How much do you know about body fat and weight loss?

Body fat, aka adipose tissue, is as relevant and influential as our brain, heart, or other body organs for sustaining our health. How is that true? Isn’t body fat bad, and shouldn’t we try to eliminate as much as possible? 

On the one hand, we hear that fat have the potential to harm our health, but having some body fat is also valuable. Here’s why:

  • Body fat protects internal organs
  • It’s the body’s chief storage form of energy
  • It serves as an emergency fuel source in times of illness and diminished food intake
  • Fat forms the major material of cell membranes
  • Regulates hormones
  • Acts as insulation regulating body temperature
  • Provides structure to our skin protecting it from aging. 
  • Provides the majority of energy needed to perform much of the body’s muscular work

However, storing excess fat throughout the body, it can be problematic leading to adverse health conditions. 

Surprisingly, researchers have learned a lot about fat over the past 30 years we did not know before. It started with the obesity pandemic beginning in the 1970s. From this time forward, it has only worsened as a nation.  

Currently, 70% of the U.S. adult population is overweight or obese. This figure is projected to increase over the next 30 years. Consequently, obesity-related conditions have also risen – type 2 diabetes, precocious puberty, cardiovascular diseases, and several cancers. 

Unfortunately, one of the worst outcomes is the rates of obesity that are increasing much faster in our children than in adults.  Obese children will likely retain that weight into adulthood, increasing their risk for severe health complications at a younger age.  

Why and how we become obese is not simply a failure of willpower. Rather, many factors include genetics, socioeconomic standing, and our day-to-day decisions, from whether we exercise or not, to what kind and how much food we eat. This complex interplay ultimately leads to a long-term increase in our calorie intake that exceeds our long-term energy expenditure of excess calories. 

White fat compared to brown fat

You may think all fat is created equal. Not true. Adipose tissue is a very misunderstood, complex organ of various types. The two main forms discussed in this article are white adipose tissue (WAT) and brown adipose tissue (BAT). 

White adipose tissue is deposited throughout the body, generally in the abdomen, chest, thighs, and upper arms. People considered obese will have an abundance of WAT compared to normal or underweight individuals. WAT is very good at storing fat to secure enough energy from food. This stored energy within the adipose tissue is released regularly in small packages of fat, providing energy for physical activities like walking five miles or mental activity when taking an exam. WAT is also commonly separated into visceral fat and subcutaneous fat. Visceral fat is generally located deep within the abdomen surrounding body organs like the liver. In contrast, subcutaneous fat is found just below the skin in areas such as the upper thighs (cellulite). 

Brown adipose tissue is found in the neck, shoulders, chest, and abdomen, but in much smaller amounts than WAT. The function of BAT is to burn stored fat and to keep us warm by creating heat. 

Measuring body fat to assess the amount distributed in a person’s body can be determined in various ways. The most common, accessible, and least expensive body fat assessments include body mass index (BMI and requires adjustments for age, sex, genetic, and ethnic background), waist circumference, bioelectrical impedance analysis, and skinfold calipers. More sophisticated, accurate, but expensive methods of assessing body fat include hydrostatic weighing (underwater weighing), dual-energy X-ray absorptiometry (DXA), and even computed tomography (CT) and magnetic resonance imaging (MRI).

One widely-believed misconception is that we are all born with the fat cells we will ever have throughout life and that these fat cells can either enlarge or shrink over time. This is not true. Studies have shown that adipogenesis (the formation of fat cells), continues during our lifetime at a median turnover rate of 8% each year, resulting in the entire replacement of adipocytes (a type of adipose tissue that stores excess energy in the form of triglycerides) every 15 years. 

Treatment for people overweight or obese

A tremendous amount of new knowledge and understanding of body fat has exploded over the past ten years. This added information can help direct how to best treat the pandemic of obesity.

There are dozens and dozens of weight-loss diets, some excellent and some not, but for long-term, sustainable weight loss, there are two best ways to achieve this feat:

  1. Reduce food consumption or calories
  2. Increase energy expenditure

In addition, there are multiple new FDA-approved treatments for the problem of excess adipose tissue or obesity. Each of these medications can be used long-term and include the following:

  • Orlistat (Xenical, Alli)
  • Phentermine-topiramate (Qsymia)
  • Naltresone-bupropion (Contrave)
  • Liraglutide (Saxenda)
  • Semaglutide (Wegovy) 

The majority of these medications work by either by reducing a person’s appetite and to feel fuller sooner after eating, or they reduce fat absorption. Depending on a person’s insurance plan will determine if the costs of these medications are covered or not. 

For severe obesity, bariatric surgery is the most effective approach to weight loss resulting in metabolic improvements quickly. Many of these surgeries success are due to the effectiveness of a person losing WAT. However, bariatric surgery is expensive, requires a person to make dramatic changes in eating style, and may result in serious side effects such as dumping syndrome, low blood sugar, and malnutrition. 

Overall, the majority of people who are overweight or obese can achieve weight loss and reduction of WAT by following a sensible healthy diet plan 90% of the time and regular exercise of moderate-to-vigorous activity. When these healthy weight loss habits are followed consistently, long-term weight loss is more likely to be sustainable.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.

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