Excess Body Fat & Your Metabolic Health: What You Should Know

Updated: May 8, 2021

Excessive body fat and pathological insulin resistance are incredibly prevalent in our modern society, with over 2 billion people worldwide being obese and overweight (Murray CJL, et al 2017).

The metabolic health epidemic has impacted all of us, even if we are in a state of good health. It is estimated that in the US alone, chronic disease (stemming from metabolic dysfunction), over the next 35 years, will create a sobering $95 trillion economic burden in direct healthcare costs, lost productivity, and disability. (Chen S, Kuhn M, Prettner K, Bloom DE 2018).

This is enough money to do a long list of positive things including: universal healthcare, free education, eradicate poverty, end unemployment, rebuild infrastructure and transportation systems, shift to renewable energy, solve social justice, income, and health disparities, end food insecurity and hunger, draw down carbon emissions and reverse climate change, and shift from industrial agriculture to regenerative farming systems that enhance and heals the earth Instead, that money is being directed towards preventable chronic diseases. It can be both motivating and empowering to view improving your health as a way of making a positive impact on your personal life, community, and the planet.

The vast majority of us have gone through life without learning or implementing effective holistic health strategies to prevent these states, which stem from modern Western lifestyles and questionable nutrition recommendations. To lose excess weight we have mostly been told to simply eat less and move more (which is technically true in a sense), but like most things, the topic is more nuanced than that.

Then, when you factor in the ultra-processed food industry actively working to hijack our biology with their hyperpalatable foods, the dietary camps, from carnivore to vegan, arguing about what whole foods are the best to eat (even though ultra-processed foods are the real problem), and the various forms of stress and traumas people experience in their lives that impact their ability to make the healthiest choices, many individuals are left rightfully confused and disheartened about what to eat and how to live to produce feelings of health and vitality.

Even though I have never looked like what anyone would consider to be overweight, I have personally witnessed the mental, emotional, and physical turmoil that carrying excess body fat can have on someone, and I am deeply empathetic to anyone experiencing that turmoil. Also, once I began learning and implementing the holistic health practices my Elements of Wellness framework is based upon, I actually dropped about ten pounds, my cheekbones and abs became more defined, and most importantly I felt healthy again after a long time constantly feeling like it was a struggle to get through my day.

The bottom line is that excess body fat carries the potential to create a lot of pathological stress and dysfunction in the body, and this article aims to bring awareness to why that is. Let's explore.

Inflammation, Oxidative Stress & Excess Body Fat

Inflammation and oxidative stress are powerful weapons of our immune system that help fight infections and more. But as a result of diet, lifestyle and unhealthy habits, these weapons are too often directed at our own bodies, resulting in chronic metabolic disruptions that ultimately drive insulin resistance. A key issue with excess body fat has to do with inflammation. Obesity is actually an inflammatory disorder, and can be referred to as a state of chronic inflammation (Visser, M., et al. 1999).

Your fat tissue is also an endocrine organ, meaning it can produce proteins and hormones, including inflammatory cytokines- which are signaling molecules involved in the inflammatory processes in the body. (Hotamisligil, G.S., N.S. Shargill, and B.M. Spiegelman 1993).

As fat cells grow too large (more on this below), blood levels of these inflammatory proteins begin to increase, allowing fat tissue itself to contribute to excess inflammation that can ultimately cause metabolic dysfunction (Hotamisligil, G.S., et al 1996).

In the presence of excess oxidative stress and caloric excess (like from overconsuming ultra-processed foods full of industrial seed oils and refined sugars and flours), your fat cells can begin to hypertrophy and become overstuffed. They then readily turn on inflammatory processes in cells throughout the body (especially the liver and muscles) as inflammatory cytokines flow from the fat tissue. When these inflammatory pathways are activated, benign fats in your circulatory system can start to become pathological fats called ceramides that actively work against insulin signaling in the cells, exacerbating insulin resistance. (Holland, W.L., et al 2011)

The tissues where these ceramides accumulate then become insulin resistant. (Bikman, B.T. 2012)

Overstuffed fat cells create over-inflamed bodies.

Where You Store Excess Body Fat Matters

An important aspect of obesity (and insulin resistance) is where you store the excess fat. Your fat can accumulate in two ways. You can grow subcutaneous fat (beneath the skin)- the typical female storage pattern (gynecoid), or a mix of subcutaneous and visceral fat (surrounding the visceral organs)- the typical male storage pattern (android). The type of fat you store is determined partly by sex, genetics, and diet. Due to the inherent differences these two fat types have on pathological insulin resistance, it might explain why women have better chances of living longer, healthier lives than men.

In general, subcutaneous fat jiggles. It is less dangerous than visceral fat. if your belly is hard and big, it's probably visceral fat. If the excess fat you are storing is visceral fat surrounding the organs, it can impede the organs functions, and makes visceral fat more inflammatory. (Ibrahim, M.M. 2010)

You can also be relatively skinny and lean looking and still have excess visceral fat - a term called “skinny fat”. The term “dad bod’ would be a synonymous popular culture reference to this visceral fat accumulation in men. Even though men's magazines like GQ say women find this visceral fat sexy and that you shouldn't worry about it, it may be wise to keep the dangers of excess visceral fat in mind. Visceral fat behaves differently, and appears to be more harmful, than subcutaneous fat.

For example, when visceral fat from obese mice is transplanted into lean mice they immediately become insulin resistant (Item, F. and D. Konrad 2012)

But, when subcutaneous fat is transplanted into a lean animal, they remain insulin sensitive and metabolically healthy (Tran, T.T., et al 2008).

Visceral fat and heart disease may go hand in hand as well. Potentially, in an effort to remove excess fat from fat cells and reduce the size, visceral fat tissue can become populated with macrophages (white blood cells whose job it is to clean up cellular messes). As visceral fat accumulates (due to genetics, diet and lifestyle) the macrophages themselves can begin to fill with fat and become “foam cells”- which are part of the core of atherosclerotic plaques.

These cells send out more inflammatory proteins to bring more macrophages, which also become foam cells over time if the wrong diet and lifestyle inputs persist. Visceral fat accumulation could then contribute to cardiovascular issues and disease. Cardiovascular disease and insulin resistance are almost inseparable. Where you find one you find the other. (Haffner, S.M., et al. 1990)

Visceral fat mostly matters if you can see visible signs of it. Measuring your ‘Waist to Hip Ratio’ is one way you can determine visceral fat accumulation. You can measure (in inches) the girth around the largest part of the belly (near the navel), and largest part around the hips/booty. Waist/Hip=Waist to Hip Ratio. For men you want ideally below 0.9 inches, and for women- ideally below 0.8 inches. Another way to determine whether you are carrying excess visceral fat is to simply lie flat on your back and look at if your belly protrudes. MRI scans will also show visceral fat accumulation very well.

Fat Cell Size & Metabolic Health

As I have mentioned, when fat cells begin to grow too large they can become an issue, and the size of your fat cells plays a key role in your metabolic health; especially when excess body fat begins accumulating.

Let's say you have two individuals, both overweight and accumulating excess body fat. One has fat accumulation due to their fat cells growing in size through hypertrophy. The other has fat accumulation due to their fat cells multiplying through hyperplasia.

The hormone insulin plays a key role here. Insulin sends a strong signal to the fat cell to store fat, and signals the cell to pull fat in from the blood, and to make new fat from glucose. Insulin also slams the “exit door” shut and prevents fat from leaving the cell, inhibiting the fat cell from shrinking- a process called lipolysis.

Fat cells can only hold so much fat, and in the setting of caloric excess and a Westernized diet and lifestyle, they begin to grow through hypertrophy, becoming overstuffed. This hypertrophy process will differ person to person based on ‘personal fat threshold’- a limit to the size of fat cells, and by extension fat mass, and will be influenced by genetics, environment, lifestyle etc. So the onset of metabolic dysfunction will differ person to person. (Taylor, R. and R.R Holman 2015).

These overstuffed fat cells are less capable of receiving sufficient insulin stimulus (insulin resistance), resulting in a degree of fat breakdown (fat leaking from the cell) despite the presence of insulin attempting to block the process (Amatruda, J.M., J.N. Livingston, and D.H. Lockwood 1975).

You are then left with fat cells that are leaking fats, and releasing the aforementioned inflammatory proteins into the bloodstream (Tandon, P., R. Wafer, and J.E.N. Minchin 2018).

As those fats and inflammatory proteins make their way to other tissues in the body (like the muscles and liver), more and more cells can become insulin resistant, and full body metabolic dysfunction can ensue.

Pathological Insulin Resistance begins in the fat cells.

The other way excess fat accumulates is from fat cells that are multiplying through hyperplasia. When fat accumulates this way, the fat cells don’t reach their growth limit, and can remain insulin sensitive (metabolically healthy). This is where the idea that obesity doesn’t always equate to poor metabolic health stems from. So although body excess fat is accumulating and being stored, if it is through hyperplasia, your metabolic health can be relatively maintained.(Weyer, C., et al 2000).

The hyperplasia fat cell individual can actually become much fatter than the hypertrophic individual, yet still maintain better metabolic health and insulin sensitivity compared to their less fat hypertrophic counterpart. An example of this are Sumo Wrestlers, who can maintain insulin sensitivity despite being obese. Regardless, there will always be a price to pay for carrying excess body fat and the odds are very low that you will become overweight and still maintain good metabolic health.

Obesity and carrying excess body fat (especially visceral) increases inflammation and oxidative stress to pathological levels, and leads to disease in the body. Obesity is also very challenging to overcome. Our often confusing, contradictory nutrition recommendations, our modern environments and lifestyles, and the various metabolic adaptations that take place when trying to lose excess fat, can make it a steady downhill cruise to accumulate excess fat, and an uphill battle to reduce that pathological body fat, and improve your health. However, consulting with a holistic health practitioner of some kind can take a lot of the frustration and confusion out of that process!

Lastly, a note on body positivity and self acceptance. Love and acceptance of yourself is of course important. But, like with spiritual bypassing (the tendency to use spiritual ideas and practices to sidestep or avoid facing unresolved emotional issues, psychological wounds, and unfinished developmental tasks), be careful not to fall into the trap of using a healthy concept like body positivity to bypass healthy nutrition and lifestyle practices, settle for an unhealthy state of being, and avoid making health improvements. Healthy nutrition and lifestyle practices are the ultimate forms of self love, and self love and true self acceptance go hand in hand.

See part 2 to learn more about some of the adaptations the body goes through when losing excess weight, and how that can make various diets and nutrition strategies potentially detrimental, and maintained fat loss more challenging.