Healthy Weight, 'Healthy Fat' The Best Scenario

Q. Dear Dr. Baskett: Why is belly fat so bad?

A. The more we are learning about obesity and weight regulation, the more we have come to appreciate fat tissue is an active endocrine organ with disease potential. The term “adiposity” refers to the quantity of fat tissue on the body. The term “adiposopathy” refers to the fat tissue that is sick or malfunctioning. Visceral, or belly fat, tends to be “sick” fat.

When we take in too many calories, our fat cells begin to hypertrophy, or get bigger. More of the fat accumulates in the abdominal cavity leading to increased belly fat. There is a correlation between increased visceral fat and metabolic diseases including type 2 diabetes, heart disease, high blood pressure, high cholesterol and triglycerides, fatty liver and certain types of cancer.

This occurs because the fat cells begin to release certain chemicals and hormones causing inflammation. These hormones and chemicals “talk” with other body organs such as the liver and the pancreas as well as the heart and circulatory system. The disease process then begins.

The onset or worsening of the metabolic syndrome and other disease processes are determined more by the characteristics of our fat tissue and not just the quantity. This is why you may encounter a person who is a “little” overweight and who has type 2 diabetes, fatty liver disease and high cholesterol. Yet, you may also encounter a person who is morbidly obese with a normal metabolic profile — no diabetes, high blood pressure or high lipids. In fact, about 20 percent of people who are morbidly obese are “healthy” on paper according to their lab results.

Thus not only do we want to be at a healthy weight, we want to have “healthy fat.”


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”.