Yes ... I'm going to be on a bit of a bookmarking post spree here :-)
This study looked at fat cell size and proliferation in obese teens and compared this to IR and fatty liver. This study seems to be consistent with the whole "critical threshold" or "normal fat capacity" theories on why some obese are relatively "metabolically healthy" while others are not. I've not, however, had a chance to read thoroughly.
Conclusions: A reduced lipo-/adipogenic capacity, fraction, and estimated number of large subcutaneous adipocytes may contribute to the abnormal distribution of abdominal fat and hepatic steatosis, as well as to insulin resistance in obese adolescents.
Thinking out loud: It seems more and more to me these days that abdominal fat - visceral in particular - is our short term buffer as Frayn describes the behavior of fat tissue in the postprandial period (recently fed state). Overages go into our subcutaneous "overflow tank". If we have insufficient capacity in that tank, our fat gets "sick".
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