A nice overview I just thought I'd share here. Ectopic Fat Depots and Cardiovascular Disease
Waist circumference was one of the earliest means of quantifying body fat distribution, and some clinical guidelines have recommended measurement of waist circumference to provide additional information regarding cardiovascular risk.4 However, waist circumference consists of both subcutaneous adipose (SAT) (classically nonectopic) and visceral adipose tissue (VAT) (classically ectopic). This is important because VAT is associated with more adverse levels of metabolic risk factors compared with SAT.5 In addition, seminal work in mice has shown that transplantation of SAT, but not VAT, to an intra-abdominal site resulted in beneficial effects on metabolism.6 Taken together, these findings suggest that information about body fat distribution beyond waist circumference may provide important insights into metabolic and cardiovascular disease risk.
There's much more but one of the issues that is confusing is the role of abdominal fat in disease/risk. Not all apples are the same apparently. This reminded me of a post Stephan wrote a while back: Is it Time to Re-write the Textbooks on Insulin and Obesity? Part II. It contained this picture and caption.
This is a photo from a paper titled "Insulin-sensitive Obesity" (2). According to the paper, that gentleman has a low insulin level similar to a lean person, and normal insulin sensitivity, despite having a body mass index of 45.2! This is true of a significant fraction of obese people, and it has been replicated in other studies (3). What differentiates insulin-sensitive from insulin-resistant obese people? Inflammation (2). Imagine that!