How body fat affects your metabolic health and risk of metabolic disease | Dr Robert Eckel

35 snips

Feb 2, 2026

Dr Robert Eckel, endocrinologist and former American Heart Association president, unpacks why obesity is more than BMI. He explains visceral versus subcutaneous fat and how adipose-driven insulin resistance develops. The conversation covers who benefits from weight loss, GLP-1 therapy questions, and practical ways to monitor metabolic risk.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

INSIGHT

Fat Distribution Trumps BMI Alone

Excess body fat's harm depends on distribution and metabolic effects, not just weight or BMI.
Visceral/central fat links to insulin resistance and many obesity-related diseases.

ADVICE

Measure Beyond BMI

Use waist measures or body composition (DEXA) in addition to BMI to assess excess fat and risk.
If preclinical obesity shows risk signals, pursue active weight-loss interventions rather than waiting.

INSIGHT

Use A Risk Gradient To Guide Treatment

A risk gradient helps decide who with excess fat should get aggressive treatment now.
Not everyone with excess adiposity immediately needs intensive therapy, but many will benefit from prevention.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

I’m joined by Dr Robert Eckel to unpack why obesity is far more complex than a BMI number and why insulin resistance plays such a central role in cardiometabolic disease.

We discuss preclinical versus clinical obesity, fat distribution, metabolic risk, and what actually improves health outcomes beyond weight loss alone.

What We Cover

Why BMI is only a starting point
Preclinical versus clinical obesity explained
Why visceral fat matters more than total fat
How insulin resistance develops with excess body fat
Who may benefit most from weight loss interventions
GLP-1 therapies, benefits and open questions

A practical, evidence-based conversation that reframes how we think about obesity, risk and long term health.

Introduction (00:00)
Clinical vs Preclinical Obesity: How Should Obesity Be Defined? (05:21)
Why Is Obesity Difficult to Diagnose and Treat in Practice? (08:06)
How Genetics and Environment Influence Body Fat Gain (20:27)
What Is Insulin Resistance and Metabolic Syndrome? (32:23)
How Insulin Sensitivity Relates to Clinical Obesity (55:26)
Why Insulin Resistance Begins in Adipose Tissue (59:49)
Physiological vs Pathological Insulin Resistance Explained (01:04:47)
How Physical Activity Improves Insulin Sensitivity (01:10:46)
Family History, Genetics, and Cardiometabolic Risk (01:12:30)
Individualised Obesity Treatment Guidelines in Clinical Care (01:15:40)
How GLP-1 Receptor Agonists Are Used in Obesity Management (01:16:12)
What Is the Obesity Paradox in Cardiometabolic Disease? (01:22:01)
Future Projections for Obesity and Cardiometabolic Health (01:30:07)
Public Health Challenges in Preventing Excess Adiposity (01:40:23)
Practical Clinical Takeaways and Final Thoughts (01:44:15)

Want to support the show?

The best way to support the show is to use the products and services offered by our sponsors. To check them out and enjoy great savings, visit theproof.com/friends. You can also support the show by leaving a review on the Apple Podcast app and sharing your favourite episodes with friends and family.

This episode is brought to you by:

38TERA

Consider 38TERA's DMN prebiotic supplement a daily multivitamin for your gut. Formulated by yours truly and gastroenterologist Dr Will Bulsiewicz. Use code THEPROOF for a discount at checkout.

Eight Sleep

Upgrade your sleep with the Pod 5 Ultra by Eight Sleep. Clinically validated to deliver up to 1 extra hour of quality sleep per night through temperature control and biometric tracking. Use code THEPROOF for $350 off at eightsleep.com/theproof. Try it risk-free for 30 days, with worldwide shipping.

WHOOP

Whoop, the most advanced fitness and health wearable available. Your personalised fitness and health coach to recover faster, sleep better, and train smarter. Claim your first month free on join.whoop.com/simon.

Simon Hill, MSc, BSc (Hons)

Subscribe & Connect:

Nourish your gut with my Plant-Based Ferments Guide and download my Two-Week Meal Plan.