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Health Information An Expert Opinion: Is There Really "One Trick" to Losing Belly Fat (Part 2)

Learn about how stress and gender can influence your waistline.

In part one of this interview, Rasa Kazlauskaite, MD, an endocrinologist with the Rush University Prevention Center, and Sheila Dugan, MD, a physical medicine and rehabilitation specialist at Rush, provided valuable tips on how to shrink your waistline to prevent the serious health problems that belly fat begets.

For part two of this Q&A, we asked these experts to talk about how stress is associated with waist girth — and to explain why excess belly fat can also affect you below the belt.

Q: You mentioned in part one of this interview that stress is one of the factors that contributes to belly fat build-up. What is the connection between stress and belly fat?

Dugan: This is a rapidly growing area of research. We're really starting to learn a lot more about the role stress plays in disease, including heart disease and diabetes.

As part of a study here at Rush, the WISH Study, in 2009 we found a strong correlation between depression and visceral fat, particularly among overweight and obese women. The results were the same even when the analysis adjusted for other variables that might explain the accumulation of visceral fat, such as the level of physical activity.

It’s been speculated that depression triggers the accumulation of visceral fat by means of certain chemical changes in the body — like the production of cortisol, which is a stress hormone — but we’re still trying to pinpoint the exact mechanism.

Kazlauskaite: That finding is in line with research findings that depression, anxiety and tension — all markers of stress — are associated with belly fat accumulation.

It’s not just that you tend to eat more when you’re stressed, it’s also what you eat. Typically, when you’re stressed you reach for what most people call comfort foods and what scientists and behavioral experts call “reward foods”: salty, sweet and creamy foods.

But another significant factor is what Dr. Dugan mentioned, the stress hormone response. Cortisol, in particular, seems to influence fat accumulation around the belly. We know that not only from research studies, but also from noticing that people with adrenal gland tumors, which cause cortisol overproduction, tend to have more belly fat and thinner arms and legs. So we can see that in nature, the stress hormone cortisol can drive abnormal fat distribution.

Dugan: That's why reducing stress is crucial to both preventing the buildup of belly fat and to losing existing belly fat.

Stress is essentially an imbalance between demands and resources. To help achieve more of a balance, I recommend carving out some time every day for an activity that will help you destress, whether it’s yoga or going for a walk or gardening or getting a massage. It doesn’t have to be a lot of time; even 30 minutes or an hour will be beneficial.

Adults, especially women, are often taking care of so many other people that they neglect to take care of themselves. But if you’re constantly putting yourself last, ignoring your own needs, the stress can get the better of you, and one of the things that can happen is you end up with more belly fat, which can lead to health problems that cause you even more stress.

Q: You also said that gender influences belly fat distribution. How so?

Kazlauskaite: When we talk about women and fat distribution, the normal female pattern would be in the shape of a pear. When we talk of the normal male body shape, we talk about an apple. What we mean is that women tend to have wider hips than waist, or an hourglass figure. Men tend to have a straighter body shape, and when they accumulate fat, it tends to be in the mid-section area, so they get a protruding stomach.

This is reflected in the fact that when we look at the diagnostic markers for metabolic syndrome, men are allowed to have a wider waist: a woman’s waist should be under 35 inches, but men are allowed a waist girth of up to 40 inches.

Of course, a lot of men don’t realize how wide their waist really is. When we measure the waist and I tell a man, your waist is 45 or 50 inches, they say I’m measuring in the wrong place, because they think their waist is where the pants waist is. But they're wearing their pants under their belly, and so they think their waist is a lot smaller than it is because their pants still fit.

Q: We've been hearing a lot about metabolic syndrome lately. What is it, and why should people be concerned about it?

Dugan: Metabolic syndrome refers to a group of markers, or risk factors, that raise your risk for heart disease, diabetes, stroke and other health problems. In fact, people with metabolic syndrome are twice as likely to develop heart disease and five times as likely to become diabetics. So there’s clearly good reason to be concerned.

As for what those markers are, having a large waist — that apple body shape — is one, although as Dr. Kazlauskaite pointed out, men are allowed to have a slightly larger waistline than women. The other four are high levels of triglycerides (a type of fat found in the blood); low HDL, or “good,” cholesterol; high blood pressure; and a high fasting blood sugar level.

If you have three of these five markers, you're considered to have metabolic syndrome and should talk to your doctor about how to reduce your risk factors, including reducing your belly fat. You don’t want to wait until you develop diabetes or heart disease to take action.

Q: Is it true that visceral fat in women tends to increase during menopause?

Dugan: Yes. It's an interesting phenomenon, really. When that delicate balance of estrogen to testosterone shifts toward testosterone during the menopausal transition, the distribution of fat also shifts and women tend to accumulate more belly fat.

In men, we know that when their testosterone decreases naturally as they age, they tend to accumulate belly fat, but in women it isn’t really about having more testosterone, it’s about upsetting the estrogen-testosterone balance. We used to think estrogen protected premenopausal women against cardiovascular disease and that the increased cardiovascular risk after menopause was related only to the loss of estrogen’s protective effect. But now we know that it’s actually the change in hormonal balance that’s largely responsible for visceral fat.

So if you’re a woman in your 30s or early 40s and you aren’t already eating healthy and exercising regularly, you should get started now and work hard to maintain these healthy behaviors throughout the menopausal transition. 

Kazlauskaite: It’s also important to note that in both men and women, shifts in hormonal balance that cause belly fat to accumulate are also associated with decreased sex drive and decreased fertility.

Sometimes I remind men: The more inches around the waist, the less action below the waist. To have good erections you have to have perfect circulation, and since belly fat increases inflammation in the blood vessels and restricts blood flow, men’s erections may not be as good.

What also happens when a man is obese is that the brain starts suppressing the stimulation of testosterone, which is associated not only with erectile dysfunction but with decreased fertility.

In women, suppression of reproductive hormones might manifest as irregular menstruation, polycystic ovary syndrome and infertility. That’s why doctors often advise women who are obese to lose weight before trying to get pregnant. 

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Please Note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

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September 2012 

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