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

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.