There are two types of fat that do not behave the same and do not carry the same health risk. Subcutaneous fat is the fat located just under the skin, the one you can pinch. Visceral fat is something else: it accumulates inside the abdominal cavity, surrounding vital organs such as the liver, the pancreas, and the intestines, and it is not visible to the naked eye, although it usually translates into a larger or firmer abdomen. Dr. Maribel Tejeda, physician at Neleva Clinic, explains the key difference: “Visceral fat is metabolically much more active. It acts almost like an endocrine organ, releasing free fatty acids directly to the liver and secreting inflammatory substances.” That is why two people with the same weight can have very different health profiles depending on where they accumulate fat.
That chronic inflammatory activity is what makes visceral fat a key marker of metabolic health and aging. “It promotes insulin resistance, raises cardiovascular risk, and keeps the body in a state of low-grade sustained inflammation, what researchers call inflammaging or inflammatory aging,” notes Dr. Tejeda. It is a better predictor of health problems than weight or body mass index because it reflects what happens inside. A slim person can have an excess of visceral fat without knowing it, a condition known as TOFI: thin outside, fat inside.
From age 45, and especially after menopause, visceral fat tends to increase even if habits have not changed. Estrogens are the drivers of that change: during fertile years they favor fat deposition in hips and thighs. With the drop in estrogens, that pattern changes and fat begins to distribute toward the abdominal viscera. “Added to this is a natural loss of muscle mass, sarcopenia, which slows basal metabolism, and changes in insulin sensitivity and hormones such as cortisol,” explains Dr. Tejeda. The result is that many women notice they gain around the waist without having changed anything.
Excess visceral fat is consistently associated with a greater risk of type 2 diabetes, cardiovascular disease, fatty liver, certain types of cancer, and even cognitive decline. But Dr. Tejeda also highlights the good news: “It is one of the fats that responds best to lifestyle changes. It tends to be among the first to reduce when diet improves and exercise is undertaken.” Reducing it is not a cosmetic issue but an investment directly in years of life with good health.
What really works in nutrition
What has the most evidence is not miracle foods but complete dietary patterns. Reducing free sugars and sugary beverages, which are directly associated with the accumulation of liver and visceral fat, is one of the most effective measures. Prioritize sufficient protein, essential to preserve muscle from age 45, and opt for fiber and low-calorie-density foods as other keys. “The Mediterranean pattern, with extra-virgin olive oil, nuts, fish and few ultra-processed foods, is one of the best studied and with the strongest evidence,” notes Dr. Tejeda.
Dr. Maribel Tejeda, physician at Neleva Clinic.
There are myths worth dispelling. Lemon on an empty stomach, ginger, or any so-called fat-burning food does not reduce visceral fat by itself. Corsets and slimming creams do not act on internal fat. Detoxes do not eliminate fat. And doing many sit-ups tones the muscle but does not eliminate the fat that covers it. “There is no way to burn fat only from the abdomen by eating: fat is lost globally,” clarifies Dr. Tejeda. Creating a moderate and sustainable caloric deficit is what works.
Why the combination of strength and cardio is the most effective
Aerobic exercise is very effective at mobilizing and reducing visceral fat because it increases energy expenditure. But after 45, strength training becomes equally important: it builds and preserves muscle mass, raises basal metabolic rate, and improves insulin sensitivity. “The combination outperforms each one separately because they attack the problem from two fronts: the aerobic training burns fat immediately, and strength modifies body composition in the medium term,” explains Dr. Tejeda. For women after menopause, strength work also protects bone mass.
The vast majority of women over 45 can realistically and measurably reduce their visceral fat with sustained changes in diet, exercise, sleep and stress management. “This fat responds especially well to lifestyle changes, which should always be the foundation,” notes Dr. Tejeda. But there are situations where professional support is advisable: when insulin resistance, prediabetes, metabolic syndrome already exist, or when changes do not yield results despite maintaining them. Menopause also merits an individualized discussion with a gynecologist or endocrinologist.
Visceral fat is not visible in the mirror but it is measurable in health. Understanding that weight gain outside is not the same as weight gain inside, and that a hard belly after 45 is not just cosmetic but metabolic, completely changes how it should be addressed. “Asking for medical help is not a failure, but another tool,” summarizes Dr. Tejeda. And acting before symptoms appear is always easier than correcting when the problem is already established.
