in lower concentration and, therefore, being less likely to cause damage.

“The wider your waist, the smaller your brain” 

I was very impressed when one of my patients said he was attending the clinic because “I want to avoid diabetes and dementia in the future.”  I think that the link between weight gain and diabetes is common knowledge, but I was interested to find out how my patient made a link between belly fat and dementia.  My patient quoted a ground-breaking study that concluded: “The wider your waist size is, the smaller your brain size will be.”

Indeed, a study examining over 700 adults found that a higher volume of visceral fat, regardless of whether the person was overweight, was associated with a smaller brain volume and an increased risk of dementia.

Similarly, with asthma, fat accumulation in the middle causes a decreased tidal volume, due to reduced chest expansion, with a flat diaphragm and weight on the chest.  In one study, 75% of patients treated for asthma in emergency departments were found to be either overweight or obese.

How to reverse central obesity 

You can help your fatty liver by losing weight, eating a healthy diet and exercising adequately.

Burning fat is good, but ideally, you should aim to trade fat for muscle.  Having a bigger muscle mass to support, with stable body weight, raises your basal metabolic rate (BMR), burning more fat, even whilst asleep.

Cut back on fake factory food (sugar and refined carbohydrates).  Replace them with real food, high in fibre and nutrients, such as fruit and vegetables, beans and legumes, nuts and seeds.  Eat adequate amounts of plant and animal proteins per meal to curb appetite and lower insulin levels.  Studies have demonstrated the benefit of the Mediterranean diet.

Monounsaturated fatty acids in avocado, olive oil, nuts and seeds were found to promote fat burning.  The EGCG in green tea also reduces liver inflammation and fat content.

A study showed that taking Berberine 500mg three times daily, combined with physical activity of 150 minutes per week, reduced liver fat by 52% in a 16-week intervention.

Omega 3 fish oil with EPA and DHA in sardines, salmon and herrings help reduce liver fat content.  Studies confirmed that a dose of 2 to 4g daily reduced fatty liver by 33%.

Soluble fibre gives a sense of fullness, slowing down the absorption of sugar and fat.  Feed your beneficial gut bacteria to produce short-chain fatty acids (SCFA), which boost fat burning.  A study demonstrated that taking 10g of soluble fibre daily reduced belly fat by 3.7%.

So, my friends, you can see that where you carry fat is far more important to your health than how much you carry.  But, again, simple lifestyle changes can prevent or reverse your central obesity.  As always, please ask any questions in the Comment section below – and please subscribe to the newsletter so that you don’t miss further vital information.  Thank you!



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Cubeddu L, Hoffmann I. Metabolic Syndrome: An All or None or a Continuum Load of Risk?

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