It’s not the fat on your belly, it’s the fat in your belly

Northwest Arkansas Democrat-Gazette - - STYLE - ROSE­MARY BOGGS Email me at: rboggs@arkansason­

It’s sim­ple. If it jig­gles, it’s fat. — Arnold Sch­warzeneg­ger

Many of us are fa­mil­iar with the real es­tate mantra “lo­ca­tion, lo­ca­tion, lo­ca­tion.” It’s be­ing ap­plied to body fat too.

In 2013, writ­ing for the American Di­a­betes As­so­ci­a­tion’s mag­a­zine Di­a­betes Fore­cast (di­a­betes­fore­cast. org), Erika Gebel, Ph.D., stated that many ex­perts con­tend that where fat lives, not just how much you have, af­fects health.

For years, body mass in­dex (BMI) has been used as an es­ti­mate of to­tal body fat. It’s a cal­cu­la­tion based on height and weight, and is charted the same way for men and women. It’s the pro­por­tion of a per­son’s weight that’s made up of fat. If you’ve never had your BMI cal­cu­lated and want to, an in­ter­net search will turn up sites where you plug in your num­bers.

Over the years there has been con­tro­versy over whether BMI is a re­li­able pre­dic­tor of who is at risk for obe­sity-linked dis­eases, in­clud­ing Type 2 di­a­betes and heart disease. BMI is a sta­tis­ti­cal tool de­vel­oped to as­sess large pop­u­la­tions, and when ap­plied to in­di­vid­u­als, it’s not al­ways ac­cu­rate. For in­stance, body­builders can be heavy with­out be­ing fat.

Also, the thought these days is that it may not be how much fat you carry that is the prob­lem — it’s where you carry it.

The ap­ple-shaped body type is an ex­am­ple of the “where you carry it” thought. That shape, with a large waist rel­a­tive to the width of the shoul­ders and hips, is known for car­ry­ing vis­ceral fat. It ac­cu­mu­lates in the ab­dom­i­nal cav­ity and can sur­round the stom­ach, liver and in­testines. This fat can be so close to the liver that it winds up turn­ing into choles­terol. From the liver it goes into the blood­stream and col­lects along artery walls. This can cause the ar­ter­ies to nar­row and har­den, a con­di­tion called ath­er­o­scle­ro­sis.

Vis­ceral fat also pro­motes a vi­cious cy­cle of in­sulin re­sis­tance. Fat around the belly raises the risk of heart at­tack or stroke, lead­ing causes of death in di­a­bet­ics. And it can lead to cer­tain can­cers.

Many women have an in­crease in belly fat as they get older be­cause of a de­creas­ing level of es­tro­gen, which is found to in­flu­ence where fat is dis­trib­uted in the body.

While doc­tors tend to fo­cus on low­er­ing pa­tient BMI to help cut down on obe­sity-re­lated risks, the mea­sure­ment can be a bit im­pre­cise. Some use waist mea­sure­ments as an in­di­ca­tor. If you are a woman with a waist size over 40 inches or a man with a waist size over 35, you could be car­ry­ing vis­ceral fat. But mea­sur­ing the waist in­cludes fat un­der the skin as well as that in the ab­dom­i­nal cav­ity.

Diet and ex­er­cise are two things we can con­trol. They help de­ter­mine how much fat builds up in our bod­ies. We can tone ab­dom­i­nal mus­cles with crunches or other tar­geted ex­er­cises, but that won’t get rid of belly fat. Vis­ceral fat re­sponds to the same diet and ex­er­cise strate­gies that help shed ex­cess pounds and lower to­tal body fat.

The di­a­betes as­so­ci­a­tion rec­om­mends we keep to­tal fat to 20 per­cent to 30 per­cent of our daily calo­ries, hold sat­u­rated fat to less than 7 per­cent and limit trans fats. But is that enough?

A study pub­lished in 2005 in the Jour­nal of Ap­plied Phys­i­ol­ogy found that ex­er­cise is a good way to pre­vent and lose belly fat. The sub­jects in­cluded 175 over­weight peo­ple who did not ex­er­cise. Re­searchers di­vided them into groups, with one group that did no ex­er­cise and three that did. Af­ter six months the noex­er­cise group gained belly fat, but those in the ex­er­cise groups lost it or at least didn’t gain more.

The as­so­ci­a­tion rec­om­mends that, along with low­er­ing fat and calo­ries, we do a com­bi­na­tion of mod­er­ate-in­ten­sity aer­o­bic ex­er­cise for at least 30 min­utes, five days a week, and strength train­ing three times a week. The strength rou­tine should tar­get all ma­jor mus­cle groups.

When peo­ple with Type 2 di­a­betes be­come ac­tive, they can lose fat but gain mus­cle. Maybe their weight won’t change, but ev­i­dence that the waist­line is shrink­ing can mo­ti­vate them to stick with it.

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