Ask Well: Do I Carry a Dangerous Amount of Belly Fat?

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Q. How can I tell if I have a dangerous amount of visceral fat? Do we understand why the body decides to store some fat as visceral fat and other as subcutaneous?

A. Visceral fat is fat that collects around the abdomen — giving a “beach ball” look in some cases — and is associated with a host of medical problems, including heart disease, diabetes, heartburn and sleep difficulties.

No one knows precisely when fat becomes dangerous, said Dr. Noyan Gokce, a staff cardiologist at the Boston University School of Medicine, who has a federal grant to investigate the differences between “healthy” and “unhealthy” fat. But fat seems to behave differently when pushed close to organs such as the kidney, liver and pancreas, he said.

Most of the health problems we associate with fat are strongly linked with visceral fat, which in many people seems to accumulate with age, said Dr. Michael Jensen, a professor of medicine at the Mayo Clinic in Rochester, Minn., and a past president of the Obesity Society, a professional group.

Although everyone carries some visceral fat, gaining excessive amounts seems to happen only if there is a dysfunction, often tied to age, in the storage of normal or “subcutaneous” fat, he said. There are several possible theories for this, including that the body simply runs out of the ability to make new healthy subcutaneous fat cells to replace old, dying ones; or that weight gained quickly overwhelms the body’s ability to store healthy fat, he said. There may also be an inflammatory process within subcutaneous fat that causes the dysfunction. Mouse studies suggest that in women, hormone changes during menopause may also play a role.

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