Anatomy of a Potbelly

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Summer might be over, but don’t let your waistline go to the dogs just yet. Looking good at the beach isn’t the only reason to flatten our tummies. Recent studies in fat distribution are giving us an even more pressing incentive to reduce our rounding stomachs: our health.

It turns out that abdominal fat (much more than fat in other parts of the body) has a major impact on whether we stay healthy and vital or put ourselves at increased risk for several chronic diseases.

First off, we’re not talking about your typical tummy fat, so don’t fret about a little paunch. All of us need a bit of internal belly fat, says expert in nutrition Pamela Peeke, MD, MPH. “We need abdominal fat to help cushion organs, maintain internal body's temperature, and it’s also a good supply of backup fuel,” says Peeke, author of Body for Life for Women: A Woman’s Plan for Physical and Mental Transformation and Fight Fat After Forty.

The issue is that not all abdominal fat is made equal. It is the type of stomach fat – and the places it’s located – that determine whether it’s likely to lead to health issues.

Two Types of Fat

Ringing all our midsections are two different kinds of fat: subcutaneous and visceral. Subcutaneous, which means “under the skin,” is the fat we can see and pinch – the jiggly stuff the majority of us lament in our bathroom mirrors. But, surprisingly, we have to worry less about subcutaneous fat than we do the visceral stuff.

Visceral, meaning “pertaining to the soft organs in the abdomen,” is the fat stored deep within our abdomens around the intestines, kidneys, pancreas and liver. This is the stuff that tends to make our tummies protrude in classic “beer belly” fashion.

While visceral fat and subcutaneous fat look much the same from a surgeon’s perspective (they have the same consistency and yellowish color), they look different under a microscope, and they function very differently on the biological level.

Subcutaneous fat is usually described as a “passive” fat since it functions primarily as a storage repository. It requires a fair bit of metabolic intervention from other body systems and glands in order to be processed for energy. Visceral fat, by contrast, is considered very “active” because it functions similar to a gland itself: It is programmed to break down and release fatty acids and other hormonal substances which are then directly metabolized by the liver.

When the fatty acids which are produced in our abdominal organs go straight to the liver, it “produces an unfavorable metabolic environment and triggers the liver to complete all sorts of bad things,” says health expert Marie Savard, MD, author, with Carol Svec, of the recent book The Body Shape Means to fix Weight Loss and Wellness: The Apples and Pears Method of Losing Weight, Living Longer and Feeling Healthier. “Excess visceral fat can lead to increased blood sugar and higher levels of insulin, and it also generates increased inflammation, which are the perfect set-up for diabetes, certain types of cancers and stroke.”

Abdominal obesity is a key risk factor for insulin resistance and “metabolic syndrome.” The chronic inflammation that results from excessive visceral fat has also been linked to heart disease, and a recent Kaiser Permanente study of 6,700 participants demonstrated that people with higher rates of abdominal fat are 145 percent more likely to develop dementia.

Visceral fat may be located in our abdomens, Peeke says, but it can wreak all sorts of damage that goes far beyond our bellies. “No other fat in the body does that,” she says. Which is precisely why we need to keep the amount of fat in our abdomens under control.

When we don’t, the result may be a belly that’s literally packed with fat, a phenomenon that may lead to a surprisingly solid protrusion – one with deceptively little pinchable fat at first glance.

Carrying excess visceral fat “is much like trying to pack 7 to 10 pounds of potatoes in a 5-pound bag,” says Silver Spring, Md.–based bariatric surgeon Gary C. Harrington, MD. “There’s forget about room for things to grow inside, so it becomes very tight.”

Potbelly Origins

So why is it that some of us tend to gain weight within our midsections? There is no single answer. Instead, the calculus behind the look of a potbelly involves four factors: genetics, eating routine, stress and hormones.

Genetics. The first part of the equation is the genetics of physique. Some of us, says Savard, are just destined to be “apples,” with an inclination to gain weight in the stomach and upper-body region, while others are fated to be “pears,” who gain weight in their hips, buttocks, thighs minimizing legs. According to Savard, it all is dependant on your waist-to-hip ratio (WHR), which is the division of the waist measurement by your hip measurement. (For an accurate WHR measurement, relax your abdomen and measure at the navel and around the bony part of the hips.)

If you’re a lady whose WHR is 0.80 or lower, you are pear shaped; if your WHR is greater than 0.80, you’re apple shaped. For men (who, for the most part, are apple shaped, since they are more inclined to store visceral fat), the cutoff is 0.90 rather than 0.80.

Many experts now agree that WHR is the perfect indicator than body mass index (BMI) when it comes to determining someone’s disease risk. Even apples who're currently slender and have a low BMI, Savard says, might be at increased risk for disease later.

“If you’re a string bean with no obvious potbelly, but your waist-to-hip ratio is more than 0.80, you will tend to have more health problems than pear-shaped people if you gain weight,” she says. When WHR is greater than 1.0 in men or 0.90 in women, health experts may diagnose the problem as “central obesity.”

Eating habits. Belly fat, like all fat, is produced when we ingest more caloric energy than our bodies can use. And our bodies were simply never made to withstand such easy access towards the kinds of calorie-dense foods available to us today.

“It’s certainly no secret that the way we eat has run out of sync with our body’s needs,” writes Floyd H. Chilton, PhD, in Inflammation Nation: The very first Clinically Proven Eating Plan to End Our Nation’s Secret Epidemic. “The majority of the evolutionary forces that shaped our genetic development were exerted over 10,000 years ago when we were hunter-gatherers. Nothing for the reason that programming could have prepared us for that Big Mac. Our bodies, and more specifically our genetics, simply aren’t designed to eat the ‘foods of affluence’ open to a twentieth-century urban dweller.”

Visceral fat was simply no problem years ago, says Savard. Go ahead and take Pima Indians of Arizona, she says, who've prototypically apple-shaped bodies. Because the Pima Indians evolved during alternating periods of feast and famine, they developed what researchers call a “thrifty gene,” which ensured that they store visceral fat during plentiful times and employ it during lean times.

Living and eating as they did traditionally, subsisting on foods they hunted, gathered or raised themselves, the Pima were rather slender. Today, however, the majority are extremely overweight and suffer a 50 % rate of diabetes among adults (95 % of those people are overweight). “Now, by having an unlimited supply of food along with a more sedentary lifestyle,” says Savard, “the issue of visceral fat is not going away.”

Food today is not just more accessible, it has been reincarnated in so many heavily processed forms that we are often eating things that our bodies do not recognize as food. Our metabolism is still hardwired to process the hunter-gatherer diet of yore, and when it encounters sugary sodas and snacks which were created in a laboratory and never in a field, it is not in a position to process or use them efficiently. Instead, our bodies are forced to sock away that stored energy in places – like our midsections – where it does more harm than good.

Potbellies, also known as “beer bellies,” are often associated with drinking. But “beer does not promote weight or waist gain anymore than any other source of calories,” says Meir Stampfer, MD, professor of nutrition and epidemiology in the Harvard School of Public Health. In fact, a 2003 study of 2,000 men and women from the Czech Republic, where people consume more beer per person than in any other country in the world, found no link between the amount of beer a person drinks and the size of his or her stomach. That said, alcoholic beverages are an often-overlooked, carb-dense supply of calories in many people’s diets. Alcohol is processed much like a sugar in the body, and because it puts an additional stress on the liver, it may undermine the body’s fat-processing abilities.

Stress. Stress is yet another major reason some of us tend to pack on excess belly fat. As Peeke puts it, with regards to weight gain, “genetics may load the gun, but environment pulls the trigger.” Peeke, who spent years researching the link between stress and fat in the National Institutes of Health, says that experiencing chronic stress isn't just toxic for our bodies but can also beget an expansive waistline.

All people may experience what Peeke terms “annoying but livable” stress like congested zones and long lines in the supermarket, but chronic stress resulting from, say, a bad marriage, an illness or career challenges can actually trigger our bodies to produce high levels of cortisol, which, among other things, gives us a powerful appetite that causes us to overeat. Even worse, Peeke points out, the weight we gain as a result of sustained cortisol production tends to settle mainly within our abdomens.

Hormones. Declining sex hormones is yet another key reason why both men and women start to develop a paunch as they age. Even pear-shaped women, whose body chemistry is mostly governed by estrogen, start to lose their estrogen advantage after menopause and therefore are exposed to increased health risks, says Savard. “Once they gain weight after menopause, the tendency would be to put on visceral fat,” she says. And if they accumulate enough visceral fat, their body shape “can transform from pear into apple.”

Middle-Slimming Strategies

Whatever the main reason, potbellies, it seems, have become something of an epidemic. The bad news is there is no quick-fix approach to tackling abdominal fat. As with other areas of the body, it’s impossible to target just one region for weight loss.

For example, commonly attempted spot remedies like crunches might tone your back and abdominal muscles, but they will do nothing for the fat stored in your belly. For that, you need to reduce your body’s store of fat overall.

But don’t be tempted by the bevy of crash diets out there either, says Savard, because you might easily end up gaining more weight. “Lowering your caloric intake by more than 25 % simply triggers your metabolism to go into starvation mode, which lowers your [resting metabolic] rate,” she says. Staying with a sensible, whole-foods diet and moderate, daily exercise will deliver far better results.

The great news is that visceral fat, while it may be stored deep down in your belly, is often the first kind of fat to burn off. The truth that this fat is metabolically active really works in your favor once you decide to get rid of it.

Forget how much you weigh, says Savard. Losing just 2 ” from your waistline can significantly decrease your risk of a host of illnesses and diseases. “Throw away your weight scale, because health is within inches, not pounds,” she emphasizes.

Eating well and exercising regularly, including lifting weights, are key to improving your chances of losing those 2 inches of visceral weight and keeping them off. Experts suggest low-to-moderate-intensity, long-duration workouts (30 minutes or more) most days of a few days. Also key to losing visceral fat is to ingest – and not avoid – crucial fat-burning fats like omega-3 essential fatty acids.

“I tell people to think of the three Fs: fiber, fat and fitness,” Savard says. “It’s pretty simple, actually: If everything you’re eating is either full of fiber or a good fat, you’re maintaining a healthy diet food, because there should be little if any refined carbohydrates or unhealthy saturated fats. You don’t have to worry about protein while using the this approach, either,” she says, “because if you are eating healthy fats, that means you’re eating fish and nuts and keeping steak to a minimum.”

Exercise and nutrition – especially eating small, well-balanced meals every three to four hours – is very important, says Peeke, and significant is learning how to manage levels of stress. “I’ve always looked at your brain in addition to the mouth and the muscle,” she says.

To start down the path of stress-resilience, Peeke offers several tips, such as creating a support system, making use of your spirituality, learning to find humor in everyday things, and finding some private space and time to record uncensored thoughts into a journal.

Upon adopting such recommended nutrition, exercise and changes in lifestyle, most people will see belly-shrinking results within a couple of months (aiming for a 1- to 2-inch reduction within six months is a good, realistic goal for a lot of). Some may see a visible difference more quickly. But again, don’t sweat what the scale says: A 2005 Duke University Clinic study showed that exercising patients lost measurable levels of visceral fat (as measured by CT scans) even when they didn’t lose much weight.

Front and Center

To some, it might seem silly to obtain so up-in-arms about a potbelly. After all, from Father christmas to a pleasingly plump grandma, abdominal girth has traditionally been perceived as relatively harmless and imbued with emotional warmth and security.

Comforting cultural myths aside, however, the fact is that abdominal fat has serious health implications that we ignore at our own peril. This is a health and fitness problem that definitely deserves our undivided attention.

While there isn't any quick-fix approach to losing abdominal fat, thinking holistically and making real changes in lifestyle can go a long way toward shedding that stubborn belly.

The payoff? We’ll not only look great at the beach next summer – we’ll feel great, too.

Paunch Be Gone!

While there is no one-size-fits-all method to lose that stubborn belly, there are many whole-body approaches you can use to tackle your waist:

Invest in inches. Instead of fretting about what you weigh, says health expert and author Marie Savard, MD, toss the scale and simply focus on what your tape-measure says. Shaving just a couple inches of visceral fat out of your waistline can drastically lower your chances of developing heart disease, diabetes and many types of cancer.

Manage your stress level. Everyone lives with what nutritional expert Pamela Peeke, MD, MPH, calls “annoying but livable” stress. But chronic stress that results from caregiving, marriage woes or job problems can in fact pack on pounds within our midsections. Find time for yourself, produce a support system, practice meditation and relaxation techniques, and learn to laugh – which not only reduces stress hormones but actually boosts your immune system.

Eat more frequently in smaller quantities. Rather than consuming three huge meals, boost your metabolism by eating several well-balanced, smaller meals throughout the day. Work in fruits and veggies in place of sweets and delicate carbs.

Rely on fat-burning fats. Don't fall under the trap of believing that dietary fat is bad for you. Simply focus on eating healthy fats, like the essential fatty acids found in fish, nuts, seeds and avocados, plus olive, seed and nut oils.

Move your bod. Try Nordic or power walking, yoga, biking, or a group-fitness class – whatever gets you going at moderate intensity for at least 30 minutes, most days of the week.

Where Belly Meets Back

In addition to upping your risk of developing all sorts of serious diseases and illnesses, potbellies are also just plain bad for your posture and spinal alignment, says Alexandria, Va. -based chiropractor Eric Berg, DC. Berg found the abdominal-fat problem so ubiquitous he now devotes most of his practice to helping people lose the weight instead of just opting for a band-aid approach, where patients are available in over and over again for chiropractic adjustments.

“A pendulous abdomen pulls the whole body forward, so the body actually compensates sometimes by creating a hump on your upper back to help stabilize itself,” Berg says. “When you've slouched shoulders and your lower back is curved in too much, you are really distorting your posture.”

People with protruding bellies who dislike up straight walk into his office every single day, Berg says. “Their belly fat keeps tension on the spine and creates areas of deterioration, which might cause the spine to form abnormal wedges, so that even if you lose weight, your spine might not fit your mold anymore,” he states. “Additionally, lots of these people have knee pain due to nerves that are being pinched within their backs due to bad posture.”

This article has been updated. It originally appeared within the November 2006 issue of Experience Life magazine.

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