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“I was thin on the outside, but fat on the inside”

Life-Saving and Life-Changing Stories from Chest CT Scans

Visceral Fat Case Studies

*All patient names are fictitious.

**Some stories have been compiled from several case studies and publications.

When Alex went to get a chest CT scan, he was certain he had no worries. But the scan showed he had too much visceral fat. The excess fat that surrounded his abdominal organs increased risk for diabetes, cancer, and heart disease. With this new information, Alex is now making lifestyle changes to reduce these risks.

Alex* noticed that as he was approaching his 70th birthday, his waist was getting thicker. He wasn’t very concerned because his weight was in the normal range and his pants still fit. Also, his blood pressure was well-controlled with a medication. He never skipped a single dose.

Since he had retired, Alex enjoyed a relaxing lifestyle. He liked to read, putter around the garden, and work on his stamp collection. He and his wife, Nancy, liked to eat out several times a week. Nancy was always asking him to take walks with her, but he declined. “I worked hard for over 50 years. Now I like sit and smell the roses.”

Nancy heard an advertisement on the radio about getting an inexpensive screening for heart and lung disease. It was a new type of technology that combined a low-dose CT scan with Artificial Intelligence to instantly tell if there was something that required follow-up. Along with evaluating the heart and lungs, the scan would also check for osteoporosis, liver problems, and visceral fat (the fat that wraps around the organs in the abdomen).

Nancy was interested in learning more about this screening. She had been a smoker but had quit about 20 years ago. She also knew that women were at risk for osteoporosis.1 This test seemed like a good way to check out several possible health issues, all for the same price.

When she told Alex about the test, he didn’t see any reason to get screened. He’d never smoked, his high blood pressure was controlled, and he didn’t need anything else “inspected.” But Nancy persisted, saying they were getting older, and it just seemed practical. Alex eventually gave in.

The purpose of the low-dose chest CT scan is to prevent disease or identify it in early stages. It is an imaging procedure that combines X-ray and computer technology to take detailed pictures of the organs, bones, and structures inside the chest and upper abdomen.

Results are instantly analyzed and compared to thousands of other scans in a database.

By using a CT scan, health care providers can get much more information than from an ordinary X-ray. It increases a health care provider’s ability to go beyond traditional risk factor calculations to create an individualized treatment plan.

Getting a CT scan is a simple and painless procedure that takes less than 30 minutes. Preparation is easy; the only restriction is to avoid any caffeine for 4 to 12 hours before the scan. Medications can be taken as usual. Often the scan is done wearing street clothes; only metal jewelry and eyeglasses need to be removed.

By the time they got back home, results from both scans were available online; the results were also sent to Alex’s and Nancy’s primary care physicians. Nancy was happy to learn that her scan showed nothing urgent. She would go over everything with her physician at her upcoming annual check-up.

Alex was shocked to learn that he had excess visceral fat and was advised to see his physician for follow-up. His doctor was direct: “You’re thin on the outside and fat on the inside.” Although Alex’s weight was normal and he didn’t appear overweight, the amount of fat around his liver, kidneys, and intestines was problematic.(2)

His physician explained to Alex that visceral fat is called “active fat” because it affects how the body’s hormones work.(2) Too much visceral fat is dangerous. Some of the negative consequences are:

  • A risk for developing type 2 diabetes.(2) Excess visceral fat causes too much insulin to be produced, leading to type 2 diabetes. Alex’s blood sugar levels had been creeping up for a while; if these levels weren’t controlled or reduced, he could become diabetic.

  • A risk for heart disease.(2) Alex already had high blood pressure. Too much visceral fat causes inflammation; combined with high cholesterol levels, the result is heart disease, called atherosclerosis.(3)

  • A risk for certain cancers.(4) There is a direct relationship between the amount of visceral fat and colorectal and pancreatic cancers. Women are at greater risk for uterine and post-menopausal breast cancer.(4)

  • A risk for Alzheimer’s disease.5 Because of the inflammatory process from too much visceral fat, the brain can be affected. There seems to be an extra risk if the visceral fat develops during middle age.(4,5)

  • A risk for stress on the joints and back.(4) The extra weight from visceral fat is hard to carry around. It also contributes to being inactive.(4)

Alex’s physician congratulated him on getting the chest CT scan. He said that there’s no other accurate way to determine if excess visceral fat is present. Although Alex seemed healthy enough, he was at serious risk for several medical problems that now could be addressed.

First on the list to reduce visceral fat: exercise. Although Alex enjoyed his relaxed lifestyle, he had to get moving. A minimum of 150 minutes of moderate exercise a week (30 minutes a day, 5 days a week) or a minimum of 75 minutes of vigorous exercise reduces the risk of cancer.(4) The American Heart Association agrees with this exercise plan to lower blood pressure and “bad” cholesterol.(6)

Alex should also look at his diet and find ways to improve it. Adding vegetables, beans, choosing lean proteins, and cutting back just 100 calories a day can make a difference.(4) Some studies show that adding calcium and vitamin D to the diet can decrease visceral fat.(7)

Just as important, Alex should avoid certain food ingredients:(7) Trans fats (found in deep-fried or processed foods) and fructose (found in soda, candy, processed baked goods).

Alex was fortunate. By getting a low-dose chest CT scan, he learned he had a potentially serious medical problem that wouldn’t have been discovered any other way. With the information from the scan, he can make a few changes to be “thin on the outside, and thin on the inside.”


  1. Osteoporosis Fast Facts. National Osteoporosis Foundation, Arlington, VA. (Accessed 3 September 2021)

  2. What is the best way to get rid of visceral fat? Medical News Today. Medically reviewed by D. Bubnis, MS, NASM-CPT, NASW Level II-CSS on February 15, 2018. (Accessed on 3 October 2021)

  3. Rapaport, L. New Heart Health Guidelines Focus on Belly Fat, Not Just Body Weight, April 27, 2021. Everyday Health/HealthGuard. (Accessed on 3 October 2021)

  4. Espat A and Cordeiro B. Drop belly fat, drop cancer risks. MDAnderson, Houston, TX. (Accessed 3 October 2021)

  5. Newman T. Belly fat linked to cognitive decline. Medical News Today. Fact-checked by T Collier. (Accessed 3 October 2021)

  6. Prevention and Treatment of High Cholesterol (Hyperlipidemia) American Heart Association, Dallas, TX. (Accessed 3 October 2021)

  7. What is Visceral Fat? WebMD. (Accessed on 3 October 2021)


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