Chronic Inflammation and Body Composition: How Inflammatory Fat Affects Your Health and What a DEXA Scan Reveals

You eat well, exercise regularly, and your weight sits within a healthy range. Yet blood tests flag elevated CRP, your GP mentions “low-grade inflammation,” and you are left wondering where it comes from. The answer may lie in a part of your body composition that scales and mirrors cannot measure: the distribution and metabolic activity of your fat tissue.

Chronic low-grade inflammation is a quiet driver of cardiovascular disease, type 2 diabetes, and accelerated ageing. What many people do not realise is that body fat itself, particularly visceral fat stored deep around the organs, behaves like an active endocrine organ, continuously releasing inflammatory signalling molecules called cytokines. The more visceral fat you carry, the louder that inflammatory signal becomes.

Acute inflammation is a healthy, short-lived immune response to injury or infection. Chronic low-grade inflammation is fundamentally different. It simmers beneath the surface for months or years, producing a sustained elevation of inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) without any obvious infection or wound.

The NHS recognises chronic inflammation as a contributing factor to conditions including heart disease, stroke, and type 2 diabetes. Research published in Nutrition, Metabolism and Cardiovascular Diseases (2024) confirmed that body composition markers, particularly fat mass and its distribution, are strongly associated with changes in inflammatory markers over time.

In practical terms, chronic inflammation means your immune system stays partially activated. This ongoing activation damages blood vessel walls, disrupts insulin signalling, and accelerates the breakdown of lean tissue. It is a silent process: most people feel no symptoms until a related condition is diagnosed.

Adipose tissue is not an inert storage depot. Fat cells, especially those in the visceral compartment around your liver, pancreas, and intestines, are metabolically active. When these cells enlarge beyond a healthy threshold, they begin secreting pro-inflammatory cytokines including tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1).

A landmark study published in Medicine (2019) demonstrated that visceral adiposity was the body composition variable most consistently associated with elevated IL-6 and CRP levels across all demographic groups. Subcutaneous fat, the layer just beneath your skin, produces far lower concentrations of these inflammatory signals.

This distinction matters because two individuals with identical body weight and BMI can carry very different proportions of visceral versus subcutaneous fat. The person with more visceral fat will typically have higher inflammatory markers, greater insulin resistance, and a higher cardiovascular risk profile, none of which a bathroom scale or BMI chart can detect.

What makes chronic inflammation particularly difficult to manage is that it feeds itself. Excess visceral fat releases inflammatory cytokines, which in turn promote further fat storage, impair muscle protein synthesis, and increase insulin resistance. Elevated insulin then encourages yet more visceral fat accumulation, which amplifies the inflammatory signal further.

Research from the Copenhagen Sarcopenia Study, published in the Journal of Cachexia, Sarcopenia and Muscle (2021), found that higher levels of inflammatory markers were associated with both lower muscle mass and greater fat mass, confirming that inflammation simultaneously erodes lean tissue and promotes fat gain.

Breaking this cycle requires more than calorie restriction alone. Targeted fat loss, particularly visceral fat reduction, combined with resistance training to preserve muscle, has been shown to produce meaningful and sustained reductions in CRP. A weight loss of as little as five to ten per cent of body mass, when it comes from the visceral compartment, can significantly lower inflammatory markers. For a deeper look at how visceral fat shapes metabolic risk markers on your DEXA report, see our guide to what your visceral fat DEXA scan results reveal about metabolic health.

A DEXA scan (dual-energy X-ray absorptiometry) provides the most precise clinical measurement of body fat distribution available outside a research setting. Unlike bioelectrical impedance scales or skinfold callipers, DEXA directly quantifies visceral adipose tissue mass, total body fat percentage, regional fat distribution (android versus gynoid), and lean mass in each limb and trunk region.

Your DEXA report will include an android-to-gynoid fat ratio, which compares fat stored around the abdomen (android region) to fat stored around the hips and thighs (gynoid region). A higher ratio indicates greater central fat accumulation, which is the pattern most strongly linked to chronic inflammation and metabolic disease.

By measuring visceral fat directly in grams, a DEXA scan removes the guesswork. You can see precisely how much inflammatory visceral fat you carry, how it compares to clinical thresholds, and whether interventions such as dietary changes, exercise programmes, or medical weight management are shifting fat from the visceral compartment where it matters most.

If your doctor suspects chronic inflammation, they will likely request a blood test for one or more of the following markers:

• High-sensitivity CRP (hs-CRP): Produced by the liver in response to IL-6, hs-CRP is the most commonly used clinical marker. Levels below 1 mg/L suggest low cardiovascular risk, 1 to 3 mg/L indicate moderate risk, and above 3 mg/L point to higher risk. Elevated visceral fat is one of the strongest predictors of persistently raised hs-CRP.
• Interleukin-6 (IL-6): A cytokine released directly by visceral fat cells that stimulates CRP production. Elevated IL-6 is associated with insulin resistance, accelerated muscle loss, and increased cardiovascular risk.
• TNF-alpha: Another pro-inflammatory cytokine linked to adipose tissue dysfunction. Chronically elevated TNF-alpha impairs insulin receptor signalling and promotes further fat accumulation.

Pairing these blood markers with a DEXA scan creates a comprehensive picture: the blood work tells you how inflamed your body is, while the DEXA scan shows you where the inflammation is likely originating.

Reducing visceral fat, and the inflammation it drives, requires a strategy that goes beyond the number on the scale. Evidence-based approaches include:

• Prioritise resistance training. Building and maintaining muscle mass improves insulin sensitivity and creates a metabolic environment that favours visceral fat mobilisation. The NHS Physical Activity Guidelines recommend strength exercises on at least two days per week.
• Focus on dietary quality. Mediterranean-style eating patterns rich in omega-3 fatty acids, fibre, and polyphenols have been shown to reduce CRP independently of weight loss. Minimising ultra-processed foods, refined sugars, and excess alcohol further lowers the inflammatory burden.
• Manage sleep and stress. Poor sleep and chronic psychological stress both elevate cortisol, which promotes visceral fat storage. Addressing these factors can be as impactful as dietary change.
• Consider medical support when appropriate. For individuals with significant visceral fat accumulation and established metabolic risk, supervised medical weight management may be warranted to achieve the degree of visceral fat reduction needed to meaningfully lower inflammatory markers.

Tracking your progress with periodic DEXA scans, typically every three to six months, lets you confirm that fat is being lost from the visceral compartment specifically, rather than from muscle or subcutaneous stores that carry less inflammatory risk.

Can you have chronic inflammation with a normal BMI?

Yes. BMI measures total body weight relative to height and cannot distinguish between fat and muscle, or between visceral and subcutaneous fat. Individuals with a normal BMI can carry elevated visceral fat, a pattern sometimes called “normal weight obesity” or “thin on the outside, fat on the inside” (TOFI). A DEXA scan is the most reliable way to identify this hidden risk.

How quickly does inflammation improve after losing visceral fat?

Studies show that CRP levels can begin to fall within weeks of meaningful visceral fat reduction. A loss of five to ten per cent of body weight, when it comes primarily from the visceral compartment, is typically enough to produce a clinically significant drop in inflammatory markers. DEXA scanning confirms whether the fat loss is occurring in the right region.

Does a DEXA scan measure inflammation directly?

No. A DEXA scan measures body composition, including visceral fat mass, which is the primary driver of chronic low-grade inflammation. To measure inflammation itself, your doctor will use a blood test for markers such as hs-CRP or IL-6. The two assessments complement each other: DEXA shows the cause, blood work shows the effect.

Is all body fat inflammatory?

Not equally. Visceral fat (stored around the internal organs) is significantly more inflammatory than subcutaneous fat (stored beneath the skin). This is why body fat distribution, which a DEXA scan quantifies precisely, matters more than total body fat percentage alone for assessing inflammatory and metabolic risk.

How often should I have a DEXA scan to track inflammation-related changes?

For most people actively working to reduce visceral fat, a scan every three to six months provides a meaningful interval to measure change. Your clinician can advise on the frequency that best suits your situation.

Understanding your visceral fat levels is the first step toward managing chronic inflammation and reducing your long-term disease risk. A DEXA body composition scan at DEXA London provides precise, clinician-grade measurements of visceral fat mass, regional fat distribution, lean mass, and bone density in a single ten-minute appointment.

Our clinic at 86 Harley Street, London, is led by Dr Emil Gadimali. To book your scan or discuss whether a DEXA assessment is right for you, call us on 0207 637 8227 or book online through our website.