‘Waist loss’ is more important than weight loss – The hidden danger of belly fat


“How do I lose belly fat?”

It’s likely that at some point in your life, you have asked this question, or wondered what the answer may be, at the very least. You aren’t alone – it’s one of the most frequently asked questions when it comes to weight loss and dieting. If you Google it, you’ll be met with an onslaught of workout videos, fad diets and ‘lose weight quick’ solutions. But beyond the aesthetics, weight around the waist, or abdominal fat is worth your time and attention for a variety of health concerns. In particular, belly fat is bad for the heart, even in people who are not otherwise overweight or obese. To put it in numbers, 2 out of 3 people at a high risk for a heart attack or stroke have extra belly fat.

Body mass index (BMI), which is weight relative to height, is commonly used to categorize adults as underweight, normal weight, overweight or obese. However, BMI does not account for the amount and distribution of fat and muscle. In India, this is a particularly important problem since South Asians have 3% to 5% higher body fat than other ethnicities with an identical BMI. In our earlier blog, we discussed the burden of heart disease in India and why it is so important to be proactive about your health. According to the National Family Health Survey-4, obesity in India has doubled in the last decade.

Not all fat is created equal

There are two main types of abdominal fat. The kind that is located in the fatty tissue just beneath the skin is known as subcutaneous fat. It behaves like the fat everywhere else in the body, meaning it is not good for health, but it is not particularly dangerous either. The second, more sinister type of fat is the kind found inside the abdomen, called visceral fat. Visceral fat cushions the internal organs and can damage your health. Where fat is stored is influenced by several factors, including heredity and hormones. High amounts of visceral fat are directly linked with higher bad cholesterol, lower good cholesterol, (find out about good and bad cholesterol in this handy guide), and insulin resistance. Insulin resistance is a condition where your body’s muscle and liver cells do not respond to the hormone that carries glucose from the bloodstream into the body cells, meaning that the levels of blood glucose rise, causing an increased risk for diabetes.

Take the pinch test: To put it very simply, the fat you can pinch is subcutaneous fat. The fat inside your abdomen can be seen and measured, but not pinched; this is visceral fat.

Why is fat around the middle such a problem?

Body fat around the middle, known otherwise as abdominal obesity is a key factor for heart disease, even in people who are not otherwise overweight or obese.

To better understand this correlation, let’s examine a research study that aimed to answer the following question: Do people with normal weight but abdominal obesity have more heart problems than people with normal weight and normal fat distribution?

After studying over 1600 individuals aged 45 years or older for a period of four years, with an appropriate representation of the population for age and sex, the researchers found that those with a normal BMI (18.5–24.9 kg/m2) and abdominal obesity had an approximately two-fold higher long-term risk of serious cardiac events compared to people without abdominal obesity, regardless of their BMI.

Further, each additional pound of fat gained was linked to a new diagnosis of high blood pressure, high triglycerides and diabetes. Even though increases in both types of fat (visceral and subcutaneous) were associated with a worsening of cardiovascular disease risk factors, the association was stronger for visceral fat compared to subcutaneous fat.

Why belly fat is even worse if you have experienced a heart attack:

It is already established that abdominal obesity is an important risk factor for having a first heart attack. But recently, researchers examined the association between abdominal obesity and the risk of a subsequent heart attack or stroke, in the largest study ever conducted on this topic, and their findings were startling.

“Patients are typically put on a stringent medical treatment regimen after their first attack to prevent second events (called secondary prevention),” said study author Dr. Hanieh Mohammadi. This secondary prevention is focused on reducing risk factors associated with cardiac events like high blood sugar, lipids and blood pressure. After following up with over 22,000 patients who had experienced their first heart attack, for a period of roughly 4 years, they found that increasing abdominal obesity was independently associated with fatal and non-fatal heart attacks and strokes, even after discounting other risk factors (such as smoking, diabetes, hypertension, blood pressure, blood lipids and body mass index [BMI]) and secondary prevention.

As Dr. Mohammadi concluded, “Abdominal obesity not only increases your risk for a first heart attack or stroke, but also the risk for recurrent events after the first misfortune. Maintaining a healthy waist circumference is important for preventing future heart attacks and strokes regardless of how many drugs you may be taking or how healthy your blood tests are.”

So how do I lose belly fat?

Back to our first question! While all this information may seem overwhelming, remember that every individual needs a certain amount of ‘healthy’ visceral fat, you need not try to get rid of it completely, but rather try to reduce the amount. With abdominal obesity, your target should be waist loss rather than weight loss.

Step 1: Identify the problem

Here are some simple ways you can figure out whether your waistline needs some work:

  1. Measure your waist-to-hip ratio:

Keep your abdomen relaxed, and measure your waist at the navel. Next, measure your hips at their widest point. Finally, divide your waist size by your hip size:

Waist (in inches) / Hips (in inches) = ratio

You should be concerned if your ratio rises above 0.95 for men, and 0.85 for women

  1. Simply measure your waist:

To measure your waist circumference properly, take your shoes off and stand with your feet together. Be sure your belly is bare. Relax and exhale. Record the measurement to the nearest one-tenth of an inch, and then repeat the measurement to be sure you’ve got it right. Refer to the table below to understand your measurements.

 MenWomen
Low-risk37 inches or less31.5 inches or less
Intermediate risk37.1 to 39.9 inches31.6 to 34.9 inches
High-risk40 inches or more35 inches or more

Step 2: Get moving!

The easy work is in measuring your waistline – doing something about it is much harder. Congratulations on taking the first step towards that journey. A heart-healthy lifestyle is simple and rewarding. Forget about fad diets, detoxing, or doing endless crunches, and remember the basics. You can only lose visceral fat by losing weight, and the only proven way to lose weight is by burning more calories than you consume. This means spending more calories with exercise and your everyday functioning than the calories that you take in from food. Sustained weight loss means that both caloric restriction and increased exercise are essential. This type of lifestyle will yield benefits that go beyond a reduction in visceral fat, like a lower blood pressure and better favorable cholesterol levels.

Key Takeaways:

  • Excess body fat around the waist is a key factor for heart disease, even in people who are not otherwise overweight or obese
  • Too much visceral fat is linked with higher bad cholesterol, lower good cholesterol, and insulin resistance
  • This type of obesity is not just associated with higher chances of a first heart attack, but also increases the likelihood of a second cardiac event
  • A heart-healthy diet and regular exercise are the most effective tools to lose visceral fat, prevent abdominal obesity and lower your risk of heart disease

For a more detailed explanation of diet and exercise, you can refer to our earlier blogs. Find out how you can eat a heart-healthy diet, and how exercise can benefit you and become a part of your routine.

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