You made it through another feast of Thanksgiving. You travelled great distances to be with family, or you went to great expense to host. Every effort was made to feed yourself and your guests the traditional meats, vegetables and sweets of this annual orgy of food. You convinced yourself that whatever damage you did to your diet you would resolve to make up in the few weeks between this holiday and the next one in just a month.

On Thanksgiving we don’t count calories. We let ourselves go for Christmas as well. Both of these holidays involve making merry with those we love and it just seems wrong to stress over one or two days a year.

If you are overweight (two out of three Americans are) then you have been convinced that yesterday you ate more calories than you expended, and you have been told since your earliest years that eating more calories than you expend will lead to an expanding waistline. We (science) now knows that that simple explanation is mostly wrong. A calorie eaten and not ‘burned’ does not always go into fat cells. “Okay, smarty-pants, where does fat in your fat cells come from, and where does it go when I am done with it?” you ask.

In a nutshell, your body fat is your biggest long-term risk for infirmity. Nothing correlates with diabetes, heart disease, and cancer better than your fat. So is your fat your fate? Everyone says, “Lose the fat to extend and improve your life,” but virtually no one can do it. So how do you lose the fat? Better yet, how do you prevent it from arriving in the first place, and preferably leave your muscle mass in place? In order to answer these questions a little more knowledge is required about what causes fat accumulation.

Lustig, Robert H. (2012-12-27). Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (pp. 75-76). Penguin Publishing Group. Kindle Edition.

Guess what? How fat develops and is consumed by your body is known. As far as how a fat cell is filled, I don’t mean to spoil the surprise, but I will tell you that the number of calories in your foods is not the only factor that decides if you will put it on or take it off after your day of feasting. Fat only gets into a fat cell one way, insulin puts it there.

There are three different ways to increase your insulin:

1. If, in response to a meal, particularly one high in refined carbohydrates, your pancreas makes extra insulin (called insulin hypersecretion), it will drive your fat cells to store energy. This happens when your brain sends a signal to the pancreas through the vagus, or “energy storage,” nerve.

2. If, because of the specific foods you eat you build up fat in your liver, this fat will make the liver sick (called insulin resistance). The pancreas has no choice but to make more insulin in order to force the liver to do its job. This raises insulin levels throughout the body, driving energy into fat cells everywhere, and making other organs sick as well.

3. If your stress hormone cortisol (which comes from your adrenal gland) increases, two things will happen. It will work on the liver and muscle to make them insulin resistant, raising your insulin and driving energy deposition into fat. It may also work on the brain to make you eat more.

Lustig, Robert H. (2012-12-27). Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (p. 82). Penguin Publishing Group. Kindle Edition.

There you have it, the three ways that fat cells are inflated. If you become resistant to the effects of insulin that means that your organs and muscles do not accept glucose from your blood as easily, and your liver will not accept energy from your blood for processing, forcing it into your fat cells instead.

On the bright side, all fat cells are not equally dangerous to your health. The fat that matters is organ fat, visceral fat, beer-belly fat. If you are a man and you look pregnant, that is the fat that kills. Ladies get it too, but of course the fat that the ladies want to lose is wiggling on their arms, jiggling in their pants or hanging from their jaws. The fat you can see easily is actually not very dangerous to your health. The fat that is deadly is hard to measure, and it can be dangerous way before it is visible.

This fact is borne out in a recent study comparing BMI to percentage body fat by X-ray methods. It appears that many as 50 percent of women and 20 percent of men who are categorized as normal on the basis of their BMI are actually obese based on their carriage of visceral (bad) fat. The study’s author, Dr. Eric Braverman, called BMI the “Baloney-Mass Index,” because it gives a false sense of security to those who follow it. Indeed, Dr. Jimmy Bell of London, using MRI scans of the abdomen, realized that body size is irrelevant; it’s visceral fat that drives disease. He coined the expression “thin on the outside, fat on the inside,” or TOFI. Bottom line, it’s your visceral fat, in particular your liver fat, that counts.

Lustig, Robert H. (2012-12-27). Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (p. 89). Penguin Publishing Group. Kindle Edition.

How do you know if you have too much visceral fat? You can look at the circumference of your waist. If your waist is 40 inches for a man or 35 inches for a woman, measured at the navel (men will wear the belt below the belly) then you likely have visceral fat. If you want to know if your visceral fat is causing health problems you look for other common signs:

Another simple method for determining your metabolic status is to look at the back of your neck, armpits, and knuckles. What you’re looking for is acanthosis nigricans, or a darkening, thickening, and ridging of the skin. Many people think this is dirt or, in the case of the neck, “ring around the collar,” but it’s actually excess insulin working on the skin (the epidermal growth factor receptor, to be exact). You might also see skin tags in these areas. Both of these are visible signs of insulin resistance and predict future risk for chronic metabolic disease.

Lustig, Robert H. (2012-12-27). Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (pp. 90-91). Penguin Publishing Group. Kindle Edition.

Losing weight is important for your health if you have visceral fat. Losing that fat, it turns out, happens first. The most important measurement of how you are doing will not be on the scale, though, it will be a measuring tape, checking that waist circumference. To markedly improve your health prospects an obese man or woman need only lose seven to ten percent of their weight, because it all comes from the organs first.

How do you do it? How do you actually go about losing that body fat that you can’t easily see? I will write about that tomorrow…