What causes excess fat?
Fat in the body broadly falls into two categories:
- Visceral fat – held deeper within the abdominal cavity, surrounding the organs. This is metabolically active and, at high levels, is linked to health risks such as type 2 diabetes and cardiovascular disease.
- Subcutaneous fat – sits just under the skin and accounts for around 80% of total body fat. This is the fat that changes the shape of the body and is far less responsive to exercise alone.
A number of factors influence how much of this fat we carry and where it settles.
Diet and activity levels remain the most common drivers. Consistently taking in more calories than we burn leads to weight gain over time, and this is the piece most within a patient’s control.
Genetics has more influence than most people expect. Where you store fat, whether that’s around the middle, the hips or the thighs, tends to follow a family pattern rather than anything you’ve done wrong.
Stress plays a bigger role than patients usually credit. Cortisol and adrenaline are released to help the body cope, and one side effect is an increase in appetite, particularly for calorie-dense food. Because abdominal fat sits so close to the liver, it’s an efficient place for the body to store this fuel, which is part of why stress and belly fat go hand in hand.
Age and hormones shift the picture too. Metabolism slows gradually as we get older, so the same habits that once maintained our weight no longer do. For women, the drop in oestrogen during the menopause frequently brings a change in fat distribution, with weight settling around the abdomen for the first time.
None of this means excess fat reflects a lack of discipline. It’s a combination of biology, hormones and lifestyle, and in many cases the last stubborn pocket is simply not going to shift through diet and exercise alone, however committed you are.