For years, obesity was viewed as a lifestyle problem rather than a medical condition. That thinking has now shifted, with the World Health Organization (WHO) formally recognising obesity as a chronic disease that quietly damages multiple organs and raises the risk of serious complications. One of its most underestimated threats is visceral fat – the hidden fat stored deep inside the abdomen around vital organs like the liver, pancreas and intestines – which is far more dangerous than the fat around your waist that you can see or pinch.
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Dr Pankaj Sharma, director of Bariatric, Robotic, and Laparoscopic Surgery at Fortis Hospital, Shalimar Bagh, and founder of Shalya Clinic, Rohini, New Delhi, spoke to HT Lifestyle about how visceral fat interferes with surgery, increasing risks of injury and hampering recovery. He explains, “As a bariatric surgeon, I often tell patients that visceral fat doesn’t just affect your daily life or your long-term health; it directly influences how safely we can perform any surgical procedure. Many patients are surprised when I explain that obesity itself is not the only concern – where the fat sits matters even more.”
Why does visceral fat increase surgical risks?
Dr Sharma describes visceral fat as “fog inside the abdomen” – something that reduces surgical visibility, increases the risk of errors even in experienced hands, and is also closely linked to multiple metabolic conditions.
He explains, “Visceral fat is strongly linked to type 2 diabetes, fatty liver disease and certain cancers too. It behaves differently from subcutaneous fat. It is biologically active, producing inflammatory chemicals, hormones, and toxins that interfere with healing and immunity and metabolic balance.” He outlines the following challenges that patients with high visceral fat face:
Difficult airway and anaesthesia challenges
According to Dr Sharma, excess fat surrounding internal organs and narrowing the respiratory pathways makes the administration of anaesthesia more complex and inherently riskier. He highlights, “It can lead to low oxygen levels and breathing problems during surgery. Many obese patients also have sleep apnea which further increases breathing risks during surgery.”
Higher risk of bleeding
Higher visceral fat also amounts to an increased risk of bleeding during surgeries. The surgeon emphasises, “Fatty tissues have more fragile, tiny blood vessels. During abdominal surgeries, this increases the chances of bleeding and makes surgical handling more delicate.”
Poor wound healing and infection
According to the surgeon, visceral fat also hampers wound healing by releasing inflammatory chemicals that disrupt the body’s recovery process. He explains, “Visceral fat produces inflammatory markers that slow down recovery. These patients are more prone to infections, delayed wound healing, and hernia formation after surgery.”
Impact on heart function
Visceral fat can also impair heart function, leaving people with higher levels more vulnerable to cardiac complications during surgery. Dr Sharma stresses, “The heart has to pump harder in people with high visceral fat. During surgery, even slight stress on the cardiovascular system can lead to arrhythmias, blood pressure fluctuations, and complications.”
Technical difficulty during surgery
The surgeon points out that visceral fat makes surgical procedures more complex, increasing the risk of injury during operations, leading to unsuccessful outcomes. Dr Sharma explains, “Excess visceral fat makes it harder for surgeons to visualise organs clearly. Instruments move slower, mobility is reduced, and the risk of injury increases.”
How does bariatric surgery help reduce risks?
According to Dr Sharma, bariatric surgery does more than promote weight loss – it is an effective treatment for obesity as a chronic disease. He highlights, “Bariatric surgery does not just change your weight; it changes your biology. Obesity is now officially recognised as a disease – and visceral fat is its most dangerous expression.”
If ignored, it can complicate even the safest surgeries. But with timely bariatric treatment, the surgeon stresses that patients can not only lose weight but also dramatically reduce surgical risks and reclaim their overall health. He outlines the following benefits:
Rapid reduction in visceral fat
Dr Sharma points out that bariatric surgery targets visceral fat – which is harder to get rid of – instead of subcutaneous fat. He explains, “Unlike dieting, which usually targets subcutaneous fat first, bariatric surgery triggers significant loss of visceral fat in the early months. This drastically improves metabolic health.”
Better diabetes and blood pressure control
High visceral fat is linked to chronic metabolic and cardiovascular conditions like type 2 diabetes and hypertension. Dr Sharma highlights, “With reduced visceral fat, insulin resistance improves, and conditions like type 2 diabetes, hypertension, and fatty liver begin to reverse. This makes future surgeries – if needed – far safer.”
Lower inflammation levels
Visceral fat releases inflammatory chemicals, and according to the surgeon, bariatric surgery can help lower this, hence supporting immune health and even aiding recovery. He explains, “Bariatric surgery reduces inflammatory markers in the blood, improving immunity, oxygenation, and healing capacity.”
Improved heart and lung function
Obesity compromises heart and lung function; bariatric surgery can help restore and improve both. Dr Sharma states, “Weight loss after surgery lifts pressure off the diaphragm, heart, and lungs. Patients breathe better, sleep better, and tolerate surgical interventions more safely.”
The surgeon concludes, “Obesity is no longer about appearance; it is about survival. When we reduce visceral fat, we are not just making surgery safer – we are giving patients a fresh chance at life, a healthier body, and a future they can look forward to with confidence.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
