Issue 188: The Belly Fat You Can’t See (And Why It Matters More Than the Rest)

I spent years staring in the mirror at the things I thought were wrong with my body. Particularly the stuff we are hyper aware of that you can pinch and flap: arms, thighs, chin, a muffin top!

Then I found out not all fat is the same.

I had subcutaneous fat, which is mostly cosmetic, but coming out of covid I also had visceral fat.

And visceral fat is different. It wraps around your organs, deep in the abdomen, where you can’t see or pinch it. You can be slim and still have too much, and visceral fat isn’t just sitting there being unhelpful, it’s hormonally active.

Here’s why it’s urgent, not just unflattering.

Visceral fat sits right next to the organs it damages, and it’s silent for decades before symptoms show. A study of over 350,000 people found a large waist can nearly double the risk of dying prematurely, even at a normal weight.

A 2025 UK Biobank study of 18,000 people found visceral fat specifically damages the brain’s white matter, years before any cognitive decline is noticeable, and a long running Californian study found people with the most abdominal fat in their 40s were nearly three times more likely to develop dementia by their 70s or 80s. It’s also linked to raised cancer risk.

Men and women store it differently.

Testosterone favours fat around the middle, so men often build visceral fat gradually from their 30s, without any dramatic trigger.

It just creeps on, and because visceral fat converts testosterone into oestrogen as it builds, it can create a slow feedback loop, more belly fat, lower testosterone, easier to store more.

If you’re a man reading this, don’t skip it, you’ve likely been managing this longer than any of us. The upside: without a hormonal shift working against you, your numbers tend to respond faster to training, sleep and cutting beer and spirits.

For women, oestrogen protects against visceral fat and favours the hip and thigh ‘pear’ pattern, until perimenopause, when that protection disappears and fat shifts to the middle even if your weight hasn’t changed. If you’re eating and moving the same and suddenly have a belly you never had, that’s your hormones changing the rules, not you doing something wrong.

How to measure it.

At Be Well we use the Styku, a 3D infrared body scanner that predicts visceral fat by modelling your shape against DEXA data. It’s not identical to a DEXA, but independent studies show it lands within 1-2% of DEXA on body composition, close enough to trust for tracking your own trend over time.

Or use waist circumference, above 80cm for women, 94cm for men signals risk, or waist-to-hip ratio, above 0.85 for women, 0.90 for men. Pick one and remeasure in six to eight weeks.

Don’t let a soft belly in the mirror convince you your internal numbers are bad, they’re not the same test.

My numbers are now a healthy 72cm waist, 92cm hips, ratio 0.78, both under the risk thresholds. And yet, I still have an ‘apron belly’ and train track stretch marks! That’s not visceral fat. That’s four pregnancies in 6 years, including an emergency cesarean, decades of weight fluctuation and hormonal changes, skin that loses elasticity permanently and some subcutaneous fat settles in a pattern that’s largely genetic (thanks Mum!). It sits under the skin, not around your organs, a completely different thing to everything else in this blog.

What to do next, in order:

1. Get your baseline – Styku, DEXA or measurements (see above).

2. Fix your sleep. Poor sleep raises cortisol, one of the biggest drivers of visceral fat, so there’s no point training hard on five broken hours.

3. Add resistance training and add protein at every meal, muscle improves insulin handling and protein keeps you full.

4. Layer in the small changes: a 10 minute walk after meals; be specific about alcohol rather than treating it as one thing. Beer and spirits are most strongly linked to visceral fat. Red wine is linked to lower visceral fat, white wine shows no effect either way. That’s not permission for unlimited red by the way, but if you’re cutting something first, make it beer and spirits.

5. Stress management isn’t all about your mind, it’s physiological. Chronic stress means chronically elevated cortisol, which means your body is primed to store fat centrally. Do whatever you can to bring your stress levels down.

Remeasure at six to eight weeks. If nothing’s moved, check sleep and alcohol first.

Tell yourself the right story!

None of this is about a flat stomach. Visceral fat is a health marker, not a cosmetic one, and one of the few you can genuinely shift with a bit of effort in a relatively short time.

No pill or powder does it for you, and fortunately for me, no apron belly undoes the good numbers underneath it.

The takeaway? Get real data on the things that actually matter to stay younger, healthier, happier for longer.

I look forward to hearing your results!

See you again at Be Well soon.