Your Fat Has a Storage Limit

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 **Resources:** Vital 5 (TyG , waist to height, etc. discussion): https://www.barbellmedicine.com/vital-5-action-plan/ Barbell Medicine coaching and templates: https://www.barbellmedicine.com Plus podcast subscription: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal (now shipping): https://www.barbellmedicine.com/shop/learning/signal/ 01. Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. *N Engl J Med.* 2004;350(25):2549-2557. doi:10.1056/NEJMoa033179 02. Mohammed BS, Cohen S, Reeds D, Young VL, Klein S. Long-term effects of large-volume liposuction on metabolic risk factors for coronary heart disease. *Obesity (Silver Spring).* 2008;16(12):2648-2651. doi:10.1038/oby.2008.418 03. Sommer I, Teufer B, Szelag M, et al. The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis. *Sci Rep.* 2020;10(1):12699. doi:10.1038/s41598-020-69498-7 04. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. *J Clin Invest.* 2005;115(5):1343-1351. doi:10.1172/JCI23621 05. Spalding KL, Arner E, Westermark PO, et al. Dynamics of fat cell turnover in humans. *Nature.* 2008;453(7196):783-787. doi:10.1038/nature06902 06. Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. *Gastroenterology.* 2010;139(2):448-455. doi:10.1053/j.gastro.2010.04.056 07. Garg A. Acquired and inherited lipodystrophies. *N Engl J Med.* 2004;350(12):1220-1234. doi:10.1056/NEJMra025261 08. Al Yaarubi S, Alsagheir A, Al Shidhani A, et al. Analysis of disease characteristics of a large patient cohort with congenital generalized lipodystrophy from the Middle East and North Africa. *Orphanet J Rare Dis.* 2024;19(1):118. doi:10.1186/s13023-024-03084-2 09. Petersen KF, Oral EA, Dufour S, et al. Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. *J Clin Invest.* 2002;109(10):1345-1350. doi:10.1172/JCI200215001 10. Miyazaki Y, Mahankali A, Matsuda M, et al. Effect of pioglitazone on abdominal fat distribution and insulin sensitivity in type 2 diabetic patients. *J Clin Endocrinol Metab.* 2002;87(6):2784-2791. doi:10.1210/jcem.87.6.8567 11. Cusi K, Orsak B, Bril F, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. *Ann Intern Med.* 2016;165(5):305-315. doi:10.7326/M15-1774 12. Taylor R, Barnes AC, Hollingsworth KG, et al. Aetiology of type 2 diabetes in people with a 'normal' body mass index: testing the personal fat threshold hypothesis. *Clin Sci (Lond).* 2023;137(16):1333-1346. doi:10.1042/CS20230586 13. Martin S, Cule M, Basty N, et al. Genetic evidence for different adiposity phenotypes and their opposing influences on ectopic fat and risk of cardiometabolic disease. *Diabetes.* 2021;70(8):1843-1856. doi:10.2337/db21-0129 14. Martin S, Sorokin EP, Thomas EL, et al. Estimating the effect of liver and pancreas volume and fat content on risk of diabetes: a Mendelian randomization study. *Diabetes Care.* 2022;45(2):460-468. doi:10.2337/dc21-1262 15. Sanyal AJ, Kaplan LM, Frias JP, et al. Triple hormone receptor agonist retatrutide for metabolic dysfunction-associated steatotic liver disease: a randomized phase 2a trial. *Nat Med.* 2024;30(7):2037-2048. doi:10.1038/s41591-024-03018-2 16. Portillo-Sanchez P, Bril F, Maximos M, et al. High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels. *J Clin Endocrinol Metab.* 2015;100(6):2231-2238. doi:10.1210/jc.2015-1966 17. Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. *J Hepatol.* 2017;67(6):1265-1273. doi:10.1016/j.jhep.2017.07.027 18. Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. *Lancet Diabetes Endocrinol.* 2025;13(3):221-262. doi:10.1016/S2213-8587(24)00316-4 19. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity: comparison with the euglycemic-hyperinsulinemic clamp. *J Clin Endocrinol Metab.* 2010;95(7):3347-3351. doi:10.1210/jc.2010-0288 20. Sánchez-García A, Rodríguez-Gutiérrez R, Mancillas-Adame L, et al. Diagnostic accuracy of the triglyceride and glucose index for insulin resistance: a systematic review. *Int J Endocrinol.* 2020;2020:4678526. doi:10.1155/2020/4678526 21. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. *Ann Intern Med.* 2003;139(10):802-809. doi:10.7326/0003-4819-139-10-200311180-00007 22. McPherson S, Hardy T, Dufour JF, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. *Am J Gastroenterol.* 2017;112(5):740-751. doi:10.1038/ajg.2016.453 23. Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. *Gut.* 2022;71(5):1006-1019. doi:10.1136/gutjnl-2021-324243 24. Bansal MB, Patton H, Morgan TR, Carr RM, Dranoff JA, Allen AM. Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD practice guidance. *Hepatology.* 2025;83(5):1326-1340. doi:10.1097/HEP.0000000000001608 Our Sponsors: \* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com \* Check out FIGS: https://wearfigs.com \* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com \* Check out Quince and use my code quince.com/BBM for a great deal: https://www.quince.com Advertising Inquiries: https://redcircle.com/brands