The science of middle age spread ... and how to get rid of it

Experts have declared waist size crucial for health, but those last few persistent pounds can be hell to shift – especially for men in middle age. There are ways to buck the trend, though, as Gavin Newsham has discovered

With travel restrictions easing, talk in our household has turned to summer holidays and the chance to grab our first week away in the sunshine for a couple of years. I welcome the opportunity, but there’s a problem. Like many middleaged men, I put on a bit of weight during lockdown (maybe 15lb or so) and I’ve been battling to shift it for a while now. That spare tyre may be important to my health, though, as NHS advice released this week that the ratio between waist size and height may be even more crucial to overall health than the muchquoted body mass index, or BMI.

But it’s hard to lose that last bit of weight, especially for a 52-year-old like me, whose dodgy knee and prematurely arthritic hip can make exercise especially unpleasant. Which leads me to the problem. A holiday in a hot destination means taking my shirt off – and nobody needs to see that, not when we have already suffered so much. It’s a problem for many middle-aged men. Remember when David Cameron was spotted shirtless on a Cornish beach and concerned locals tried to roll him back into the sea? At times, it seems like a battle we can’t win. As Phyllis Diller said: “Maybe it’s true that life begins at 50 – but everything else starts to wear out, fall out, or spread out.”

It’s not just me – men are getting fatter: in 2017, the European Society of Cardiology ranked British men as the most obese in a study of 47 countries – and it’s a problem that gets worse from midlife. According to the Health Survey for England 2017, the levels of obesity in England have nearly doubled from 15 per cent to 29 per cent since 1993, and now 28.7 per cent of adults in England are classed as obese, with a further 35.6 per cent classified as overweight. From the ages of 45 to 64, however, these figures rise to 36 per cent obese and 39 per cent overweight.

The trouble for men is that once you hit middle age it’s significantly more difficult to shift that excess weight. And I should know. In the past decade I’ve been as heavy as 14 and a half stone and as “light” as 11 and a half stone, but the struggle in maintaining a weight at which I’m happy seems never-ending.

As men age, their levels of testosterone and human growth hormone wane, making it much tougher to burn calories and build muscle. As muscle mass deteriorates, it’s replaced by new layers of fat, especially around the waist and stomach: middle-age spread. By the time you hit your 60s and 70s you can have up to 30 per cent more body fat than you had in your 20s. Some people, by dint of genetics and hormones, are more predisposed to this than others, but anyone can be affected if they have a poor diet and a sedentary lifestyle.

Fat, in and of itself, isn’t necessarily

bad – we need fatty acids to help our fat-burning metabolism function efficiently. But “visceral fat” is not good. Dr Anand Velusamy, consultant endocrinologist at London Bridge Hospital, part of HCA UK, explains: “The old medical saying goes that ‘Women are shaped like pears and men like apples.’ This is because of men’s susceptibility to easily accumulate visceral fat around the abdomen as opposed to women where, by nature, the fat distribution is predominantly subcutaneous, or under the skin, especially in the gluteal region.”

Visceral fat differs to subcutaneous fat in that the former builds up in your abdominal cavity, around your internal organs, while the latter deposits directly under the skin. Why does it happen? Well, it’s all about the “chylomicrons”, the fat-transporting molecules produced in our small intestines which, unfortunately for men, are naturally larger and greater in number in middleaged males compared with women. As visceral fat lurks in the abdominal cavity, with its proximity to vital organs such as the liver, intestines and pancreas, it means a greater risk of a range of serious health conditions, including high blood pressure, abnormal blood cholesterol levels, respiratory issues and type 2 diabetes. In the case of type 2 diabetes, for example, the liver can’t respond to the insulin as fast as it needs to if it’s covered in visceral fat.

Indeed, comprehensive new research co-led by Dr Luanluan Sun at the University of Cambridge reveals that people with type 2 diabetes have a higher risk of 57 health conditions, including kidney disease, neurological illnesses and cancer. The study examined data from three million people as well as GP records and 116 common illnesses that occur in middle age.

Moreover, those with type 2 diabetes were more likely to suffer from these complaints up to five years earlier than those without it. “Increased abdominal fat can lead to metabolic syndrome, which is considered to be a precursor for increased mortality, leading to heart attacks, strokes and also certain types of cancer,” adds Dr Velusamy.

Belly fat isn’t the only issue. The higher your body mass index (BMI) the more likely men are to suffer from pseudogynecomastia, or “man boobs”. While all men naturally produce some of the female hormone oestrogen, it’s usually overridden by its male counterpart, testosterone, preventing breast tissue from growing. When that balance changes, however, is when you might just see the onset of moobs.

And while they’re often the butt of jokes, moobs can also lead to lack of body confidence, low self-esteem and even trouble in forming relationships. “Man boobs in middle-aged men are not uncommon,” says Dr Velusamy. “An unhealthy diet, a sedentary lifestyle and excessive alcohol consumption can all increase your likelihood of developing them.”

He’s right about the alcohol. When you drink, your body converts booze into acetate, which has the knock-on effect of turning carbohydrates and proteins into fat. And drinking leads to poor food choices, whether late-night snacking or fat-rich foods to mop up the hangover. Studies also show that taking an alcoholic drink with a meal can increase your food intake by up to 30 per cent.

Drinking also disrupts your sleep, both in terms of quality and quantity, which, according to new research just published by the Mayo Clinic, can lead to weight gain. In a controlled study led by Dr Naima Covassin, a cardiovascular medicine researcher, it was found that those participants who did not sleep well, had a nine per cent increase in their total of abdominal fat and an 11 per cent increase in abdominal visceral fat, compared with those who slept more soundly. It’s thought that inadequate sleep results in a higher calorie intake and, consequently, an increase in weight and fat accumulation, even in relatively fit people. And if people are awake longer, they will usually eat more but not generally engage in additional physical activity.

As our case studies (right) show, ditching alcohol really can work wonders, not just for your mental wellbeing and sleep quality, but, crucially, for your waistline. Look at the Michelinstarred chef Tom Kerridge. He knocked booze on the head and lost an astonishing 12 stone.

He’s not the only one. Former Labour MP Tom Watson dropped from 22 stone to 14 and succeeded in putting his type 2 diabetes into remission, while music mogul Simon Cowell is a shadow of his former self, thanks largely to a new vegan diet. Even MasterChef’s Gregg Wallace, a man who eats for a living, has a six-pack these days. Wallace used to drink seven days a week, often starting at 10am. “It got so bad at one point the owner of the local pub used to let me in when he was still in his dressing gown,” he said in November 2020. When he drastically cut back, thanks largely to the help of his fourth wife, Anna, he lost four stone.

And while the sight of Boris Johnson jogging along the sands of Blackpool beach prompted much ridicule recently – one critic said he looked like the Honey Monster escaping from the Sugar Puffs factory – the Prime Minister is to be commended for at least trying to keep middle-age spread at bay. After being hospitalised with Covid in April 2020, Johnson concluded his excess weight had played a part in his inability to cope with the virus and immediately went on a diet, shedding a stone.

So it can be done – but often it’s the middle-age mindset that’s preventing men from committing to making a real change, as Dr Andreas Michaelides, chief of psychology at behaviouralchange specialists Noom, explains. “The secret is to start small because you’re not the same person you used to be,” he says. “Finding and maintaining motivation is one of the most difficult aspects of trying to lose weight after a period of being overweight or obese,” Michaelides points out. “You have to build on the small successes, but once you go from that external feeling of doing something because you have to do it – to tick it off your list, if you like – to a more internal feeling of doing something because it makes you feel good, you’re well on your way.”

James Heagney, gym director at KX, a health and fitness club in Chelsea, agrees. A personal trainer with more than 20 years’ experience, he specialises in sports therapy and nutrition and has also coached athletes to Olympic gold. He’s noticed a real uptick in the number of middle-aged men seeking his expertise. “When men are north of 50, they tend to be driven by information or a health scare – it could be a worrying cholesterol reading or maybe their blood pressure is too high. They tend to be driven to do something because they’re concerned not so much by longevity or the quantity of life but the quality of it.”

For Heagney, the process of tackling middle-age spread begins with understanding why your body is the way it is. Typically, as we age we all slow down, whether that’s in the number of steps we do each day or the frequency, and the type of sport and activities we tend to engage in. It’s why golf and bowls suddenly seem attractive as you slip into middle age and beyond. “In that respect, it’s not so much over-consumption that’s the problem with middle-age spread, it’s under-activity,” he says.

By the age of 40 you are already beginning to lose muscle mass naturally, even if you’re relatively active, and when that happens, fat will begin to form instead of muscle, slowing down your metabolism in the process. Genetics and hormones will also have an impact on the rate your metabolism changes and, therefore, the rate at which you will be able to lose that abdominal fat.

Finding the right kind of exercise is often what stops someone succeeding in losing weight. I’ve tried most things: cycling, swimming, running – I could be a triathlete if I didn’t hate each and every one of them. Now I do a few spin classes each week with maybe one or two gym sessions, if I can be bothered. It helps that my wife accompanies/ drags me there too, otherwise I’d still be at home rooting in the cupboard for that third packet of Wheat Crunchies.

The more you enjoy a particular activity, the more likely you are to form an emotional attachment to it and achieve your goal. And while cardiovascular activities, such as running or cycling, will always be of benefit, research suggests that these can be even more effective if combined with weight training. A Harvard University study of 10,500 men over a 12-year period discovered that those who added just 20 minutes of weights to their usual cardio workout were less susceptible to gaining age-related fat around their stomachs than those who chose to only use the treadmill, as it helped to build and retain muscle mass, thereby reducing the likelihood of fat replacing it.

Consider the impact of your “nonexercise activity thermogenesis” (NEAT) as well. Put simply, this is the heat your body produces when doing all those everyday things that aren’t