A troubling reality has emerged in modern healthcare: visceral fat. It is one of the most dangerous forms of body fat and receives minimal attention from medical professionals despite its critical role in chronic disease development. Metabolic health expert Dr. Ben Bikman talked about it in a recent podcast. According to him, this oversight stems from a fundamental flaw in our healthcare system’s approach to metabolic disorders.
Modern clinical care operates under what Dr. Bikman calls a “glucose-centric paradigm,” where doctors focus almost exclusively on blood sugar levels while ignoring the underlying insulin dysfunction that drives visceral fat accumulation. This creates a dangerous blind spot in medical practice, as visceral fat represents a significant health threat that often goes undetected and untreated.
Unlike subcutaneous fat that sits just beneath the skin, visceral fat wraps around internal organs and behaves more like an active endocrine organ. This type of fat releases inflammatory compounds and disrupts normal metabolic processes, contributing to insulin resistance, cardiovascular disease, and numerous chronic conditions. Yet because visceral fat accumulation doesn’t immediately affect blood glucose levels, it flies under the radar of conventional medical screening.
The lack of attention to visceral fat isn’t just a matter of medical oversight—it’s also influenced by healthcare economics. Visceral fat diagnosis and treatment don’t generate significant revenue streams for medical practices. Unlike conditions that require expensive medications, surgeries, or frequent monitoring, addressing visceral fat primarily involves lifestyle interventions that don’t translate into profitable medical procedures.
Dr. Bikman explains that measuring insulin levels, which would help identify visceral fat accumulation early, isn’t standard practice in annual checkups. “The consequence of the glucose-centric paradigm… it’s increasingly harder to overlook because of what we know with regards to insulin,” he notes. This creates a situation where patients with dangerous levels of visceral fat remain undiagnosed until they develop full-blown type 2 diabetes or cardiovascular disease.
Visceral fat becomes particularly problematic because it can only expand through hypertrophy—the enlargement of existing fat cells—rather than creating new ones. As these fat cells grow larger, they become insulin resistant and pro-inflammatory, creating a cascade of metabolic dysfunction.
“The hypertrophic fat cell becomes insulin resistant to stop growth and it becomes pro-inflammatory to try to correct blood flow,” Dr. Bikman explains. This process leads to the release of harmful substances into the bloodstream, including ceramides that directly cause insulin resistance in other tissues.
The solution to this healthcare gap requires both systemic changes and individual action. Healthcare providers need to incorporate insulin measurements into routine screening and recognize visceral fat as a serious medical condition worthy of intervention. From a patient perspective, focusing on insulin-lowering strategies—particularly controlling refined carbohydrates and implementing time-restricted eating—can effectively reduce visceral fat even without direct medical supervision.
The irony is striking: while our healthcare system excels at treating the expensive complications of visceral fat accumulation, it largely ignores the simple, cost-effective prevention strategies that could eliminate the problem before it begins. Until this changes, patients must take responsibility for understanding and addressing their visceral fat levels, often without the guidance or incentive structure that our medical system should provide.