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I wasn't sure which topic this should fall under but i figured diabetes was most appropriate.

I am an active, healthy 23 y/o woman of asian and european desecent. During my childhood and early teens, i was borderline underweight. Now I easily maintain normal weight and BMI.

However I'm concerned about possible visceral fat. My family has a history of diabetes and CV diseases.

In spite of being under to normal weight, eating healthily and exercising moderately, I have always, and still have an obvious belly of hard fat even at my skinniest and most lean (42kg).

I understand that to lose viseral fat i have to lose overall weight but i'm afraid to lose too much as my BMI right now is about 18. The smallest part of my waist is 26", abdomen (ard navel) 30", hips (ard hip bone) is 31" and widest part (ard butt) is 35".

My blood work is normal and i don't have any metabolic disorders. How is it I have visceral fat and how do i lose it? If i lose weight in my limbs, i'll look anorexic.

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replied September 15th, 2009
Diabetes Answer A7252

I have to agree that weight issues can be very frustrating. You are also correct in concerns regarding visceral fat distribution as its association with cardiovascular risk. You mention asian background in your history. There are data that suggest that metabolic syndrome which includes features such as abnormal choelsterol, heart disease, and diabetes occurs at lower body mass index levels compared to caucasians. There is also data that maternal effects during pregnancy such as gestational diabetes impacts body fat distribution. All of these items may impact your current situation.

Some thoughts specific to your case include
- Avoidance of fructose-sweetened beverages or products
- Avoidance of tran-fats
- Regular aerobic activity

If not done, I suggest screening by your health care provider for metabolic risk factors and development of a treatment regimen to address any abnormalities detected.

I hope this helps you.

Joel Steelman, MD
Pediatric Endocrine
Cook Children's Medical Center

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