Medical Associates Clinic

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Gettysburg Medical News
The Clinical View
31 January 2007
by Phillip Hoffsten 

What is Visceral Fat?

            A patient recently came to the clinic for his yearly physical exam.  Like two thirds of our population he was substantially overweight at 230 pounds and five feet 10 inches tall.  He was a hard working farmer/rancher, very solid build but with more of a tummy (beer belly) than he wanted.  He made jokes about not being too fat; he said he was just too short.  He had gained 3-4 pounds per year for a full 8 years that I graphed out for him using the clinic records.  I also showed him the waist size of 44 inches now as compared to a waist size of 37 inches he had at the time of an insurance exam in 1998.  I pointed out that at 56 years of age he was a prime candidate for the early age heart attack at least partly because of all his “visceral fat”.  He looked a little confused and said fat was fat; what did I mean “visceral fat”?

            So I described for him the observation made by Dr. Jean Hague at the University of  Marseille in France fifty years ago.  Dr. Hague noted that there was male pattern obesity where the fat was primarily in the abdomen.  He called this “android obesity” and it came to be called apple shaped obesity.  It tended to occur in men and was associated with high blood pressure, diabetes mellitus, and high blood cholesterols which were markers for early age heart attacks.  These men had most of their fat on the inside of the abdomen sandwiched in between the layers of the guts.  Since the “guts” are scientifically called the “viscera”, this fat has come to be called “visceral fat”.  Because of the association with early age heart attacks, visceral fat is dangerous stuff.

            Dr. Hague noted that there was another pattern of fat deposition seen commonly in premenopausal women where the fat tended to deposit on the hips and thighs.  This female pattern of obesity came to be called pear shaped obesity.  These women tended to have relatively small waists even though they could weigh 230 pounds just like their husbands.  Unlike their husbands these very overweight women did not have diabetes mellitus, high blood pressure, or high cholesterols.  Most strikingly they did not have early age heart attacks.  Dr. Hague coined the term “gynoid obesity” to describe this kind of fat distribution.

            Some women also have the male pattern “android obesity” and it is every bit as disease causing in them as it is in men.  In addition to predisposing to early age heart attacks, visceral fat is associated with heart failure, Alzheimer’s disease, colon cancer, gall stones, breast cancer, sleep apnea, and “all cause mortality” in both men and women.

            International studies involving 180,000 patients have shown that if a man has waist circumference greater than 40 inches, he has abnormally increased amounts of visceral fat.  For a woman, a waist circumference greater than 35 inches is a marker for increased visceral fat.  With a waist circumference of 44 inches, the gentleman above was told he was now a card carrying member of the “visceral fat club”.  I could tell him as much about his risks just from his waist size as I could by measuring his cholesterol, his blood pressure, or his blood sugar.  More than a 40 inch waist size, the man is at increased risk of early age disease.

            The conversation then got philosophical as he asked how in the world one kind of fat seemed to cause disease and the other did not.  I told him that we do not know why, but that visceral fat functions as a gland like the thyroid or the adrenals or the testis/ovaries, etc.  The difference was that those glands secret hormones that are beneficial to the body.  Visceral fat has been found to secret a number of hormones and inflammatory substances that are harmful for blood vessels in the body and lead to blockages causing heart attacks, strokes, and peripheral vascular disease.  In addition, visceral fat is associated with the person becoming insulin insensitive; in other words, in a person with larger amounts of visceral fat, insulin just does not lower blood sugars like it should and the person becomes diabetic

            To develop this inquiry further, studies have now been done in mice and then confirmed in humans that show marked genetic differences between visceral fat cells from the abdomen and fat cells from the thighs.  Scientists can now predict the fat pattern distribution of the person just by analyzing the genetic make up of the fat cells.

          All this high powered research does not even begin to answer the question of how to deal with visceral fat.  The age old answer of “eat less and exercise more” is still all we have. The sad truth is that eating less is the most important part of this advice.  You only burn 100 calories per mile walked.  Fat is worth 4000 calories per pound; to burn a pound of fat costs a 40 mile walk!!  Cutting calories by one meal per day loses a pound a week.                 Developing research on “trans” fats now seems to show they are flat out poisonous causing a disproportionate amount of visceral fat.  Note New York City has outlawed the use of trans fats to make French fries and other fried foods.  Whether this will have an impact is still in the testing stage but it is a start.  Speaking for myself, I believe that trans fat is a problem and would think it is something we ought to consider getting rid of in South Dakota.

            The gentleman above was told about all of this.  I am not sure if he “heard” any of it.  But, fate willing, he will be back next year and then maybe his “hearing defect” will be improved.  If not, the odds are about the same as playing Russian roulette.  There is about 1 chance in five something ugly may happen to him in the next 5 years.  Of course, as he pointed out, there are 4 chances out of five that something won’t.  I do not think his hearing is as good as I would like.