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Posted on Thursday December 4, 2025 in VAT-TRAP
An article written by Dr Edward Leatham, Consultant Cardiologist © 2025 E.Leatham
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Most people associate protein with gym culture — shakes, weights, muscle-building. But for anyone interested in healthy ageing, metabolic resilience, fat loss, and long-term independence, protein deserves far more attention. Adequate daily protein intake is one of the most powerful and controllable levers we have for preserving muscle mass and reducing visceral fat — especially as we get older.
A growing body of research now confirms an uncomfortable truth: the current recommended dietary allowance (RDA) of 0.8 g/kg/day is insufficient for maintaining muscle mass or metabolic health in adults and the shortfall becomes more harmful with age.
This article explains why protein needs rise over time, how inactivity accelerates muscle loss, why calculating protein using your lean or target body weight is crucial, and why anyone trying to reduce visceral adipose tissue (VAT) must deliberately build and feed their muscle.
The protein RDA was derived from nitrogen balance studies that underestimate true physiological needs. More accurate stable isotope tracer studies show that adults require 1.2–1.6 g/kg/day simply to remain in neutral protein balance — meaning no daily loss of lean tissue (1).
Because the body has no storage pool for amino acids, any deficit must be covered by breaking down muscle. Even small shortfalls, accumulated over years, contribute to sarcopenia and frailty.
As we age, muscles respond less efficiently to dietary protein — a phenomenon known as anabolic resistance. Compared with younger adults, older individuals experience:
Crucially, inactivity is the major driver, not age alone. Studies immobilising a single limb show that even young adults develop anabolic resistance within days (2). The good news: resistance training restores anabolic sensitivity at any age.
Muscle loss across the lifespan does not occur smoothly. It happens in sudden drops after:
Younger adults regain lost muscle relatively easily. Adults over 60 often do not — returning only partway to baseline. Over years, these “hits” accumulate until individuals cross the frailty threshold, where everyday tasks such as climbing stairs or rising from a chair become difficult.
Adequate protein and resistance training are the strongest interventions we have to prevent or delay that decline.
A huge number of people are looking to lose weight as part of general lifestyle improvement. However from the medical perspective, the main priority in our cardiac patients is to recommend and assist in achieving metabolically healthy visceral adipose tissue (VAT) — the fat packed around the abdominal organs, which is harmful. It raises inflammation, fuels hypertension, insulin resistance, worsens glucose regulation, and increases risk of atrial fibrillation, coronary disease, stroke and dementia.
Many patients attempt to “lose VAT” through calorie restriction, either with, or without GLP-mimetic injections — but dieting or taking the ‘skinny jab’, without resistance training often leads to more muscle loss than fat loss. Metabolism slows, strength declines, and VAT becomes stubborn.
VAT loss requires muscle gain.
Here’s why:
In short:
Muscle acts as the metabolic engine that burns VAT.
Resistance training builds the engine.
Protein fuels the engine.
This is why older adults, sedentary individuals, and anyone on GLP-1 therapy (who may undereat protein) must be deliberate with both strength training and adequate protein intake to ensure that VAT — not muscle — is what they lose.
1.2 g/kg/day
1.6 g/kg/day
1.6–2.2 g/kg/day
A major meta-analysis of 49 trials shows that combining resistance training with higher protein intake (up to 1.6 g/kg/day) increases lean mass by ~27% and strength by ~10% compared with training alone (3).
Above 1.6 g/kg/day, benefits continue but become smaller — useful for athletes or those deliberately “banking” muscle for later life.
Protein needs scale with lean mass, not with excess fat. Calculating protein from current weight can greatly overestimate requirements and discourage adherence.
Instead, use:
A man weighing 110 kg, with a realistic healthy target weight of 80 kg:
The target-weight approach is physiologically accurate and far more achievable.
This method is clinically validated and used in sports nutrition, obesity medicine, and geriatric practice (4).
During calorie restriction, the body becomes more inclined to break down muscle for energy. Higher protein intake:
Research shows that ≥2.0 g/kg/day (using target weight) better preserves muscle during weight loss than lower intakes (5). This is especially important for older adults and anyone on GLP-1 medications, which suppress appetite and reduce spontaneous protein intake.
Protein provides the raw material; resistance training provides the signal. Together they:
Yet only ~22% of older adults meet basic strength-training recommendations (6). Improving this single behaviour could have more impact on healthy ageing than almost any medication.
| Goal | Daily protein target | Notes |
| Avoid muscle loss | 1.2 g/kg/day | Minimum for adults over 50 |
| Optimal for healthy ageing | 1.6 g/kg/day | Supports mobility and strength |
| Build/maintain muscle | 1.6–2.2 g/kg/day | Especially important with training |
| VAT reduction or GLP-1 therapy | ≥2.0 g/kg/day | Essential to preserve muscle during fat loss |
Protein intake becomes more important, not less, as we age. Declining anabolic sensitivity, reduced appetite, and repeated catabolic events all work against the preservation of muscle — unless we intervene deliberately.
If you want to maintain strength, mobility, metabolic health, and independence into later life, the formula is simple:
Build and feed your muscle now, and your future self — aged 70, 80, or 90 — will thank you.
In cardiometabolic medicine, muscle is not a cosmetic tissue but a metabolic organ. Evidence consistently shows that strength, not muscle mass, predicts insulin resistance, cardiovascular risk, and survival. Many older adults are not losing muscle tissue — they are losing muscle function, and that is the pathology that matters.
Having a stent or bypass is not the end of the story—it is the beginning of a new chapter in managing your cardiovascular health. With the right combination of medications, lifestyle changes, rehabilitation programmes, and vigilant follow-up using advanced diagnostic techniques, you can greatly reduce your risk of future events. Stay engaged with your healthcare team, keep informed about new therapies and guidelines, and commit to sustainable lifestyle adjustments to ensure the best possible long-term health.
January isn’t just about weight loss. Much winter weight gain occurs as visceral fat, which drives insulin resistance and cardiovascular risk. Measuring your waist, not just your weight, gives a clearer picture of metabolic health. Building muscle and reducing visceral fat supports a healthier metabolism long after January ends.
Medicine must change in response to rising costs, growing complexity and workforce pressures. Doctors and health influencers must empower individuals to take responsibility for their own wellbeing. My role has evolved from fixing broken hearts to preventing them from breaking in the first place.