The visceral fat paradox: Why even slim Indians face hidden metabolic risks, doctors reveal

In India, a growing body of medical evidence is challenging a long-held assumption: that slim individuals are metabolically healthy. Speaking at the launch of a cardiology textbook on obesity and lipid management, Dr Jitendra Singh underscored a critical concern—abdominal or central obesity may be a bigger risk factor than overall body weight.

This is particularly relevant in the Indian context, where even individuals who appear lean externally may carry dangerous levels of visceral fat, the type of fat that accumulates deep within the abdomen.

What is visceral fat—and why is it dangerous?

Visceral fat is not the fat you can pinch under your skin. It wraps around vital organs such as the liver and intestines, making it far more metabolically active—and harmful.

According to Dr Afshan Saeed, Unani consultant at Hamdard Wellness, this “hidden fat” is linked to a condition called TOFI (thin outside, fat inside) or metabolically obese normal weight (MONW).

Unlike subcutaneous fat, visceral fat releases inflammatory chemicals that can:

• Trigger insulin resistance
• Increase risk of type 2 diabetes
• Raise chances of heart disease and hypertension
• Contribute to fatty liver disease

In simple terms, a person may have a normal Body Mass Index (BMI), yet still be at high metabolic risk.

The ‘thin-fat Indian’ phenotype explained

Experts say Indians are genetically and metabolically predisposed to store fat differently.

Dr Rajiv Kovil, diabetologist and weight loss specialist, describes this as the “thin-fat Indian” phenotype—where fat accumulates not just around the abdomen, but also in organs like the liver and pancreas.

This fat is ectopic (stored in the wrong places) and metabolically active, which means:

• It directly disrupts insulin function
• It promotes chronic inflammation
• It accelerates cardiovascular complications

Crucially, this means BMI alone is a poor indicator of health for Indians.

Why abdominal obesity is a bigger red flag

Central obesity—fat concentrated around the waist—is increasingly being seen as a stronger predictor of disease than total body weight.

Even in people who are not classified as overweight, excess abdominal fat has been linked to:

• Early-onset cardiovascular disease
• Hypertension
• Metabolic dysfunction-associated fatty liver disease (MASLD)
• Rising incidence of diabetes among younger populations

This aligns with broader public health concerns in India, where lifestyle shifts—sedentary habits, poor diet, and sleep disruption—are compounding risks.

The limits of BMI—and what to track instead

Relying solely on BMI can create a false sense of security. Doctors now recommend a more nuanced approach:

More useful indicators include:

• Waist circumference
• Waist-to-hip ratio
• Body fat percentage
• Blood markers (glucose, lipids, insulin levels)

In other words, metabolic health matters more than how you look.

Can you be fit but still at risk?

Here’s where common assumptions need scrutiny.

You might assume:

“I’m thin, so I’m healthy”

“I exercise occasionally, so I’m safe”

But experts caution that:

Lack of strength training can lead to low muscle mass and higher fat percentage

Crash dieting or overexertion without recovery may worsen metabolic imbalance

Poor sleep and stress can increase fat storage—especially abdominal fat

Even fitness routines, if unscientific, can backfire.

What actually helps reduce visceral fat

Doctors emphasise targeted, sustainable interventions over quick fixes:

• Strength training over just cardio

Building muscle improves insulin sensitivity and reduces fat storage.

• Balanced, whole-food diet

Focus on fibre, protein, and healthy fats; cut down ultra-processed foods and excess oil.

• Sleep and recovery

Chronic sleep deprivation is strongly linked to abdominal fat gain.

• Metabolic monitoring

Regular screening for blood sugar, cholesterol, and liver health.

Some traditional systems like Unani medicine also recommend digestive-supporting herbs such as ginger and cumin, though these should complement—not replace—medical advice.