Targeting visceral and ectopic adiposity: pharmacological and surgical interventions beyond global weight loss

Abstract

The recognition of ectopic adipose tissue as a metabolically active endocrine organ has refined the current understanding of obesity-related complications. Adipose accumulation within non-subcutaneous compartments such as hepatic, epicardial, perirenal, and intramuscular fat contributes to organ-specific dysfunction through proinflammatory cytokine release, dysregulated lipid metabolism, and impaired insulin signalling. These pathophysiological effects frequently occur independently of body mass index, highlighting the limitations of traditional anthropometric assessments in risk stratification. Emerging clinical evidence indicates that reductions in ectopic fat volumes are more strongly associated with metabolic and cardiovascular improvement than absolute weight loss alone. This review synthesises current data on therapeutic strategies that preferentially reduce regional adiposity, including pharmacological agents, metabolic endoscopic interventions, and bariatric procedures. The objective is to emphasise the clinical relevance of depot-specific adipose reduction as a central therapeutic goal in the management of obesity-associated chronic diseases, supporting a shift toward fat-distribution-focused treatment paradigms within precision medicine.