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What body fat does, and where it sits

Body fat stores energy and makes hormones. Fat deep in the belly is linked to higher risk, and a tape measure around your waist gives a rough guide at home.

KiloCare Team · · 5 min read · How we write and review

A navy belt hangs from a wooden hook beside a wardrobe in a sunlit bedroom, with a blue armchair and a folded shirt below.

What body fat does

Body fat stores energy and makes hormones.

A 2014 review in the journal Cell describes how body fat takes in calories after a meal, and releases them as fatty acids during fasting.[1] It describes two hormones made by fat.

  • Leptin, a hormone made by fat, rises with the amount of fat and signals to the brain about appetite and energy use.[1]
  • Adiponectin, another hormone from fat, generally helps the body respond to insulin. Its level is lower when fat builds up around the organs.[1]

The review notes that much of this evidence on hormones comes from studies in animals. Fat also cushions parts of the body, such as the pads of the heel and toe, and plays a part in reproduction.[1]

Fat under the skin and fat around the organs

Much of the body's fat sits under the skin, and visceral fat, deep in the belly around the organs, is linked to a higher risk of heart and metabolic disease.

Fat deep inside the belly, around the organs, is called visceral fat. A 2020 consensus statement from an international expert group describes what may happen when the store under the skin is full. Extra fat then goes to the belly and into organs such as the liver, muscle, pancreas and heart. Fat inside organs is called ectopic fat.[2] The group presents this as a possible explanation.

A 2019 statement from the International Atherosclerosis Society calls visceral fat, measured by CT or MRI scans, a marker of higher risk of heart and metabolic disease and death in its own right. It adds that fat in the liver and around the heart might add to the risk.[3] India's dietary guidelines say fat around the belly and organs "is now considered to be more harmful".[4]

A WHO report on the waist, published in 2011, says that from late middle age, fat moves from under the skin to deep in the belly, and lean mass is lost.[5]

In Finnish data the report summarises, published in 2007, the average waist of 18,975 adults aged 25 to 64 grew by 2.7 cm in men and 4.3 cm in women over 15 years.[5] Average BMI rose only a little over the same years, except in the youngest group. This was a change across the population in each age group. It does not show what ageing does to one person.

More body fat at the same BMI

At the same BMI, Asian groups tend to carry more body fat than people of European descent.

India's guidelines set a lower healthy BMI for Asians, up to 23, for this reason.[4] BMI and its cutoffs are explained in what the number on the scale measures.

A 2002 review of studies in Singapore, Indonesia and Hong Kong compared Asian groups, including Indians living in Singapore, with people of European descent. At the same BMI, the Asian groups in this review generally had 3 to 5 percentage points more body fat.[6]

In 2004 the Lancet printed body scans of 2 doctors with almost the same BMI of about 22. The doctor of Indian origin carried about 21% body fat, and the other doctor about 9%.[7][8] They are 2 men, so this says nothing about Indians in general. It shows that 2 people with the same BMI can carry very different amounts of fat.

A 2007 study in Canada of 822 adults from 4 ethnic groups, aged 30 to 65, found that BMI underestimated visceral fat in South Asians.[9]

How to measure your waist

Measure halfway between your lowest rib and the top of your hip bone, with the tape level, at the end of a normal breath out.

Measuring your waist
  1. Stand with your feet together and your arms relaxed at your sides.[10]
  2. Put the tape halfway between your lowest rib and the top of your hip bone, on bare skin or light clothing.[10]
  3. Keep the tape level all round, snug but not pressing into the skin.[10]
  4. Breathe normally for a few breaths. Read the tape at the end of a normal breath out.[10]
  5. Measure twice. If the 2 readings are within 1 cm, take the average. If they differ by more than 1 cm, measure twice again.[5]
  • Stay relaxed while you measure. WHO's 2011 report notes that people often pull the stomach in without meaning to.[5]
  • India's 2024 dietary guidelines link a waist above 90 cm in men and above 80 cm in women with a higher risk of several lifestyle diseases.[4]
  • In ICMR-INDIAB, a national survey of adults aged 20 and over carried out from 2008 to 2020, about 4 in 10 (39.5%) had abdominal obesity, as the survey defined it.[11]

Activity and visceral fat

Regular activity can help reduce visceral fat, even without weight loss.

  • India's guidelines say being physically active and eating a healthy diet help reduce abdominal obesity.[4]
  • The Endocrine Society of India's 2022 guidelines look at aerobic activity, 30 to 60 minutes of moderate to vigorous effort on most days. They say it helps reduce visceral and ectopic fat, even without weight loss.[12]
  • The 2020 consensus statement found that routine, moderate exercise, diet changes or both can shrink the waist by an amount that matters for health.[2] In trials, a smaller waist went with better heart and metabolic risk factors, with or without weight loss.[2]

Whether stomach exercises target belly fat is covered in when you lose fat, where does it go?

Measure your waist the same way each time, and note the date beside it. Show your doctor the waist and the weight together.

When to check with a doctor:

  • Anyone who takes medicine for diabetes should check with their doctor before changing how much they eat. The same applies to blood pressure medicine.
  • If you have been inactive, or have a heart, joint or back problem, see a doctor before you start strength exercise.
  • If you get chest pain, or breathlessness that is new or worse than usual, stop and see a doctor.

Medical disclaimer: This article is general information. It does not replace advice from your doctor about your own health.

Common questions

India's 2024 dietary guidelines from ICMR-NIN link a waist above 90 cm in men and above 80 cm in women with a higher risk of several lifestyle diseases.

WHO's survey manual measures the waist halfway between the bottom of the lowest rib and the top of the hip bone. Keep the tape level all round, breathe out normally, then read it. Do not pull your stomach in.

The Endocrine Society of India's 2022 guidelines say regular aerobic activity helps reduce visceral fat, the fat around the organs, even without weight loss. A 2020 expert consensus statement adds that in trials, a smaller waist went with better heart and metabolic risk factors, with or without weight loss.

Sources

  1. Rosen ED, Spiegelman BM. What we talk about when we talk about fat. Cell. 2014;156(1-2):20-44. doi:10.1016/j.cell.2013.12.012. PMID: 24439368. Available from: pmc.ncbi.nlm.nih.govCited atIntroductionAdipokinesAdipokinesFunctions of fat
  2. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16(3):177-189. doi:10.1038/s41574-019-0310-7. PMID: 32020062. Available from: pmc.ncbi.nlm.nih.govCited atFig. 2 legendAbstractMain text, trial evidence, refs 71 to 76
  3. Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7(9):715-725. doi:10.1016/S2213-8587(19)30084-1. PMID: 31301983. Available from: pubmed.ncbi.nlm.nih.govCited atAbstract
  4. ICMR-NIN Expert Committee. Dietary Guidelines for Indians - 2024. Hyderabad: ICMR-National Institute of Nutrition; 2024. Available from: nin.res.inCited atp. 63, Guideline 9p. 63, Guideline 9p. 64, Guideline 9p. 62, Guideline 9
  5. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008. Geneva: World Health Organization; 2011. Available from: iris.who.intCited atp. 9, §3.3p. 9, §3.3p. 7, §2.5p. 6, §2.2.4
  6. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141-6. doi:10.1046/j.1467-789x.2002.00065.x. PMID: 12164465. Available from: pubmed.ncbi.nlm.nih.govCited atAbstract
  7. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet. 2004;363(9403):163. doi:10.1016/S0140-6736(03)15269-5. PMID: 14726172. Available from: pubmed.ncbi.nlm.nih.govCited at
  8. Kishore BK. Reverse epidemiology of obesity paradox: Fact or fiction?. Physiol Rep. 2024;12(21):e70107. doi:10.14814/phy2.70107. PMID: 39472276. Available from: pmc.ncbi.nlm.nih.govCited atFigure 9 legend, reproducing the 2004 image
  9. Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353-9. doi:10.1093/ajcn/86.2.353. PMID: 17684205. Available from: pubmed.ncbi.nlm.nih.govCited atAbstract
  10. World Health Organization. WHO STEPS surveillance manual: the WHO STEPwise approach to noncommunicable disease risk factor surveillance. Geneva: World Health Organization; 2017. Available from: who.intCited atpp. 3-5-10 to 3-5-11p. 3-5-10p. 3-5-11p. 3-5-11
  11. Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023;11(7):474-489. doi:10.1016/S2213-8587(23)00119-5. PMID: 37301218. Available from: pubmed.ncbi.nlm.nih.govCited atAbstract, Findings
  12. Madhu SV, Kapoor N, Das S, Raizada N, Kalra S, Endocrine Society of India. ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity In India. Indian J Endocrinol Metab. 2022;26(4):295-318. doi:10.4103/2230-8210.356236. PMID: 36185955. Available from: pmc.ncbi.nlm.nih.govCited atRecommendation 7.16