Fat matters! But visceral fat matters more

By Dr Mick Watts MBBS MRCGP June 2026

Most of us know when our weight has changed.

A belt notch moves. Our shirt feels tighter. The scales become less inviting!

Perhaps we start choosing clothes that disguise rather than fit.

I say this as a GP, but also as a man who has had to deal with it. Central weight can creep on quietly. It can happen during busy years, stressful years, family years, working years, or simply because habits change and the body changes with them.

Mick 2015 around 91 kg on holiday (Mumbai)

This is not about shame.

Mick 2026 around 82kg on holiday (Norway) - I miss the darker hair and beard but not that shirt!

Most men carrying extra weight already know it. We do not need a lecture. But it helps to really understand why it matters, and what can realistically be done about it when the time is right for us.

From a medical point of view, the issue is not simply how we look. It is what excess weight, particularly around the middle, is doing to our health.

For many men, weight tends to collect around the abdomen. Men tend to store excess weight more centrally than women, particularly before women reach menopause.. Some of this fat lies just under the skin. Some sits deeper inside the body, around the internal organs. This deeper fat is called visceral fat.

Visceral fat really matters because it is not just stored energy. It is a more active tissue than the fat under the skin. Visceral fat does not usually harm us by simply pressing on the organs. Its effect is more chemical than mechanical. It releases fatty acids and inflammatory signals that can affect the liver, blood sugar, cholesterol and insulin function. Over time, this can place the body’s metabolic system, including the pancreas, under greater strain. It is linked with insulin resistance, raised blood pressure, abnormal cholesterol, fatty liver disease, inflammation and cardiovascular risk.

Put simply, an increasing waistline is not just a matter of appearance. It is an early warning sign from the body’s metabolism.

That may sound discouraging, but it should not. The encouraging part is that metabolic health will improve as weight is shifted. Often, it improves before reaching any dramatic target weight loss. Visceral fat tends to fall substantially with weight loss, and often falls by a greater percentage than subcutaneous fat, particularly early in weight loss.

Even modest weight loss can reduce blood pressure, improve blood sugar, improve cholesterol, reduce liver fat, improve mobility and help us feel better in ourselves. We do not have to become athletes. We do not have to achieve perfection. We can simply move the direction of travel.

A useful first step is simply to recognise where we are now.

For most men, that means knowing our weight, our Body Mass Index (BMI) and, where appropriate, our blood pressure and a few basic blood blood results. BMI is not perfect. It does not tell us everything about muscle, fitness or where fat is carried. But it is accessible, easy to calculate and a useful place to begin.

In my clinic I use waist measurement which can add important information, particularly when discussing central weight and metabolic risk. I also measure muscle percentage, fat percentage, and estimate visceral fat. But for many men, the first useful step is not a tape measure. It is awareness. Weight and height allow you to work out your BMI. It may also help to know your Blood pressure. Your Cholesterol (Blood fats), your HbA1c (Helps decide your risk of diabetes) and you Liver function (Which can show the presence of fat around the liver). These can easily be requested through your GP. Taking these measures together can give you a much clearer picture of what is happening and whether change is needed.

So what works?

The answer is simple in principle, though not always easy in practice.

Exercise regularly. Eat mostly healthy real food. Understand calories. Preserve muscle. Sleep better. Reduce alcohol where needed. Repeat ordinary good decisions often enough for the body to respond.

Exercise is central because it improves your metabolic health even before dramatic weight loss occurs. Walking, cycling, swimming, running, sport and structured cardio all help. Strength training is also important because muscle protects metabolism, mobility and long term independence.

Food matters just as much.

For most of us, the best starting point is not an extreme diet. It is a return to real home cooked food. More protein. More vegetables. More fibre. Fewer ultra processed foods. Less liquid sugary foods and drinks. Less grazing. Less alcohol. Reducing calories eaten without much thought.

Calorie counting can be very useful, at least for a while. Not because life should become a spreadsheet, but because most of us underestimate what we eat. Tracking intake turns guesswork into information. It shows where the weight is coming from and where change is most likely to work. In clinic I generally tell people what their baseline calorie intake should be based upon age and sex, then we can work out roughly how many calories are needed a day depending how much exercise they are doing.

This is where many of us can make real progress.

Exercise helps the body use energy better. Real food improves nutrition and appetite control. Calorie awareness creates the deficit needed for weight loss. Strength work helps protect muscle while fat is lost.

Together, these remain the foundation.

There is also a newer conversation about weight loss, the role of medication. It is important to be honest about this.

For the right person, under proper medical supervision, medication can now be a very useful tool. It may reduce appetite by reducing food noise, support adherence to lower calorie eating and help some people achieve weight loss that previously felt out of reach.

Pro and cons of weight loss medications need detailed discussion with your health care professional

But medication is not a casual shortcut. It is not suitable for everyone. It has side effects, cautions and cost implications. It also works best when combined with lifestyle change.

Medication may open the door. It does not replace walking through it.

The central message is hopeful.

If we carry too much weight around the middle, we are not powerless. We can understand it. We can check the metabolic markers that matter. We can begin with changes that are realistic rather than heroic.

A walk after meals.

A better breakfast.

A couple of strength sessions each week.

Less alcohol in the evening.

Tracking calories for a month.

Initially aiming to lose five percent of body weight.

Even simply stopping gradual weight gain.

These are not small things. They are the beginning of metabolic repair.

Central weight is not the whole story of men’s health. But it is a really important part of the journey.

When we address it, we are not just trying to look different. We are reducing metabolic strain. We are protecting the heart, liver, blood vessels, joints and future independence.

That is not vanity.

That is preventive medicine.

This blog is written for general information and encouragement. It is not a substitute for personal medical advice. Every person’s health, circumstances and risks are different. If you have concerns about your weight, BMI, blood pressure, blood sugar, cholesterol, liver health, or whether weight loss medication is appropriate for you, please speak to your own GP or healthcare professional.

(Mick is a Private GP at Windsor Wellness Clinic with a particular interest in men’s health, healthy ageing and lifestyle medicine.)