Hidden Fat Around the Organs
Written by the Editorial Team.
Fat around the organs and in the liver rarely shows on the scales. The editorial team explains why the waist says more than weight, what NICE recommends, and what the research of Jimmy Bell and Roy Taylor shows.
Your weight has barely moved, yet your trousers fit differently. Weight is a single number, and it cannot tell you where the body stores its fat.
Fat under the skin is visible. Fat around the organs is quiet, and more metabolically active.
Two kinds of fat
Subcutaneous fat sits under the skin. Visceral fat surrounds the organs in the abdomen, and fat can also accumulate inside the liver and pancreas. Visceral and liver fat release inflammatory signals and are strongly associated with insulin resistance.
Jimmy Bell, a professor at the University of Westminster who studies body composition with MRI, introduced the term TOFI for people who are thin outside and fat inside. His imaging work shows that a normal weight does not rule out significant internal fat.
Fat in the liver and pancreas
Roy Taylor at Newcastle University proposed the twin cycle hypothesis: fat in the liver increases insulin resistance, the pancreas releases more insulin, and over time fat in the pancreas reduces its capacity. His DiRECT trial, published in The Lancet in 2018, found that structured weight loss put almost half of participants with type 2 diabetes into remission after one year. Taylor describes the theory in his book Life Without Diabetes.
The measure that helps
NICE guidance NG246 recommends waist-to-height ratio as a practical indicator. A ratio of 0.5 or above signals increased risk, and 0.6 or above signals high risk. To find your ratio, divide your waist measurement by your height, using the same units.
A waist measured at the level of the navel gives more information than the scales, and it is easy to track.
What reduces internal fat
Regular movement, resistance training, adequate sleep and a diet rich in vegetables, pulses and protein all reduce liver and visceral fat. Weight loss, where appropriate, reduces it most quickly. Alcohol contributes to liver fat and is worth reviewing.
If you have concerns, your GP can check liver enzymes and discuss a liver health assessment.
Attention without judgement
Calm Power includes a respectful relationship with the body. The waist is information, and it asks for attention without criticism.
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What's next
For more evidence-based perspectives on sustaining energy, explore our Energy Management collection.
For the wider picture on energy, sleep and hormones after 40, explore our Lifestyle Medicine for Women 40+ resource.
For a guided route from depletion back to steadiness, visit Return to Calm Power.
FAQ
What is visceral fat?
Visceral fat is stored around the abdominal organs. It is metabolically active and linked with insulin resistance.
Practical step: measure your waist at the navel.
Can I have a normal weight and still have fat around my organs?
Yes. This is the pattern Jimmy Bell calls TOFI.
Practical step: track your waist as well as your weight.
What waist-to-height ratio is healthy?
NICE advises that 0.5 or above indicates increased risk and 0.6 or above high risk.
Practical step: divide your waist by your height.
What is fatty liver?
It is fat stored in liver cells. It is common, often silent, and responds to lifestyle changes.
Practical step: ask your GP about liver tests if you have risk factors.
How do I reduce fat around my organs?
Movement, strength training, sleep, fibre-rich food and, where appropriate, gradual weight loss help.
Practical step: add a daily walk and two strength sessions.
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