The evolving concepts in visceral obesity: What anesthesiologists need to know

Obesity, an ever-evolving global epidemic, continues to offer some of the most controversial and at times, polarizing debates in the modern-day medicine; whether it is for the formers' ethnic intricacies, or for that matter, its potential outcome associations. Given the far-reaching implications of obesity however, the recent developments in characterization of the same, are of special interest to an anesthesiologist caring for this predilected cohort of patients. The expert propositions, in this regard, outline the much-required need to think beyond the body mass index (BMI), traditionally used to define obesity. To that effect, motivated by the understanding of obesity as an adiposity-based chronic disease, visceral obesity has gained particular attention with the cost-effective and adaptable anthropometric measures: waist circumference, waist-to-hip ratio, and of late waist-to-height ratio, outperforming the isolated predictive and prognostic utility of BMI in the corresponding literature. Moreover, it is for the concept of visceral obesity that may aid in the distinction of metabolically unhealthy obesity from the metabolically healthy obesity. Hence, focusing the evolving updates on visceral obesity, the index narrative review comprehensively discusses the topic, underlining the points relevant to anesthesiologists, such as cardiometabolic risk profiling, relationship to metabolic syndrome, metabolic inflammation, operative outcomes, the perplexity surrounding "obesity paradox," and the useful insights provided by critical care medicine and the viral pandemic.