Why does abdominal fat matter? What can we do about it?

Visceral fat, also known as intra-abdominal fat, is the fat that surrounds the organs in the abdominal cavity, such as the liver, pancreas, and intestines. Unlike subcutaneous fat, which is located just beneath the skin, visceral fat is deeper and surrounds these vital organs. Here's why visceral fat poses a threat to cardiovascular health:

1. Inflammatory Effects: Visceral fat is metabolically active and can release inflammatory substances, such as cytokines and adipokines, into the bloodstream. These substances can lead to a state of chronic low-grade inflammation in the body, which is associated with an increased risk of cardiovascular disease.

1. Insulin Resistance: Excess visceral fat is strongly linked to insulin resistance, a condition in which the body's cells become less responsive to the effects of insulin. Insulin resistance can lead to elevated blood sugar levels and an increased risk of developing type 2 diabetes. Diabetes is a significant risk factor for cardiovascular disease.

1. Dyslipidemia: Visceral fat accumulation is associated with an abnormal lipid profile characterized by high levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), and increased levels of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol). This pattern, known as dyslipidemia, contributes to the development of atherosclerosis, the buildup of fatty plaques in the arteries that can lead to heart attacks and strokes.

1. Increased Free Fatty Acid Release: Visceral fat cells have a higher rate of releasing free fatty acids into the bloodstream compared to subcutaneous fat cells. Elevated levels of free fatty acids can lead to adverse metabolic effects, including insulin resistance, impaired glucose metabolism, and increased production of very-low-density lipoproteins (VLDL) in the liver. These effects contribute to the development of cardiovascular risk factors.

Haemodynamic Changes: Excess visceral fat can affect the functioning of the heart and blood vessels. It can lead to increased production of certain hormones, such as angiotensinogen, which can contribute to high blood pressure (hypertension) and promote vasoconstriction. Elevated blood pressure and changes in blood vessel function can strain the cardiovascular system and increase the risk of cardiovascular disease.

It's important to note that reducing visceral fat through lifestyle changes, such as regular exercise, a healthy diet, and weight loss, can have significant benefits for cardiovascular health and overall well-being.

Semaglutide is one of a class of medicines known as glucagon-like peptide-1 receptor agonists, or GLP-1 agonists, which have been studied for their effect on visceral fat. In the UK, semaglutide is licensed under one brand for the treatment of type 2 diabetes, and under a different brand at a higher dose for weight management. Both are prescription-only. Which one is appropriate, if either, is a clinical decision made after an assessment rather than something to choose from a website.

GLP-1 agonists work by mimicking the action of a hormone called glucagon-like peptide-1, which is naturally produced in the gut. These medicines help regulate blood sugar levels by increasing insulin secretion, reducing glucagon release, slowing down gastric emptying, and promoting a feeling of fullness.

While their primary mechanism of action relates to blood sugar control, some studies have looked at their effect on body weight and body composition, including visceral fat.

One study published in Diabetes Care in 2018 evaluated the effects of semaglutide on body weight and metabolic parameters in individuals with obesity. Participants who received semaglutide experienced greater weight loss and reductions in waist circumference, a measure of visceral fat, than those who received a placebo.

Another study published in The Lancet in 2019, the Semaglutide Treatment Effect in People with Obesity (STEP) trial, examined the effects of semaglutide on weight loss in individuals with obesity. It reported significant weight loss in the treatment group, along with improvements in several cardiometabolic risk factors.

These studies suggest semaglutide may have a role in reducing visceral fat, but more research is needed to establish a direct link. Individual responses vary, and any effect is influenced by diet, exercise and overall lifestyle. No medicine replaces those things; at best it makes them easier to sustain.

If you would like to know whether medication has a part to play alongside lifestyle change, our doctors will go through it with you at a consultation. Call the clinic on 0333 335 6414 if you would rather talk it through first.

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