"The pathogenic potential of fat tissue is not solely due to how calories are stored but also due to where those calories are stored.” – Harold Bays

Adiposopathy is a term that essentially means “sick fat.” Think of the term Cardiomyopathy which refers to a “sick” or diseased heart muscle. This is the same.

We are beginning to appreciate the differences between subcutaneous fat – the fat tissue that is under our skin and visceral or abdominal fat. Visceral fat is the fat that is stored in the abdomen and around our major organs. It is this fat that is implicated in Adiposopathy.

Obesity is now the first leading cause of preventable death in our country and is associated with many different diseases. Diabetes type 2, high blood pressure, high cholesterol and triglycerides, fatty liver disease, and even certain types of cancer are often correlated with carrying extra fat on the body. Did you ever wonder why?

The answer is in the sick fat. As more fat is accumulated on the body, the fat cells hypertrophy (get bigger), become dysfunctional, and more fat is deposited in the visceral area. This fat tissue is an active endocrine and immune entity, releasing various chemicals and hormones that are involved in metabolic disease.

For example, one of the hormones made in the fat cell is Adiponectin. Adiponectin is an anti-inflammatory chemical that helps suppress disease processes. When Adiposopathy develops, the fat cells do not produce the same amount of Adiponectin resulting in increased inflammation and progression to diseases such as Atherosclerosis and Diabetes type 2.

When you have increased visceral or sick fat, there is also an increase in the release of Free Fatty Acids. These FFA circulate in the bloodstream to other organs and tissues and are toxic, again resulting in increased inflammation and damage.

Visfatin and TNF-alpha are other chemicals made in the fat cell. Their production and release are increased with increasing visceral fat. Visfatin is involved in insulin resistance, a precursor to Diabetes type 2. TNF-alpha is a potent inflammatory chemical that is destructive to tissue including the cartilage in joints.

The communication between these chemicals and other organs and tissues is referred to as “crosstalk.” Impaired crosstalk results when the inflammatory chemicals and other hormones are released from the fat cells into the bloodstream and then travel to various organs and tissues, causing change in healthy functioning.

Thus, the amount of fat on the body is not always as important as WHERE it is deposited.

To review, Adiposopathy involves:

  • Impaired fat cell formation
  • Fat cell hypertrophy
  • Visceral adiposity
  • Increased release of FFA
  • Release of various destructive chemicals and hormones from the fat cell
  • Increased inflammation
  • Impaired crosstalk
  • Development of metabolic disease

The goal of any weight loss program whether it is surgical or non-surgical is to bring about change in habits so that you will lose weight and visceral fat, thus leading to decreased adiposopathy and decreased disease. Be wary of crash or extreme diets. These diets may bring about rapid weight loss but are often associated with the loss of muscle mass. Also, when dieting, you are typically not making changes in habits that will be permanent so that any weight lost is often regained and then some. Much of the regained weight is due to additional fat mass in the visceral area.

Kathleen Baskett, MD is the Medical Director of Weight Management at St. Vincent Healthcare. She is a graduate of the University of Maryland School of Medicine, and the author of “Moving Forward: The Weigh to a Healthier Weight”.