Gut Check: The Skinny on Belly Fat

WRITTEN BY Holly Fisher

About 59 percent of American adults are saddled with abdominal obesity. While our bodies do need some belly fat to cushion vital organs, too much central padding can have weighty consequences. Even in someone with a healthy BMI, a thicker waistline points to a heavier risk for heart and other health problems. Read on to learn more about the dangers of belly fat and strategies for slimming down

Ah, swimsuit season—that daunting time of year when shirts are shed and midriffs bared, leaving many wishing for six-pack abs rather than a potbelly. Of course, most Americans find their waistlines expanding with age, even as swimsuit styles shrink ever smaller. While bathing gowns and bloomer suits aren’t likely to make a comeback, learning about belly fat can reshape our view of a healthy figure. Trimming your tummy isn’t just about bolstering confidence in a swimsuit; it’s key to fending off a host of chronic diseases.

So what makes this deep-seated fat so dangerous, and how can you banish the bulge? Roper St. Francis Healthcare affiliated obesity medicine doctor John Cleek and registered dietitian Michelle Grossman shed light on the science behind belly fat.

Tummy Troubles: Why belly fat is the worst kind of body fat

The desire to be little in the middle often stems from aesthetics rather than wellness. “Most people aren’t aware of the serious health impacts of carrying too much fat around their waist,” explains Dr. Cleek, pointing out that waist circumference is now a recognized predictor for chronic disease.

Dr. John Cleek

While you might assume that fat is fat, there are, in fact, two classifications of body fat, and location matters. “Belly fat is metabolically different from the fat in your thighs, arms and legs, which isn’t nearly as detrimental,” says the doctor. Belly fat (medically known as visceral fat) wraps around the organs and intestines, while subcutaneous fat exists just under the skin (in other words, fat you can pinch). In most people, belly fat accounts for about 10 percent of overall body fat, but its location deep within the abdomen makes it perilous. “Visceral fat releases more fatty acids and inflammatory chemicals directly into the liver, increasing the risk of major medical issues such as diabetes, cancer, heart disease and hypertension,” he continues. This “active fat,” as it is sometimes called, secretes hormones, protein and other substances that interfere with the body’s ideal functioning.

Women who measure more than 35 inches at the waist and men who measure more than 40 inches have a higher risk for developing complications linked to abdominal obesity. As a person’s waist-to-hip ratio increases, so too does their risk for cardiovascular disease, breast and colorectal cancer, dementia and asthma, notes a recent report from Harvard Health Publishing. In fact, a 2008 study found that for every inch added to a healthy waistline, annual healthcare costs jumped by about three percent for women and five percent for men.

Excess visceral fat can also contribute to insulin resistance, putting those with bigger bellies at risk for type 2 diabetes. “Insulin is critical for controlling blood sugar,” explains Dr. Cleek. But when cells become resistant to insulin and blood sugar levels remain high, the pancreas begins pumping out more and more insulin in response. Rising insulin levels then have an adverse effect on the body’s ability to break down fat. As the midsection gets larger, the body has to work harder to control blood sugar, resulting in even more insulin. “You can get stuck in a vicious cycle.”

Middle Ground: What you can and can’t do to slim your waist (Hint: It’s not sit-ups.)

Knowing what causes excess belly fat is the first step to reducing girth. Lifestyle choices certainly play a significant role in how much weight we carry around the abdomen, but some factors that lead to a rounder figure, such as hormones and DNA, are out of our control. Researchers estimate that genetics influences 60 to 80 percent of a person’s body mass, so some people must work harder to lose weight overall and thus trim their midsections.

Declining levels of estrogen in menopausal women also lead to increased fat storage. When estrogen drops, body fat gets redistributed from the hips, buttocks and thighs to the abdomen, causing a woman’s figure to shift from a pear to an apple shape.

So what can we do to control visceral fat? Dr. Cleek says there isn’t one specific diet or exercise that will target the belly alone. (While crunches will certainly tone your tummy, that muscle definition won’t be visible if your abdominals are covered by excess fat.) “To really lose belly fat, you have to lose weight in general,” says Dr. Cleek.

That’s a tall order for almost half the population. According to the Centers for Disease Control and Prevention, the prevalence for obesity was 42 percent between 2017 and 2018, up from 30 percent eight years prior. And those numbers don’t take into account pounds packed on during COVID-19. Dr. Cleek says many of his patients gained 20 to 25 pounds during the pandemic thanks to a lack of activity, easy access to snacking and stress eating.

Dietitian Michelle Grossman works closely with Dr. Cleek to help patients lose weight by nurturing sustainable healthy habits.

“A lot of patients are looking for a quick fix, but we focus on long-term lifestyle changes,” she says. The dietitian often reminds patients that every pound counts. “Many people assume they need to see a big drop on the scale, but even losing five to 10 percent of your weight can help with disease prevention,” explains Grossman. “Small changes add up over time.”

Center of Attention: Strategies to shed pounds and pant sizes

Focus on balancing your nutrition, upping your activity and reducing stress levels, suggests Grossman, who promotes these key lifestyle changes to patients who want to lose weight and become healthier in general.

Michelle Grossman

The dietitian recommends incorporating plenty of lean proteins and non-starchy vegetables into your daily eating to help you stay fuller longer and lessen cravings. She also warns that alcohol and high-fat foods can make belly fat worse.

When it comes to activity, most people believe they have to exercise for 30 minutes, five days a week. “That’s a great goal,” Grossman says, “but not everyone can do that on day one.” Instead, start where you are simply by increasing activity in your daily life—park farther from the grocery store, take the stairs rather than the elevator or get up from your desk several times a day to walk around. Eventually, you can work your way up to more activity and exercise.

Stress also impacts weight loss. When the body is under constant tension, the hormone cortisol remains at a high level, which can lead to weight gain, particularly in—you guessed it—the midsection. Grossman advises patients who need to lose weight to look for ways to manage their stress, such as yoga, talking to a friend or finding an enjoyable hobby.

When it comes to weight loss, everyone wants a secret formula, but the dietitian emphasizes that the solution really boils down to making sustainable lifestyle changes. That can be tough when you’re juggling work, family and other responsibilities. “You have to put yourself first,” she says.

Grossman encourages patients to set realistic weight goals and focus on body composition, including that waist circumference, more than a number on the scale. “You want to eat well and be more active to help your health, not just for your appearance.” While the advent of bathing suit season may provide an annual gut check, a lean waistline isn’t just a summertime accessory—minding your middle is a year-round endeavor towards long-term wellness.

Focus on Self: Amanda Mayer has always struggled with size, but after the birth of her fifth child, “I let myself go,” she says. With her weight at 343 pounds, Amanda decided it was time for a change. “I’m tired of being a big girl.” She started her journey towards a healthier self last fall under the guidance of her primary care doctor and an obesity medicine team. Together, the 37-year-old and her boyfriend now count calories, eat a Iow-carb diet and sip water rather than sugary drinks. In seven months, she has shed 40 pounds and three sizes. “I’m happy with where I am, though not yet where I want to be,” says Amanda.

Measure Your Middle

Waist size alone isn’t used to diagnose health conditions, but it can help doctors screen for weight-related issues. Follow these steps to measure your waist circumference at home:

  1. Stand up and remove any bulky clothing.
  2. Loop a flexible tape measure around your abdomen at belly-button level. It should be taught but not digging into your midsection.
  3. Breathe in gently, then measure on an exhale. Repeat three times to be sure you get a consistent result.

Battle of the Bulge

“One exercise that will trim inches from your waist!” “Shed belly jelly with this simple diet!” It’s easy to get sucked into promises of quick-fix solutions, but health professionals agree there’s no magic bullet when it comes to reducing belly fat. You can’t spot-treat a specific body part. Instead, focus on losing weight overall through better nutrition and regular exercise.

Step by Step: After Ed Barnes left the Navy in 2001, he hardly noticed the additional pounds creeping onto his six-foot frame year after year. But when he needed a seat belt extender while flying in 2019, the retiree realized his poor exercise and eating habits had gotten the better of him. “I said, ‘That’s it. I’m doing something about this.’” In January 2020, with the help of Dr. Cleek, Ed began a regular walking routine. “I used to sit down after half a mile. Now, by mile three, I’m just getting warm,” laughs the 64-year-old, who logs four to six miles daily. He and his wife revamped their eating habits, too, relying on plenty of veggies and lean meat. Ed, who weighed 340 pounds at the outset, has lost 102 pounds. With the green light from his doctor, he’s now set his sights on hiking a stretch of the Appalachian Trail.

Belly Fat + Diabetes

Medical studies undeniably link abdominal obesity with type 2 diabetes. That’s because too much belly fat can lead to insulin resistance, meaning the body’s muscle and liver cells don’t respond properly to normal insulin levels. As a result, glucose levels in the blood rise—along with the risk for diabetes. Diabetics also face other potential health issues, including nerve damage, skin disorders, kidney disease, eye and foot complications, high blood pressure and heart disease. The American Diabetes Association reports that one in 10 U.S. adults struggles with diabetes, and another 1.5 million get diagnosed every year. The good news? Thoughtful lifestyle changes, such as fine-tuning your daily diet and pumping up physical activity, can cut a person’s risk of developing type 2 diabetes by more than half.

Photographs by (Dr. Cleek) Erica Navarro; (Amanda & Ed) Scott Henderson; & courtesy of (Grossman) Michelle Grossman