In 2004 a surgeon removed about ten kilograms of fat from fifteen women and measured everything that mattered. Nothing improved. Four years later, it still hadn't.
That result should have ended an argument about body fat. Instead the argument got more specific, and the version you've heard most recently is that visceral fat, the fat around your organs, is the dangerous kind. I've said a version of that myself on this show, and in this episode I expand upon it.
This one starts from the beginning: what your fat is actually for, what insulin is, and what insulin resistance means, in plain terms and assuming nothing. Then four experiments that all point the same direction. Fat removed surgically, and the disease doesn't follow. People born with no fat tissue at all, who get the entire disease anyway. A hormone that reversed a 48% fatty liver without adding a gram of fat. And a diabetes drug that made people heavier and healthier at the same time.
The second half is practical. What a fatty liver actually does over twenty years, what BMI can and can't do, why the Lancet Commission changed the definition of obesity in 2025, and the exact order of tests I'd use, including the TyG index, FIB-4, and where each one stops working.
Part one of two. Next episode is about muscle.
Timestamps:
00:00 The Liposuction Experiment
02:06 The Visceral Fat Correction
05:47 What Fat Is For
08:14 The Carb Insulin Model
10:51 Filling The Garage
14:35 Taking The Fat Out
17:57 Born Without Fat Tissue
22:52 Heavier And Healthier
25:05 Neptune And Vulcan
29:57 The Patient Nobody Checked
33:59 What Every Ruler Missed
36:00 What To Actually Order
40:29 What Obesity Actually Is
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