For many would-be dieters, the number on the scale or the size of clothing they wear is what they focus on. For others, the body mass index is the number that they concentrate on instead. But, those dieters might all be missing the big picture when it comes to their actual health risk from their extra weight. Visceral fat, typically found in the abdominal cavity, surrounding the internal organs, is more of a health risk off than other types of fat and can be found even in those who have normal BMIs or appear to be of relatively normal weights.

Visceral fat is not like regular fat not only because it tends to gather above the waistline, creating an apple shape to the body but because it is actually active tissue. Unlike other types of fat that just sits there, visceral fat releases a number of hormones and other compounds that can dramatically increase the risk of heart disease, high blood pressure, stroke, Type 2 Diabetes, metabolic syndrome, certain types of cancers and sleep apnea.

According to a study conducted by the Mayo Clinic, visceral fat, coupled with coronary artery disease increases the risk of dying up to to twice as high. That study, which involved over 16,000 people from five different countries, found that having both a large waistline and certain types of heart disease, gave the people a risk comparable to smoking a pack of cigarettes every day or having high cholesterol.

Additional studies have shown that while there is no limit to who might develop visceral fat, women who are post-menopausal might be at slightly higher risk. In addition, these women’s risk of heart disease, stroke and other conditions are also at increased risk which means they are doubly in danger. Once women hit the age where menopause has started or will soon start, their metabolism usually slows down increasing their risk for weight gain.

There have been a few studies that have contradicted the threat of visceral fat, saying that all fat is created equally, however a number of people in the Mayo Clinic study had normal weights or a BMI that fell in the normal range and still had the high amount of visceral fat and the early warning signs of a number of serious health conditions.

To prevent the collection of visceral fat, it is important to try to stay at a normal weight and to exercise on a regular basis. To break down more internal fat stores, using high intensity interval workouts might work better than slow and steady workouts because they cause the body to work anaerobically and push past the comfort zone. It is also important to include more fruits, vegetables and lean proteins in the daily diet.

Finally, stress and a lack of adequate sleep might also play a role in the production and storage of visceral fat, so it is important to learn to deal with stress before it becomes a problem and to get at least eight hours of shut eye each night.