Types of Belly Fat: Visceral vs Subcutaneous

The types of belly fat you carry matter far more than most people realise. Not all abdominal fat is the same: subcutaneous fat sits just beneath the skin, while visceral fat wraps around your internal organs and carries significant metabolic risks. A third type, ectopic fat, accumulates within organs such as the liver. Understanding these distinctions helps explain why waist size can be a more meaningful health indicator than weight alone, and why two people with identical BMI readings can have very different risk profiles for conditions such as type 2 diabetes and cardiovascular disease.

What are the different types of belly fat and why do they matter?

The two main types are subcutaneous fat, which is soft and pinchable beneath the skin, and visceral fat, which surrounds internal organs and is metabolically active. A third type, ectopic fat, accumulates within organs such as the liver and carries its own health risks.

There are two main types of belly fat: subcutaneous fat, which sits just beneath the skin, and visceral fat, which surrounds the internal organs deep within the abdominal cavity. Understanding the difference matters because these two fat types carry very different health implications.

Subcutaneous fat is the soft, pinchable layer you can feel when you press your abdomen. It acts partly as an energy reserve and provides some insulation. While excess subcutaneous fat contributes to overweight and obesity, it is generally considered less metabolically harmful than its deeper counterpart.

Visceral fat is packed around organs such as the liver, pancreas and intestines. It is metabolically active, releasing hormones and inflammatory chemicals that can disrupt normal body function.^[18][19] Even people who appear slim can carry significant amounts of visceral fat, a pattern sometimes described as metabolically unhealthy normal weight (MUNW) or normal weight obesity, where metabolic risk is elevated despite a normal body mass index (BMI).^[16][17]

A third, less commonly discussed type is ectopic fat, which accumulates within organs themselves, particularly the liver and the heart. Ectopic fat is closely linked to visceral fat accumulation and carries its own set of health risks. Recognising that belly fat is not a single, uniform tissue is the first step towards understanding why waist size and body composition matter beyond simple weight measurements. Lifestyle approaches such as improved diet and increased physical activity tend to reduce both visceral and subcutaneous fat, though visceral fat often responds more readily to these changes.

How does visceral fat affect your health risks?

Visceral fat raises the risk of type 2 diabetes, cardiovascular disease, high blood pressure and at least 13 obesity-related cancers by secreting inflammatory chemicals and fatty acids directly into the liver's circulation. It also promotes insulin resistance and can contribute to metabolic dysfunction-associated steatotic liver disease (MASLD).

Visceral fat is associated with a significantly raised risk of serious health conditions, including type 2 diabetes, cardiovascular disease, high blood pressure and certain obesity-related cancers. Cancer Research UK identifies excess body fat, including abdominal fat, as a risk factor for at least 13 types of cancer, including bowel, breast (post-menopausal) and endometrial cancers.^[1]

Unlike subcutaneous fat, visceral fat behaves almost like an endocrine organ, secreting pro-inflammatory cytokines and free fatty acids directly into the portal circulation, which feeds into the liver.^[2][3] This chemical signalling can promote insulin resistance, a state in which the body's cells respond less effectively to insulin, and which can progress to type 2 diabetes over time.

The liver, exposed to a high load of fatty acids from visceral fat, may develop metabolic dysfunction-associated steatotic liver disease (MASLD, previously termed non-alcoholic fatty liver disease or NAFLD). In some individuals, MASLD can progress through stages of inflammation and fibrosis; specialist hepatology guidance from the British Society of Gastroenterology (BSG) and the European Association for the Study of the Liver (EASL) describes this natural history and the factors that influence progression.

Cardiovascular risk is also elevated because visceral fat is associated with raised LDL cholesterol, raised triglycerides and raised inflammatory markers such as C-reactive protein (CRP), alongside lower levels of protective HDL cholesterol.^[3][18] In UK clinical practice, central adiposity measured by waist circumference is used alongside BMI to inform cardiovascular and metabolic risk assessment, as reflected in NHS and NICE guidance on obesity and weight management.^[7][8]

Hormonal effects are also notable. Visceral fat can influence cortisol metabolism and sex hormone balance, which may encourage further fat deposition in the abdominal region. For women, the hormonal shifts of the menopause are associated with a redistribution of fat towards the visceral compartment, increasing cardiovascular risk in the post-menopausal years. Addressing visceral fat accumulation is therefore a meaningful clinical priority, not simply a cosmetic concern.

What causes belly fat to build up around your middle?

Belly fat accumulates through a combination of poor diet, physical inactivity, chronic stress, poor sleep, hormonal changes and genetic predisposition. Visceral fat deposition is particularly influenced by cortisol, declining sex hormones during ageing, and diets high in ultra-processed foods and refined sugars.

Belly fat accumulates through a combination of dietary habits, physical inactivity, hormonal changes, poor sleep, chronic stress and genetic predisposition, with no single cause acting in isolation. Understanding these drivers helps explain why some people gain abdominal fat more readily than others, even when their overall calorie intake appears similar.

Diet plays a central role. Diets high in ultra-processed foods, refined carbohydrates, added sugars and saturated fats promote both subcutaneous and visceral fat deposition. Excess dietary sugar, particularly fructose found in sweetened drinks and processed foods, is metabolised in the liver and has been associated in research studies with increased visceral and ectopic fat accumulation, though the evidence in humans is still developing.

Cortisol, the body's primary stress hormone, promotes fat storage in the abdominal region. Chronic psychological stress, shift work and consistently poor sleep are associated with raised cortisol levels, which may contribute to visceral fat gain; however, much of the evidence in humans is observational, and the relationship is likely to involve multiple interacting factors rather than a simple direct cause. NHS weight management guidance increasingly recognises sleep and stress alongside diet and physical activity as relevant lifestyle factors.

Hormonal changes are particularly significant. In women, declining oestrogen levels during the perimenopause and menopause shift fat distribution from the hips and thighs towards the abdomen. In men, falling testosterone levels with age have a similar effect. Conditions such as polycystic ovary syndrome (PCOS) can also promote central fat accumulation. Hypothyroidism is associated with modest weight gain and changes in body composition; if you suspect a thyroid problem, your GP can arrange appropriate testing.

Genetics influence where the body preferentially stores fat, meaning some individuals are more prone to visceral deposition even at modest levels of overall adiposity. Ethnicity also plays a role. NICE public health guidance (PH46) recommends using lower BMI thresholds to trigger assessment in South Asian, Chinese and other Asian groups, reflecting greater metabolic risk at lower body weight.^[10] The International Diabetes Federation (IDF) consensus on ethnic-specific waist circumference thresholds similarly recommends lower cut-offs for South Asian, Chinese and Japanese populations. Evidence on waist thresholds for Black African and Black Caribbean populations is less uniform across international guidelines, and clinical judgement alongside individual risk factor assessment remains important for these groups.

How can you tell which type of belly fat you have?

Waist circumference is the most practical clinical indicator of visceral fat risk, with NHS thresholds of 94 cm for men and 80 cm for women (Europid adults) signalling increased risk. More precise measurement requires CT, MRI or DEXA scanning, which are used in specialist or research settings.

Waist circumference measurement is the most practical and widely recommended clinical tool for estimating abdominal fat distribution. NHS and NICE guidance identifies it as a useful indicator of visceral fat risk alongside BMI. For Europid (white European) adults, a waist circumference of 94 cm (37 inches) or above in men, or 80 cm (31.5 inches) or above in women, is associated with increased health risk. Risk is considered high at 102 cm (40 inches) or above in men and 88 cm (34.5 inches) or above in women. The International Diabetes Federation (IDF) recommends lower thresholds for South Asian, Chinese and Japanese populations, reflecting greater metabolic risk at equivalent measurements; for example, the IDF threshold for South Asian men is 90 cm and for South Asian women is 80 cm.^[11]

To measure your waist accurately, find the midpoint between the bottom of your lowest rib and the top of your hip bone, wrap a tape measure around this point at the end of a normal breath out, and ensure the tape is snug but not compressing the skin. This measurement reflects total abdominal girth but cannot distinguish precisely between subcutaneous and visceral fat on its own.

The waist-to-hip ratio (WHR) adds further information by comparing waist circumference to hip circumference. The World Health Organization considers a WHR above 0.90 in men or above 0.85 in women to indicate high risk. Some clinicians and public health bodies also use the waist-to-height ratio, where a value above 0.5 is considered a marker of excess central adiposity across most adult populations.

More precise measurement of visceral fat requires imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI), which are used in research settings but are not routinely available in clinical practice. Dual-energy X-ray absorptiometry (DEXA) scanning can estimate body fat distribution and may be available in some specialist weight management services.

If your waist measurement falls in the high-risk band, or if you have additional risk factors such as a family history of type 2 diabetes or cardiovascular disease, speaking to your GP is the appropriate first step. Your GP can arrange relevant assessments such as a QRISK cardiovascular risk calculation or an HbA1c blood test for diabetes risk. Bolt Pharmacy is a GPhC-registered UK online pharmacy offering online weight-management consultations, with prescriber review and pharmacist support, as one option for those exploring further assessment and support.

Scientific References

1. Cancer Research UK: Does body weight affect cancer risk?.
2. A causative link between visceral adiposity and hepatic insulin resistance.
3. Visceral fat and metabolic inflammation: the portal theory revisited. Obesity Reviews.
4. From excess adiposity to insulin resistance: the role of free fatty acids. Vascular Pharmacology.
5. Non-alcoholic fatty liver disease and obesity: biochemical, metabolic and clinical presentations. World Journal of Gastroenterology.
6. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease.
7. Overweight and obesity management (NG246): Identifying and assessing overweight, obesity and central adiposity.
8. Overweight and obesity in adults.
9. Waist circumference as a measure for indicating need for weight management. BMJ.
10. Appendix A1: Summary of evidence from surveillance — PH46 (lower BMI thresholds for Asian populations).
11. International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome (ethnic-specific waist circumference thresholds).
12. World Health Organization: Waist circumference and waist-hip ratio — report of a WHO expert consultation.
13. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutrition Research Reviews.
14. Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean Journal of Pediatrics.
15. Anthropometric indices: How they compare in screening of cardio-metabolic risks in a Nigerian sub-population. African Journal of Medicine and Medical Sciences.
16. Normal-weight obesity and adverse health outcomes in women: a systematic review and meta-analysis. Obesity Pillars.
17. Normal weight obesity: a South Asian phenotype. Current Opinion in Endocrinology, Diabetes, and Obesity.
18. Male Obesity and Cardiometabolic Risk: Inflammatory Mechanisms and Clinical Implications. Biomedicines.
19. Crosstalk between visceral adipose tissue secretome and tumoral microenvironment in obesity-induced colorectal cancer. Biochimica et Biophysica Acta.
20. Perimenopause and metabolic vulnerability: hormones, body composition and lifestyle changes. Climacteric.
21. Global epidemiological patterns and disease burden of MASLD — 2023 multisociety Delphi consensus on nomenclature. Clinical and Molecular Hepatology.

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