How do I know if I have visceral fat vs. just being overweight?

Waist circumference at the navel is the practical clinical proxy for visceral fat in office settings, a waist above 40 inches in men indicates visceral fat accumulation that carries metabolic and cardiovascular risk independent of BMI, and the waist-to-height ratio (waist circumference in cm divided by height in cm, with a threshold of 0.5 as the risk cutoff) is a more population-generalizable tool that adjusts for height (Ashwell & Hsieh, Nutr Rev, 2005).

BMI does not distinguish visceral from subcutaneous fat. A man with a BMI of 27 (modestly overweight) and a waist circumference of 39 inches may have limited visceral fat with predominantly subcutaneous distribution, lower metabolic risk. A man with a BMI of 23 (normal) but a waist of 36 inches and a "thin-fat" body composition (normal weight with central fat distribution and low muscle mass) may have significant visceral fat and elevated metabolic risk. The waist-to-height ratio of 0.5 captures both scenarios better than BMI alone.

Honesty Scale: Solid (1) for waist circumference and waist-to-height ratio as visceral fat proxies. Solid (1) for their cardiovascular risk relevance independent of BMI.

What to do: Measure your waist circumference at the navel level (not at the narrowest point of the waist) with a non-stretchy tape measure, relaxed breath. Calculate your waist-to-height ratio. If above 0.5, you are in the metabolically elevated risk range regardless of what the scale says.

For the full picture, read The Visceral Fat Deep Dive