All fat is not equal. When belly fat is under the skin (subcutaneous) it does not pose the same health danger as the visceral fat that wraps around the internal organs. Visceral fat is associated with diabetes and heart problems even more than body mass index (BMI). Nobody knows why this is so, but it is speculated that visceral fat leads to harmful inflammation. In comparison, fat under the skin weighs you down but does not seem especially hazardous to health.

To determine what kind of fat you have, try this test on yourself or a very close acquaintance: if someone has a big belly, try to pinch it; if you get a big chunk in your hand, it is probably subcutaneous fat. If not, it’s probably visceral fat.

“How you lose fat may be just as important as how much fat you lose.”  Dr. Samuel Klein, professor of medicine and nutritional science at Washington University School of Medicine describes the belly fat dilemma to the Los Angeles Times, August 25, 2012.

Belly fat is a strong, though imperfect, warning of potential health problems such as heart disease and diabetes. "If you see someone with a big belly, that's a person who is probably at higher risk," Klein says. "Someone who just has a big butt probably has less risk."

Klein led a 2004 study that showed patients could instantly lose 30 pounds or more of subcutaneous fat through liposuction without seeing any of the health benefits normally associated with weight loss, such as lower blood pressure, lower cholesterol and greater sensitivity to insulin. For visceral fat, which is directly connected with health issues, liposuction will not work. Instead, you need to cut calories and get more exercise.

Another interesting fact, according to Klein, is that about one out of four obese people seem to have perfectly fine cholesterol, blood pressure and insulin sensitivity, “as if all of that fat didn't really matter.” So, you can’t predict if a big-bellied person will have health problems without a battery of tests.

If you want to improve your appearance, and you are not obese, you can consider a noninvasive "body shaping" procedure. Plastic surgeons or other qualified professionals can use high-intensity ultrasound to destroy fat cells, tighten collagen and remove a couple of inches from your waist. But according to a past president of the American Society for Aesthetic Plastic Surgery (ASAPS), “Almost all patients with a BMI over 30 need to slim down before getting the procedure."