Belly fat, not weight: rethinking GLP-1 in the UK
Peter Paumgardhen | Last update: 12th August 2025
GLP-1 treatments are not really about losing weight but about reducing dangerous visceral fat, says David A Kessler, one of the United States’ most respected public health experts. He has stirred debate with his recent article in The Atlantic, saying it’s visceral fat that drives serious diseases (the fat you can see and feel under your skin, often called love handles or muffin top). His perspective challenges the way we measure success and raises important questions about the UK’s approach to GLP-1 access
TL;DR
- David Kessler argues that GLP-1 drugs are about tackling visceral fat and improving health, not just the number on the scales.
- BMI is outdated and misleading, while waist size, blood lipids and metabolic markers offer a better picture of risk.
- There is no clear plan for tapering or stopping GLP-1 treatment, and this gap needs urgent research in both the US and UK.
- SlimrChat questions whether the UK should still rely on BMI-based criteria for GLP-1 access.
Who is David Kessler* and why this matters?
David A Kessler is the former commissioner of the US Food and Drug Administration and co leader of Operation Warp Speed, the programme that accelerated vaccine rollout during the pandemic. His reputation as a trusted voice in public health makes his latest insights particularly important.
In his Atlantic article, he argues that it is not excess weight itself that poses the greatest threat, but the build-up of visceral fat around vital organs. This is directly linked to conditions such as heart disease, type 2 diabetes, fatty liver and certain cancers. For those considering GLP-1 treatments in the UK, understanding how visceral fat drives these health issues is crucial.
Kessler’s perspective challenges the BMI-led approach still common in Britain. By focusing on visceral fat, GLP-1 UK treatment strategies could shift toward a more health-focused and risk-based model rather than simply chasing weight loss.
David Aaron Kessler at a Hudson Union Society event in April 2009, photograph by Justin Hoch, licensed under CC BY 2.0. Available via Wikimedia Commons.
What Kessler actually says…
Kessler points out that focusing solely on weight loss misses the bigger health picture. Visceral fat, the fat stored around organs like the liver and heart, is far more harmful than fat on the arms or thighs. This fat causes inflammation and disrupts metabolism, increasing the risk of chronic disease. According to Kessler, reductions in waist size and improvements in markers such as triglycerides and HDL cholesterol are more reliable indicators of improved health than BMI.
Why BMI-based criteria could miss high-risk Britons
BMI fails to show how fat is distributed or distinguish between muscle and fat. It also does not reflect how some groups, particularly South Asians, can develop metabolic conditions at a lower BMI compared with white populations. In the UK this means that many people who would benefit from GLP-1 treatment may not meet the current BMI-based requirements of the NHS or private providers. This approach risks leaving high-risk individuals without effective treatment.
The challenge of no clear exit plan
Another issue highlighted by Kessler is the lack of data on how to taper or safely stop GLP-1 treatment. Most patients do not stay on these drugs for life, often due to cost or side effects, yet research on long-term strategies is limited. There is a need for clear evidence on whether intermittent use or lower maintenance doses can provide lasting benefits without weight regain.
What you can do now?
- Measure your waist circumference alongside your weight to track changes more accurately.
- Ask your GP to test your lipid profile, HbA1c and liver enzymes, and request fasting insulin if it is available.
- If you are from a higher-risk ethnic group, make sure your doctor considers your metabolic health, not just BMI.
SlimrChat take
Kessler’s article reflects a shift we have long discussed at SlimrChat. GLP-1 access should be based on metabolic risk, not BMI alone. For the UK, this means updating NHS and private guidelines to consider waist measurements, blood markers and cardiometabolic health. It also means demanding research into long-term treatment strategies, including safe ways to taper or adjust doses.
This is about making access fairer and more effective, not simply broader. What do you think? Join the conversation in the SlimrChat Forums.
*This David Kessler, not to be confused with the fictional David Kessler from American Werewolf in London (one of SlimrChat’s favourite films)