Visceral Obesity with Excess Ectopic Fat: A Prevalent and High-Risk Condition Requiring Concerted Clinical and Public Health Actions

Abstract

The current epidemic of chronic societal diseases results from the exposition of a growing segment of the population to a “toxic” environment not compatible with healthy behaviours. About 60% of all deaths result from noncommunicable chronic diseases that are largely attributed to 4 behaviours: smoking, excessive alcohol consumption, poor nutritional habits, and lack of physical activity. Despite the fact that such behaviours are critical for health, few physicians assess nutritional quality and physical activity level in clinical practice. Cardiometabolic imaging studies have consistently found that the health risk of overweight and obesity is largely determined by the accumulation of fat in the abdomen (excess visceral adiposity) which is a good marker of an accumulation of toxic lipids in normally lean tissues such as the heart, the liver, the skeletal muscle, the kidney, and the pancreas, a condition that has been described as ectopic fat deposition. At any given body mass index, an elevated waistline is predictive of an increased accumulation of abdominal fat which is more likely to be resulting from an excess of visceral fat when accompanied by elevated triglyceride concentrations, a condition that we have defined as “hypertriglyceridemic waist.” It is proposed that 4 key “lifestyle vital signs” should be assessed and targeted in clinical practice as powerful predictors of various health outcomes: waist circumference, cardiorespiratory fitness, nutritional quality and physical activity level. Substantial benefits should be expected from assessing the above 4 “lifestyle vital signs.” It is proposed that the time for “preventive lifestyle medicine” has come.