What Needs to Shift?

Standing in front of patients day after day has taught me something profound: what we can't see often matters more than what we can.

I’ve seen “fit” appearing individuals crumble under the weight of health burdens, while those labelled by society as “overweight” carry surprising metabolic health, all because of where their fat calls home.

The Fat Storage Apartment 🏢

Not all body fat is equal. Where it’s stored makes all the difference.

Imagine your body as a high-rise apartment:

Subcutaneous fat—the kind you can pinch under your skin and see in the mirror—is like your body’s basement storage unit.

• It’s where your body tucks excess energy from food and keeps it out of trouble.

• It might taint your beach photos and taunt your mirror, but metabolically, it’s mostly harmless.

But safe, basement storage space is finite. Once it’s full, the excess energy has to be stored somewhere. So, it spills into your living room, blocks hallways, and creates hazards. That’s visceral fat.

Visceral fat is the overflow once your basement storage is maxed out. It wraps around your internal organs, and turns the clean “living space” in your body into a hazard zone.

• This clutter is out of sight and wraps around your liver, pancreas and intestines.

• Unlike its harmless cousin (subcutaneous fat), visceral fat doesn’t just sit there. It’s busy wrecking your metabolic health.

The Double Deception 🎭

This is where the mirror and weight scale lead people (and most doctors) astray.

Your scale spits out a number, but it doesn’t tell you how that weight is distributed. How much of it is muscle? Subcutaneous fat? Visceral fat? The scale is blind to the details.

Worse, it seduces you into thinking any drop in weight is a win (as explored in Issue #3, that mindset can drive you down the dangerous path of muscle loss).

Your mirror plays a similar trick.

A slim waistline and toned frame might seem like success, but it may be a beautiful facade hiding deeper chaos. Even if your abs ripple perfectly, visceral fat might be lurking around your organs and staging a silent takeover.

This is the double deception. Two people with the same weight and appearance can have radically different risk profiles.

• One person might have plenty of subcutaneous fat, but little visceral fat.

• The other, despite looking lean, has limited safe storage and ends up with more fat packed around the organs (visceral), raising risk in ways neither the mirror nor the scale can show.

That’s why you can’t judge metabolic risk just by looking in the mirror or the scale. How much fat you carry does matter, but where it’s stored matters more.

Some Basements Are Bigger Than Others 📦

Some people genetically inherit large basements. They might look slightly overweight, but they have the capacity to park the excess energy under the skin, where it causes the least harm.

Others inherit broom closets for storage space. They might look slim and lean, but run out of safe, subcutaneous (under the skin) storage early. Any extra fat spills into the “living space” (visceral fat), wrapped around organs, quietly sabotaging their health.

Ironically, it’s the slim, “naturally lean” people who are often the last to realize they’re at risk, because their bodies don’t give any outward warning.

What You Can’t See Can Hurt You 🫣

This is why so many health problems develop quietly, in people who think they’re ‘winning’ on the surface. Once visceral fat sets up camp around your organs, it becomes the lead architect of chronic disease³:

 🔥 It Fuels Inflammation

Each pound of visceral fat is like a tiny arsonist, sparking low-grade fires in your body's forest— feeding heart disease, diabetes, and cancer.¹

📈 It Scrambles Your Metabolism

It interferes with your hormones, insulin levels, spiking blood sugar, and setting the stage for diabetes and accelerated aging.² 

⚠️ It Advances Fatty Liver Disease

The fat infiltrates your liver⁴, crowds your pancreas and increases risk of mortality and metabolic syndrome.

You can only change what you’re willing to look for. This is where body composition scans are essential. They reveal what your bathroom mirror won't tell you.

Your Next Move

Peek Behind the Curtain 🔬

• Common Trap: Trusting that flat abs = metabolic health.

• The Tool: Body composition scans (like DEXA) reveal what your mirror and scale would rather ignore—a map of where your fat lives.

• Power Move: Book a DEXA scan and use it to guide your next strategic move.

Cut Calories, Not Corners 📊

• Common Trap: Randomly slashing calories, which forces your body to burn both fat and precious muscle; like demolishing the house to fix a leaky roof.

• The Strategy: Create a small calorie deficit (200-300 calories daily) by eating fewer calories than you burn (use MyFitnessPal to find your baseline).

• Power Move: Keep protein high (~1-1.5g per kg of body weight), and maintain strength training. That’s how you keep A-list talent (muscle) and boot the party-crashers (visceral fat).

Flex Your Fat-Burning Muscles 💪

• Common Trap: Focusing only on "cardio" and ignoring muscle. The less muscle you keep, the harder it is to lose visceral fat (and keep it off).

• The Strategy: Strength training is your body's casting director: it keeps star performers (muscle) and cuts the understudies (visceral fat).

• Power Move: Just 15 minutes of daily resistance training (squats, planks, push-ups) signals your body: keep the muscle, lose the fat.

Let Fibre Do the Heavy Lifting 🥗

• Common Trap: Running on low-fibre foods, which spike your blood sugar and expedite fat gain.

• The Strategy: Fibre is your body's traffic police, minimizing blood sugar surges and keeping fat storage in check.⁵ 

• Power Move: Aim for 25–30g of fibre daily.

Time Your Final Call ⏰

• Common Trap: Treating your body like it's always open for business. (Even as a doctor, I'm guilty. Hello, night shifts!)

• The Strategy: Insulin sensitivity drops before sleep, when you’re least equipped to handle calories.⁶ Eating late is like trying to deliver packages when the warehouse is closing. They get dumped where you least want them—around your organs.

• Do This Instead: Close the kitchen 3 hours before bed. Give your body's night shift workers (sleep hormones) a clear path to do their job without running into the day crew (digestion).

Who Else Is Talking About it?

Not all fat is created equal. In this short video, Dr. Peter Attia breaks down why visceral fat is the real villain lurking in your body, and why it’s not where you carry it, but what it does that makes it so dangerous.