Metabolic Obesity: Redefining Fat

When many of us think of fat, we picture folds and rolls that jiggle. The fat that the health and beauty industries market toward is that which is under the skin, otherwise known as subcutaneous fat. It’s the same fat that puckers through weak connective tissue grids creating what we call cellulite. While this fat is concerning from both an aesthetic and health oriented perspective, there is a far more insidious kind of fat not always visible on the outside who is responsible for a host of diseases in the long term. This fat is not assessed by volume like those caliper pinching tools used to tell you your overall body fat %, but by location. This is your deeper fat reserve – your visceral fat.

The how to of measuring one kind of fat…caliper in action

Visceral fat (also known as brown fat or metabolic fat) gets its name because of where you find it – nestled deep in the abdominal cavity surrounding organs (i.e. viscera) like the liver, intestines, pancreas and kidneys. It’s there as an energy back up for your vital organs as well as to cushion and protect them. Your body is hardwired to maintain this fat, unless there is a deficit (i.e. starvation or intense exercise). In fact, even when not starving, this fat produces substances that affect insulin levels and communicate with the liver to influence blood fat content ensuring that the vital organs always get fed. In a famine, this fat will be the first to go before your body resorts to breaking down surface fat, muscles and organs for fuel. Now, imagine that you have more than what you need of this highly active fat? It pumps out pro-inflammatory cells into your blood stream, since it has a tight relationship with a major blood vessel to the liver and heart. These cells cause insulin resistance which is the precursor to Type II diabetes as well as promote the development of heart disease, atherosclerosis (hardening of the arteries) and cancer of the bowel. Research even suggests that visceral fat increases production of the stress hormone, cortisol, and reduces levels of feel-good endorphins, leaving you feeling low on so many levels.

Being that it is so metabolically active, plentiful visceral fat is not the easiest to get rid of. This is also why people who have excess are now being termed metabolically obese regardless of whether they look lean or large. The tell tale sign of this excess in most people is the gut. While the gut is more prevalent in men who tend to have more fat stores in their belly region due to their hormones, menopausal women can also display this type of distention. Waist circumference will give you an inkling as to whether visceral fat is high; 35 inches or more in women and 40 inches and above for men. Another factor that affects visceral fat accumulation beyond gender and hormones is heredity/ethnic background. If people in your family tend to be apple shaped, meaning that more of their fat resides in the upper body, chances are your visceral fat is going to be higher. Following patterns amongst ethnic groups, it was found that excess visceral fat pops up in white men, African American women, Asian Indian and Japanese men and women most often. In addition, certain environmental factors play a role such as smoking and the consumption of compounds in food that mimic estrogen. Known as xenoestrogen or “foreign estrogen” they enter the body through the eating of plants and meats that have been exposed to or naturally contain these compounds and wreak havoc on hormonal levels which mess with visceral fat accumulation. However, many people suffer from metabolic obesity, as I noted earlier, without any outward sign of a large tummy. In fact, they might look pretty lean to the naked eye and register BMI’s that are in normal range.  The only way they find out their visceral fat is high is through an MRI or CT like scan, where the fat’s location can be clearly seen, as demonstrated in the below image. Of course, this is a costly test that is not always accessible or covered by insurance.

MRI Scan done in Britain of an outwardly thin person, who clearly has a large amount of visceral fat, as seen in the white regions of his abdomen (http://www.telegraph.co.uk/news/uknews/1536556/Get-in-touch-with-your-inner-fat.html)

 

So now that your perception of fat is altered, what can you do to reduce excess visceral fat? A 2007 study indicated that High-Intesity exercise was most effective when done at least 4-5 hours a week. Another added bonus for some of the individuals taking part in this study, when combined with dietary tweaking, was an overall reduction of their subcutaneous fat % thus putting BMI levels in normal range. I can’t think of a better prescription than food and exercise. Of course, the best people to consult with for said script would be a nutritionist or registered dietician and a personal trainer. The former for an overhaul of your diet and eating habits and the latter for the right training regimen. My personal feeling with respect to trainers is to do your research and look for someone who has a strong background (cumulative experience and/or degree) in exercise physiology or kinesiology to construct a program of exercise that best suits your body, fitness level and individual goals. Physical therapists and doctors that specialize in sports medicine can be great sources for referrals of this kind.

 

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Cellulite is NOT an itis…

On the left, cellulitis; On the right, cellulite – big difference!

I can’t tell you how many times, when discussing “trouble spots” with a client they refer to their cellulitis. What they mean to say is their cellulite, but the term they choose has nothing to do with the aesthetic appearance of their wobbly bits (see image above). It is understandable that for some women, the look of cellulite can feel like a serious medical condition. With summer unexpectedly here, they become acutely aware of their “imperfections” and panic; rushing to the spa for any firming, toning and detoxifying treatments available in the hopes that they can bare their flesh without fierce judgements. Cellulite doesn’t happen overnight, though. We are all born with a certain amount of fat cells that are distributed throughout our bodies according to our genetics. As we enter puberty, hormonal fluctuations affect our metabolism and shifts the distribution of the fat underneath our skin. The same thing occurs as we age and enter into menopause. In 80 to 90% of women, some level of cellulite will be visible; however the following factors greatly influence its widespread formation. Take notes:

  • Poor circulation and lymphatic drainage

The tissues in your body need to be fed and then flushed of the by products and toxins left behind after the fact. However, if you have a genetic or pathological insufficiency, the “toilet water” sits and festers, causing the breakdown of the matrix that holds the fat cells in their proper place. Since it all has to get flushed up and out, the areas most affected are the extremities. Exactly where you don’t want to see the cellulite.

  • Increased levels of stress hormones in the blood

We all know a high stress lifestyle can take a toll on our health, but it also has an affect on our fat distribution and connective tissue. Cortisol and catecholamines are stress hormones release by the adrenal glands as part of our “fight-or-flight” sympathetic nervous response. The body instinctively slows its metabolism and increases its “padding” of fat as it reacts to survive. The presence of the hormones over long periods of time can start to break down connective tissue, which as mentioned above, creates the matrix that holds the fat cells at bay. Once the matrix is damaged, the fat cells push up against the lower layers of skin, which is the puckered look that we all recognize as cellulite. The slowed metabolism also causes weight gain, which swells the size of the fat cells, making them pucker up even more.

  • Yo-yo dieting

Weight fluctuations occur as a result of physiological and hormonal changes. Step on the scale in the morning and again at night, and you could see your number rise or fall by 5-8 lbs. This is normal. Patterns of weight loss and gain over long periods of time of more than 20 lbs, damages the elasticity of the skin and connective tissue matrix. Out pops the cellulite.

  • Liposuction

Remember how we are all born with a certain number of fat cells? This procedure removes them from specific areas of the body also referred to as “re-contouring.” Once the fat cells are gone, they are gone. However, should the individual gain weight, the fat cells that are left redistribute the bulk in places the individual never had before. This is why the best candidates for liposuction are those who lead an active lifestyle and have a consistently clean diet.

And speaking of active lifestyles and clean diets, let’s segue into how one can address cellulite. Certain treatments and topical applications can produce visible results if the person remains consistent with modifications to their diet and exercise. Here are some of the one’s I can vouch for in my professional and personal practice. Still taking notes, I hope :-).

Dry brushing per day keeps the cellulite at bay…

Dry Brushing – One of my favorites is dry brushing. The practice consists of lightly brushing the surface of the skin in long upward strokes, starting at the lower limbs and moving upwards toward the heart. The brush bristles should be made of natural fibers and the brush itself easy to grip in order to properly handle it. Not only will you exfoliate the top layer of skin, but the increased blood flow to the capillary networks renews and tightens the skin’s surface. The movement towards the heart promotes proper circulation and flushing of the tissues via the lymphatic system. Done daily, it’s a great way to diminish the dimples.

Flushing and tightening

Caffeine, topically applied – As a little girl in Greece, every female relative young and old swore by their CLARINS cellulite cream and slathered in liberally in all corners and crevices of their bodies. What many creams geared toward cellulite contain is caffeine and what they do is act as a diuretic for the tissues, flushing out excess fluid and helping to tighten the surface of the skin. The cellulite puckers less; happy times on the beach. What I have seen work best is an application of caffeinated cream prior to a workout. The combination of an exercise induced sweat and that of the caffeine is like a one-two punch, firming and flushing. Also, since tissue repair happens during sleep, an application at night can be effective as well.

Courtesy of “8 Kilos to 50” Tumblr (You go girl!)

Get your sweat on and build muscle Recall how earlier we talked about people having a predisposed amount of fat cells that are distributed under the deepest level of skin in different ways dependent on genetics, hormones and age. These factors are sort of written in stone; however what you can control is how much a fat cell can swell. Therefore, the amount of lean muscle you build will reduce the size of the fat cells and help spike your metabolism, as muscle requires more calories than fat for maintenance. Reducing your overall body fat % will counter the factors you cannot control. A wonderful little exercise known as the Bulgarian Split Squat can do a whole lot to diminish the look of the dimples that many women have directly under their gluteal fold. At least, that’s what I have found within my own workouts. A tiny addendum to this bit on exercise is to make sure you are hydrating properly to flush your system out while also maintaining a balanced diet that is specific to your activity level and overall bodily needs. Consulting a registered dietician or certified nutritionist for advice is a great way to make sure you are eating right for you, cellulite or not.

It is also important to keep in mind that within that 80-90% of women who have cellulite are the fashion models, actresses and popular girls we gush(ed) over and/or envy. It’s a fact of physiological life that we can address to a certain extent, but inevitably must come to accept. Be good to your body through all its transformations and transitions and hopefully, it will be good to you.