Belly fat: The battle of the bulge

An expanding waistline is sometimes seen as the price of getting older. Although overeating and lack of physical activity are the main reasons why people pack on excess pounds, aging does contribute to weight gain as well as to an increase in body fat.  That’s because as you age, you gradually lose muscle and fat accounts for a greater percentage of your weight.  Less muscle mass also leads to a decrease in the rate at which your body uses calories, which can make it more challenging to lose or stay in the same weight.

At midlife, many women see their midsection start to widen, even if they aren’t gaining weight.  This is likely due to decreasing levels of estrogen, which appears to influence where fat is distributed in the body.  The tendency to gain or carry weight around the waist — having an “apple” rather than a “pear” shape — can have a genetic component as well. 

More than skin-deep

Although putting on too much weight, in general, can have negative effects on your health, abdominal weight gain is considered particularly unhealthy. Yes, when it comes to body fat, location counts, and each year brings new evidence that the fat lying deep within the abdomen is more perilous than the fat you can pinch with your fingers.  In fact, research has shown that having a wide waist measurement — 35 inches or more in women, and 40 inches or more in men — is an important, independent risk factor for disease.

The trouble with belly fat is that it’s not limited to the extra layer of padding located just below the skin (subcutaneous fat). It also includes visceral fat — which lies deep inside your abdomen, surrounding your internal organs, such as the liver, intestines, and other organs (see diagram).  It’s also stored in the omentum, an apron-like flap of tissue that lies under the belly muscles and blankets the intestines. The omentum gets harder and thicker as it fills with fat.  Even if you don’t actually gain weight, your waistline can grow by inches as visceral fat pushes out against the abdominal wall.

Subcutaneous fat is hard to ignore because you can see and grab hold of the extra layer of cushioning it creates. However, research has shown that visceral fat, although not clearly visible, is associated with far more dangerous health consequences.  That’s because an excessive amount of this fat produces substances that can raise blood pressure, negatively alter good and bad cholesterol levels, and impair the body’s ability to use insulin (insulin resistance).  All of this can increase the risk of cardiovascular disease, stroke, type 2 diabetes, and other serious health problems.  An excessive amount of any fat, including visceral fat, also boosts estrogen levels.  This can increase the risk of breast and colorectal cancers.

Research has also associated belly fat with an increased risk of premature death — regardless of weight. In fact, some studies have found that even when some persons were considered having a normal weight, according to standard body mass index (BMI) measurements, a large waistline elevated the chances of dying of cardiovascular disease, cancer, and other causes.

Measuring your middle

Like it or not, waist size matters.  That’s because your waist measurement is a good indicator of   whether you’re carrying too much fat around your belly.

Other measurements, such as the BMI or waist-hip ratio, can be helpful. Yet they may not be as good at showing your body fat percentage or fat distribution, particularly after menopause. To measure your waist circumference:

•  Place a tape measure around your bare stomach just above your hip bone (at about the level of the navel).

•  Pull the tape measure until it fits snugly around you, but doesn’t push into your skin.

• Make sure the tape measure is level all the way around.

• Relax, exhale, and measure your waist, resisting the urge to suck in your stomach.

Having a waist circumference of 35 inches or more in women and 40 inches or more in men, indicates that you have an unhealthy concentration of belly fat and are at greater risk of health problems such as cardiovascular disease, high blood pressure, and type 2 diabetes.

Trimming the fat

Where you tend to gain fat depends on your genes, your hormones, your age, your birth weight (smaller babies more readily add belly fat later in life) and whether you’ve had children (women who have given birth tend to develop more visceral fat than women who haven’t).

You can’t change your birth weight or your genes, and you can’t hold off menopause. (Studies are mixed about whether hormone replacement therapy influences visceral fat gain). But there are several ways you can minimize the accumulation of visceral fat.  The good news is that because it’s more readily metabolized into fatty acids, it responds more efficiently to diet and exercise than fat on the hips and thighs.  Here are some approaches that may help:

• Keep moving.  Exercise can help trim visceral fat or help prevent its growth with aerobic activity (such as brisk walking) and strength training (exercising with weights). Spot exercises, such as sit-ups, can tighten abdominal muscles but won’t get at visceral fat.

Exercise can also help keep fat from coming back.  In a study at the University of Alabama, Birmingham, dieting women lost an average of 24 pounds and reduced both visceral and subcutaneous fat, with or without aerobic or strength-training exercise.  In the following year, those who maintained their exercise programs — a modest 40 minutes a week —maintained their visceral fat loss, while those who didn’t exercise or abandoned their programs showed a 33-percent average increase in visceral fat.

• Eat right.   Choose a balanced diet that helps you achieve and maintain a healthy weight.  Include plenty of calcium: According to another study from the University of Alabama, Birmingham, the more calcium a woman consumes, the less visceral fat she gains.  Avoid products that seem to encourage fat deposition, including trans fats (hydrogenated vegetable oils) and fructose-sweetened foods and beverages.

In a recent report, a Swedish study found that excess saturated fat may lead to more belly fat than excess polyunsaturated fat. The researchers fed 37 young lean people an average of three 250-calorie muffins a day that were made with either palm oil (a saturated fat) or sunflower oil (a polyunsaturated fat).  The number of daily muffins was adjusted to make each participant gain three percent of his/her initial weight.  After seven weeks, both groups had gained three-and-a-half pounds worth of fat and muscle.  However, more of the weight gained by the sat fat eaters was deep belly (visceral) fat, while more of the weight gained by the poly eaters was muscle.

So, what should you do? Replace saturated fats (in foods like red meats, dairy, and butter) with polyunsaturated fats (in foods like oils, fish, and nuts).  It should at least help lower your risk of heart disease aside from possibly help you gain less belly fat.

• Don’t smoke.  The more you smoke, the more likely you are to store fat in your abdomen rather than on your hips and thighs. 

• Get your sleep. Too little is bad. A five-year study found that adults under age 40 who slept five hours or less a night accumulated significantly more visceral fat.  But too much isn’t good, either — young adults who slept more than eight hours also added visceral fat.  (This relationship wasn’t found in people over age 40).

• Mind your mood. In the Study of Women’s Health Across the Nation, middle-aged women who showed more hostility and had more depressive symptoms also had more visceral fat. In other studies, higher levels of the stress hormone cortisol were associated with a buildup of visceral fat even in lean women.

• Forget the quick fix. Liposuction for cosmetic fat removal doesn’t reach inside the abdominal wall.

Take the above recommendations to heart and you might just win your battle with the bulge!