Can Your Face Tell You Something About Visceral Fat? What I Learned From Decades of Measuring Body Fat
For more than 30 years as a trainer and coach, I measured a lot of body fat.
And I mean a lot.
For much of that time, I used a 12-site skinfold protocol—although in practice I measured 11.
I consistently skipped the twelfth site, which was right around the gluteal fold at the top of the hamstring.
Skinfold testing is personal enough already. You're literally grabbing someone's body fat, pinching it with a pair of calipers and writing down the number. I decided putting my hand that close to someone's glute was one data point I could live without.
So I measured 11.
And two of those measurements were unusual:
The cheek and chin.
Clients occasionally asked:
“Why are you measuring my face?”
My answer was simple:
Because sometimes I see the changes here first.
When someone was losing body fat, changes in the cheek and chin could show up surprisingly quickly.
At the time, that was simply useful information for me as a coach.
But after watching people's bodies change for decades, I've started wondering whether those facial measurements might have been telling me something more.
Not just:
How much fat does this person have?
But:
Where does this person's body tend to store its fat—and could changes in the face tell us something about changes we can't see?
That's a very different question.
And I have a hypothesis.
Body Fat Isn't Just About How Much You Have
We tend to talk about body fat as though it's one number.
You're 15% body fat.
You're 25%.
You're 35%.
But that number leaves something important out.
Where is the fat?
Two people can weigh the same amount and have similar body-fat percentages while looking very different—and potentially having very different metabolic risk.
Some fat is stored directly underneath the skin. That's called subcutaneous fat.
That's what I was grabbing with my skinfold calipers.
Other fat is stored deeper inside the abdomen, around the internal organs.
That's visceral fat.
And physiologically, the distinction matters.
Research continues to show that fat stored in different locations doesn't necessarily behave the same way metabolically. Greater visceral adiposity, in particular, is associated with greater cardiometabolic risk.
So the question isn't simply:
How fat are you?
It's also:
Where are you fat?
Remember the Apple and the Pear?
For years, one of the simplest ways of explaining this was the apple versus pear body shape.
It sounds almost too simplistic to be scientific.
But the basic idea is useful.
A person with more of a pear shape tends to carry proportionally more fat around the hips, buttocks and thighs.
A person with more of an apple shape tends to carry proportionally more fat centrally, particularly around the abdomen.
Obviously, human beings don't actually come in two shapes.
There's an enormous spectrum between the two.
But the analogy illustrates something important:
Fat distribution matters.
Greater central or “apple-shaped” adiposity is associated with greater cardiometabolic risk, while greater gluteofemoral—or hip and thigh—fat storage tends to be associated with a more favorable metabolic profile.
So you could have two people of similar height and weight, with similar BMI and perhaps even similar overall body-fat percentages.
One carries considerably more fat around the hips and thighs.
The other carries considerably more around the abdomen.
Those aren't necessarily the same physiological situation.
And that leads to the question that interests me:
If where we store fat matters everywhere else, why wouldn't we at least ask whether the face is part of that pattern too?
When an Observation Becomes a Pattern
If you measure someone's body fat once and notice something unusual, it doesn't mean very much.
Maybe you measure a second person and notice the same thing.
Interesting.
But it could still be coincidence.
The perspective changes when you're doing this over and over again, year after year, across hundreds of people and thousands of individual measurements.
At some point, you're no longer remembering one interesting client.
You're recognizing a pattern.
That still isn't scientific proof. I want to make that distinction very clear.
Repeated professional observation doesn't replace a controlled study.
But it can give you something extremely valuable:
A question worth studying.
That's really how this idea developed for me.
I wasn't sitting at a desk trying to invent a theory about facial fat and visceral fat.
I was standing in front of people with calipers in my hand.
Measure the cheek.
Measure the chin.
Measure the abdomen.
Do it again weeks later.
Do it with the next person.
Then the next.
And keep doing it for years.
Eventually, you begin noticing relationships that you weren't necessarily looking for when you started.
That's where this hypothesis came from.
My Hypothesis: The Face May Tell Us More Than We Think
Here's what I think.
My hypothesis is that facial fat is strongly associated with visceral fat—and that measurable changes in facial fat may give us a useful clue that larger changes are occurring in visceral fat.
That's my bet.
I could be wrong.
But after more than 30 years of measuring body fat and watching people's bodies change, I don't think I am.
What I don't know is how strong the relationship is.
I don't know whether the cheek, chin or some combination of facial measurements would prove most useful.
I don't know whether the relationship changes with age or sex.
And I don't know how accurately it could ultimately be quantified.
Those are questions for research.
But I suspect there's a relationship here that hasn't been fully connected yet.
Part of what made me wonder about it was aging.
I had watched people get leaner.
I had watched people gain weight.
And eventually, I had watched a lot of people get older.
It seemed to me that as some people aged and accumulated more central body fat, their faces also became fuller and rounder.
Was that simply because they had more total body fat?
Possibly.
But could the facial change also be associated with the change in where they were storing that fat?
I think it might be.
We know aging can change fat distribution.
People don't necessarily just accumulate more fat as they get older. Research describes a tendency toward greater abdominal and visceral fat accumulation, sometimes even without corresponding increases in total body weight or overall adiposity.
In very simple terms, our fat distribution can become somewhat more apple-like as we age.
So I started wondering:
Could some of the changes I was seeing in the face be an outward signal of a larger change occurring internally?
I couldn't answer that with the measurements I was taking.
But apparently I wasn't the only person who wondered whether cheeks and visceral fat might be connected.
Someone Actually Studied “Chubby Cheeks”
Years later, I came across a 1998 paper published in The New England Journal of Medicine with a title that immediately caught my attention:
“Relation Between Chubby Cheeks and Visceral Fat.”
I couldn't have named it better myself.
Researchers examined CT scans from 25 patients and measured buccal fat in the cheek, visceral fat inside the abdomen and abdominal subcutaneous fat.
They found a significant positive relationship between buccal fat and visceral fat.
Here's the part I find particularly interesting.
In this small group, cheek fat was not significantly correlated with abdominal subcutaneous fat or BMI.
Now, 25 people is a small study.
It doesn't establish that facial fat can reliably predict visceral fat.
And it certainly doesn't establish the stronger hypothesis I'm proposing—that changes in facial fat might track changes in visceral fat over time.
But it does tell us something important:
The idea isn't coming completely out of thin air.
There is at least some published evidence that cheek fat and visceral fat are associated.
What we don't know is how far that relationship goes.
The Measurement Problem
This brings us to something that bothered me throughout my career.
What we'd ideally like to measure and what we can realistically measure aren't always the same thing.
I could measure subcutaneous fat very precisely.
I used Harpenden® skinfold calipers, professional-grade instruments that cost me somewhere around $400 even back then.
These weren't inexpensive consumer calipers. Harpenden calipers have been widely used in clinical and research settings for decades.
My protocol included the cheek and chin.
It also included several sites around the trunk:
Umbilical (right around the belly button)
Suprailiac (just above the hip bone—roughly the love-handle area)
Midaxillary (along the side of the torso underneath the armpit)
Those measurements gave me information about subcutaneous fat—the fat underneath the skin that I could actually pinch.
But no matter how sophisticated my calipers were, they couldn't directly measure what was happening deeper inside the abdomen.
To actually quantify visceral fat, we'd ideally use imaging such as CT or MRI.
And that's considerably different from pulling a pair of Harpenden calipers out of my bag.
Which brings me to the irony of all this.
I was using a roughly $400 precision instrument to take repeated measurements at sites all over the body.
But looking back, one of the most useful additional measurements might have required something considerably less sophisticated.
A tape measure.
The $400 Calipers—and the Tape Measure I Wish I'd Used
I didn't routinely measure waist circumference.
Looking back, I wish I had.
A tape measure still wouldn't have directly measured visceral fat.
Waist circumference can't perfectly tell us how much abdominal fat is visceral versus how much is subcutaneous.
But research shows that it can still be remarkably useful.
A 2018 meta-analysis combined 29 publications involving more than 16,000 participants and examined relationships between waist circumference, BMI, visceral adipose tissue and subcutaneous adipose tissue.
Waist circumference was more strongly correlated with visceral fat than BMI was.
In plain English:
A tape measure can't tell you exactly what's happening inside the abdomen, but it can provide useful information about central and visceral adiposity.
And there's an important principle hiding in there.
We're using something we can easily measure on the outside of the body to give us information about something we can't easily see on the inside.
That's essentially what I'm proposing we investigate with the face.
Had I routinely added waist circumference to what I was already doing, I would have had:
Cheek skinfold.
Chin skinfold.
Umbilical skinfold.
Suprailiac skinfold.
Midaxillary skinfold.
The rest of the body's skinfolds.
And waist circumference.
Repeated across the same people as their bodies changed.
Now I wonder what I would have seen.
Would decreasing cheek and chin skinfolds have tracked decreasing waist circumference?
Would the abdominal skinfolds have explained most of the waist change?
Would certain people have lost a lot around the waist without corresponding changes in their abdominal skinfolds?
Would age have changed the relationship?
Would apple-shaped people have shown a different facial pattern than pear-shaped people?
And most importantly: if I had been able to measure visceral fat directly, would changes in the face have tracked it?
That's the question I wish I'd been able to answer.
Where This Idea Really Comes From
There's another piece of background here that deserves its own article.
Much of the way I learned to think about detailed skinfold testing came through Charles Poliquin, who was a mentor of mine.
The broader idea was that where someone stores body fat may tell us more than simply how much body fat they have.
There's a much larger discussion to be had about that idea, what the evidence supports, what remains theoretical and what decades of actually measuring people taught me.
I'll save that for another article.
But this particular connection—the possibility that facial-fat changes might track visceral-fat changes—is my hypothesis.
It's not something Charles taught me.
In fact, I spent decades taking these measurements before I started wondering whether there might be another relationship hiding in the data.
Could the Face Be a Canary in the Coal Mine?
That's probably the simplest way I can describe what I'm proposing.
Maybe the face is a canary in the coal mine for visceral fat.
Not because I've proven it.
I haven't.
But because I suspect facial fat may change in a way that gives us an observable clue about a larger change occurring deeper inside the body.
We already do this elsewhere.
Waist circumference gives us information about central and visceral adiposity without directly measuring visceral fat.
Body shape gives us information about fat distribution.
Maybe facial fat gives us information too.
And my suspicion goes beyond simply saying that people with more visceral fat might, on average, have fuller faces.
I think the changes may matter.
If someone's facial fat decreases substantially, perhaps there's a reasonable probability that visceral fat is decreasing as well.
If facial fat increases over time—particularly alongside a shift toward greater central adiposity—perhaps it's giving us another clue about what's occurring internally.
Maybe cheek fat primarily tracks total body fat.
Maybe it tracks particular subcutaneous depots.
Maybe it tracks visceral fat more closely than we realize.
Maybe the relationship changes with age.
Maybe it's different in men and women.
Those details remain unanswered.
But the central hypothesis is straightforward:
Changes in facial fat may provide a visible and measurable signal of changes in visceral fat.
That's what I'd like to see tested.
How Would We Actually Test It?
What I'd really like to see is a longitudinal study.
That sounds sophisticated.
The idea isn't.
Follow the same people over time and keep measuring them.
Measure overall body fat.
Measure cheek and chin skinfolds.
Measure abdominal skinfolds.
Measure waist circumference.
Use CT or MRI to quantify visceral fat.
And then repeat everything.
Do it while people lose weight.
Do it while people gain weight.
Do it as people age.
Then don't simply ask:
Do people with more facial fat also tend to have more visceral fat?
Ask what I think is the more interesting question:
Do changes in facial fat predict changes in visceral fat within the same person over time?
That's a much more useful question.
Maybe a 2-millimeter reduction in a particular facial measurement tends to correspond with some predictable change in visceral adipose tissue.
Maybe it's not that simple at all.
Maybe cheek and chin need to be combined.
Maybe age and sex need to be factored into the equation.
Maybe the relationship only becomes meaningful when facial measurements are combined with waist circumference and other skinfold sites.
I don't know what the equation is.
But I suspect there's an equation there to find.
And if there is, something as accessible as changes in facial fat could potentially provide information about something that's otherwise considerably harder and more expensive to measure.
That's worth investigating.
If I Had to Place a Bet
There's an important difference between an observation, a hypothesis and a conclusion.
So let me be very clear about which one I'm making.
For more than 30 years, I observed people's faces changing along with their body composition.
I watched cheek and chin skinfolds change.
I watched people age.
I watched some people accumulate more central body fat.
And eventually I began wondering whether those observations were connected.
Published research tells us that where we store body fat matters.
It tells us that apple- and pear-type fat distributions aren't necessarily metabolically equivalent.
It tells us that aging can shift fat distribution toward greater central and visceral adiposity.
And at least one intriguing study has found a significant relationship between buccal cheek fat and visceral abdominal fat.
None of that proves my hypothesis.
So here's my bet:
I think facial fat is more strongly associated with visceral fat than we currently appreciate. And I think changes in facial fat may eventually prove useful for detecting larger changes in visceral adiposity.
I could be wrong.
But I don't think I am.
The good news is that this isn't something we need to argue about forever.
It's measurable.
It's testable.
Design the right study, collect enough data and see what happens.
Maybe the relationship turns out to be weak.
Maybe it's only useful in certain populations.
Or maybe somebody eventually connects the dots and discovers that the face has been giving us a useful metabolic clue all along.
For decades I had calipers in my hand measuring the cheek, chin and almost everything else I could pinch.
I just didn't know the question I'd eventually want to ask.
And had I known?
I would have added a tape measure.
Frequently Asked Questions
What is the difference between apple-shaped and pear-shaped body fat?
An apple-shaped distribution describes carrying proportionally more fat centrally, particularly around the abdomen. A pear-shaped distribution describes proportionally greater fat storage around the hips, buttocks and thighs. Research suggests that where fat is stored matters metabolically, with central adiposity generally associated with greater cardiometabolic risk.
Is visceral fat the same as belly fat?
Not exactly. Abdominal fat includes both subcutaneous fat underneath the skin and visceral fat deeper inside the abdomen around the organs. Waist size can provide useful information about central adiposity, but it doesn't tell us precisely how much of each type is present.
Can facial fat tell us anything about visceral fat?
There is some intriguing evidence that it might. A small CT study published in The New England Journal of Medicine found a significant positive relationship between buccal cheek fat and visceral abdominal fat. What hasn't been established is how strong that relationship is across larger populations or whether changes in facial fat can reliably track changes in visceral fat over time.
That's the hypothesis I'm proposing.
Is cheek fat associated with visceral fat?
At least one published study has reported such an association. In the small New England Journal of Medicine CT study discussed above, buccal cheek fat was significantly associated with visceral abdominal fat, while it was not significantly associated with abdominal subcutaneous fat or BMI in that sample. Larger and longitudinal studies would help determine how meaningful and useful that relationship actually is.
Could facial-fat changes be used to track visceral-fat loss?
That's not established yet. My hypothesis is that they potentially could be. Testing that properly would require repeated facial-fat measurements alongside direct measurements of visceral fat, ideally with CT or MRI, as individuals gain fat, lose fat or age.
Does waist circumference measure visceral fat?
Not directly. Waist circumference includes contributions from different abdominal tissues. However, research supports it as a practical surrogate for central and visceral adiposity.
Does body-fat distribution change as we age?
Research indicates that aging is commonly accompanied by changes in regional fat distribution, including greater abdominal and visceral adiposity. Importantly, changes in distribution can occur even when changes in overall body weight or total adiposity aren't particularly dramatic.
Michael Wohltmann, CSCS, ACSM-EP
President, Epoch Nutrition Sciences
References
1. Levine JA, Ray A, Jensen MD. Relation between chubby cheeks and visceral fat. New England Journal of Medicine. 1998;339(26):1946–1947. doi:10.1056/NEJM199812243392619.
Researchers examined CT imaging from 25 patients and reported a significant positive relationship between buccal cheek fat and visceral abdominal fat. In the sample, buccal fat was not significantly correlated with abdominal subcutaneous fat or BMI.
2. Ping Z, Pei X, Xia P, et al. Anthropometric indices as surrogates for estimating abdominal visceral and subcutaneous adipose tissue: A meta-analysis with 16,129 participants. Diabetes Research and Clinical Practice. 2018;143:310–319. doi:10.1016/j.diabres.2018.08.005.
Meta-analysis of 29 publications involving 16,129 participants examining anthropometric measurements as surrogates for abdominal visceral and subcutaneous adipose tissue. Waist circumference showed a stronger relationship with visceral adipose tissue than BMI, although relationships varied among populations.
3. Kuk JL, Saunders TJ, Davidson LE, Ross R. Age-related changes in total and regional fat distribution. Ageing Research Reviews. 2009;8(4):339–348. doi:10.1016/j.arr.2009.06.001.
Review examining age-related changes in body composition, including preferential increases in abdominal and visceral fat and changes in lower-body subcutaneous fat distribution.
4. Divoux A, Fried SK. Depot-Dependent Biology of Human Adipose Tissues and Metabolic Health. Annual Review of Nutrition. 2026;46:75–97. doi:10.1146/annurev-nutr-061824-053907.
Review examining differences among human adipose-tissue depots and their relationships with metabolic health, including central versus gluteofemoral fat distribution.
5. Cintra-Andrade JH, Ripka WL, Heymsfield SB. Skinfold calipers: which instrument to use? Journal of Nutritional Science. 2023;12:e82. doi:10.1017/jns.2023.58.
Review of skinfold-caliper instruments, including Harpenden®, and their longstanding use in clinical and research settings.
Research Note
This article intentionally distinguishes between published evidence, professional observation and hypothesis.
Published research has reported an association between buccal cheek fat and visceral abdominal fat. However, whether facial-fat measurements can reliably estimate visceral adiposity—and particularly whether changes in facial fat can predict changes in visceral fat within the same person over time—has not been established.
My hypothesis is that they can.
Determining whether that hypothesis is correct will require larger studies using repeated facial-fat measurements alongside direct measurements of visceral adipose tissue.
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