Welcome to the first of three deep-dive videos in our series looking at the DEXA scan metrics of key interest to Peter Attia. Peter is the author of the bestselling book Outlive: The Science & Art of Longevity.
In this first video, we’ll be looking at visceral fat.
In Outlive, Attia likens a person’s normal, subcutaneous fat storage to a bathtub. Our changing level of body fat is like the water level in the bath, he says, rising and falling depending on how fast water flows in from the tap and how quickly it drains down the plughole. When we eat ‘at maintenance’ (calories in = calories out), our fat and weight stay the same, akin to the water level in the bath remaining constant because it fills and empties at the same rate.
But it’s when the taps are fully opened and the bathtub fills and spills over (that is, we eat way more calories than we burn) that problems arise. When our subcutaneous stores fill up, fat spills over into your muscle tissue, blood, liver and pancreas, and around your heart and other organs.
This excess, overspill fat is linked with what Attia calls The Four Horsemen - heart disease, cancer, dementia and diabetes. The fat that accumulates around your organs is visceral fat, which Attia describes as “anything but harmless”.
He says our risk from visceral fat is based on our own genetic capacity to store subcutaneous fat - some people have a bathtub, some a full-size jacuzzi, others a small bucket.
On the Bodyscan DEXA report, your visceral fat result is shown by the last number in the Adipose Tissue table.
Diagnostic thresholds have been applied, such that a measurement below 100 is considered normal. Between 100-160 is ‘increased risk’ and above 160 as ‘high risk.
Bodyscan data shows that visceral fat increases with age, and once you reach the 50th percentile (the average) for overall body fat, visceral fat will double between your 20s and your 50s.
Being ‘average’ might sound OK but in Outlive, Attia says, “It doesn’t take much visceral fat to cause problems.” Even a 40-year-old man with average total body fat “would be considered at exceptionally high risk for cardiovascular disease and type 2 diabetes, in the top 5 percent of risk for your age and sex.”
Now, Bodyscan data shows that visceral fat can remain very low regardless of age. At the lowest percentiles there is little change in the value. In contrast, the highest percentiles we see visceral fat climbing higher and higher - for men and women over 50, visceral fat scores are double those for the under-30s.
In all percentiles, women suffer from a faster rate of increase in visceral fat as they age, particularly after menopause, and at the highest percentiles, women end up with as much visceral fat or more than men.
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