Bad news for OA/RA/AS --- Beer belly? Weight?
firechief
Doctors should measure more than your weight at
appointments. They should measure your waist.
For years, scientists have observed that an
apple-shaped figure or a big beer belly is a
health risk. But now they have gained more
insight into why this is so.
They've discovered that people with wide girths
are more likely to have large amounts of
deep-hidden belly fat around their organs. It
might be the most dangerous kind of fat and
could increase a person's risk of diabetes,
heart disease, stroke and some types of cancer.
This fat, which is called visceral or
intra-abdominal fat, is linked to high
cholesterol, high insulin, high triglycerides,
high blood pressure and other problems.
Researchers are investigating whether visceral
fat secretes more inflammatory molecules that
are linked to diseases than other types of fat.
And because most people in the USA weigh too
much and many carry extra weight in the belly,
experts are racing to discover how to reduce the
killer fat. So far, physical activity and weight
loss appear to be the key. Several new studies
indicate that regular exercise, such as brisk
walking for 30 to 45 minutes a day, can
significantly decrease such fat.
At greatest risk of developing health problems
from too much hidden belly fat are men whose
waists are wider than 40 inches and women whose
waists are wider than 35 inches. If your waist
measurement is that high, "you've fallen off
the edge of the cliff," says George Blackburn,
associate director of the division of nutrition
at Harvard Medical School.
People with waists that wide need to reduce them
immediately, says Robert Ross, an exercise
physiologist at Queen's University in Kingston,
Ontario. But even people whose waists are
several inches smaller could be at risk, he
says.
Experts say they don't know the optimal waist
size for good health. But they do know this:
Your waist circumference "is an absolute vital
sign" in determining your health, Blackburn
says. You need to know this plus your weight and
body mass index, a formula that takes height and
weight into account.
"In addition to the stethoscope around their
necks, physicians should be carrying a tape
measure," Ross says. Waist circumference is an
independent risk factor for serious diseases,
similar to factors such as weighing too much and
high blood pressure, he says.
Most people don't know how much hidden belly fat
they have because the only accurate way to
determine it is with CT or MRI scans. But doing
those tests for millions of people is
unnecessary and too costly at this point,
experts say. And measuring waist girth is a good
guide.
Although people who are overweight or obese are
more likely to have large amounts of visceral
fat, normal-weight people also can have too
much.
Older people need to be particularly vigilant
about their waist measurement. A recent study
found that some men and women 70 to 80 years old
with normal body weight still had an increased
risk of type 2 diabetes if they had large
amounts of visceral fat.
"An important factor is where in the body their
excess fat is stored," says Bret Goodpaster,
assistant professor in the division of
endocrinology and metabolism at the University
of Pittsburgh.
Scientists aren't sure why some people have more
of this fat than others. As people get older,
they often become less active, which could
partly explain the increase in the fat, Ross
says. "The processes by which we lay down
excess visceral fat are not completely
understood. It's very likely that genes, sex
hormones and stress hormones (cortisol) play a
role."
He says that as men age, many notice that their
belly gets bigger, and they start losing muscles
in their legs. Women experience similar effects.
Scientists also don't know exactly why the
visceral fat seems to take such a toll on
health, and they are investigating it
vigorously.
One explanation called the portal theory
suggests that this fat secretes fatty acids near
the liver, possibly causing some of the health
problems that lead to diabetes, heart disease
and high blood pressure. This theory is being
questioned now, Ross says, and "there are far
more new and exciting hypotheses currently being
investigated."
"While it remains to be determined the exact
cause that links visceral fat with health
risk," Ross says, "what is absolutely clear is
that this is a relatively little depot of fat
that conveys a very big health risk."
Overall, visceral fat is a small amount of the
total body fat. In a slightly overweight
middle-aged man, about 15% to 20% of his fat is
visceral fat, and about 10% to 15% of a
pre-menopausal woman's body fat may be the
intra-abdominal kind, he says.
Although visceral fat seems to be particularly
hazardous to health, it's not the only bad guy
under the tape measure. Subcutaneous fat, the
kind right under the skin, also is a factor,
Ross says. "Subcutaneous fat is not just
hanging out. Both visceral and subcutaneous fat
contribute to health problems, but it would
appear that visceral contributes more."
The two fats act differently in the body,
experts say. "If you put visceral fat in a
petri dish and you put subcutaneous fat in a
petri dish and stimulate them, the visceral fat
will produce a lot more inflammatory molecules
that can raise a person's risk of heart disease
and diabetes," says Tim Church, medical
director of the Cooper Institute in Dallas.
Losing weight and increasing exercise appear to
be key to decreasing this fat. A study at the
Fred Hutchinson Cancer Center in Seattle found
that overweight postmenopausal women who
exercised regularly for a year lost 3.4% to 6.9%
of their intra-abdominal fat, depending on how
active they were. They were told not to change
their diet. Exercisers lost about 3 pounds.
To get the benefit from physical activity, lead
researcher Anne McTiernan recommends aiming for
30 to 45 minutes of brisk walking (as if you're
late for the bus) five days a week. "I suspect
if you exercise for 60 minutes a day, you'll get
even more fat loss," she says.
The exercise should be intense enough that you
feel your heart rate increase and might sweat,
but you should be able to hold a conversation.
It appears that visceral fat could be the first
kind of fat to be lost when you drop weight
through exercise, McTiernan says.
Research by Ross of Queen's University showed
that men who became more active lost a
significant amount of this fat and reduced their
waist size. These studies might help explain why
some people who begin exercise programs say
their pants fit better, but they're not noticing
much weight loss, Church says.
People who have become devoted exercisers know
firsthand how activity can shrink this fat and
their waist size:
* Bernyce Edwards, 70, of Seattle, a participant
in McTiernan's study, kept her diet the same but
exercised an hour four times a week doing
aerobics, walking or weight training. In a year,
she dropped 12 pounds, and her visceral fat
decreased by 26%.
* Larry Langley, 55, of Irving, Texas, weighed
355 pounds and had a 58-inch waist when he
decided he had to reduce his girth. He enrolled
in a weight-management program at the Cooper
Institute in Dallas and began walking daily,
watching portions and counting calories and fat
grams. He lost 137 pounds and 16 inches around
his middle in a little over a year. He now walks
5 miles a day at a nearby mall.
* Deborah McElroy, 44, of Battersea, Ontario,
participated in a visceral-fat study at Queen's
University. She walked and ran on a treadmill
for an hour a day seven days a week, and she
changed her diet by cutting back on fats and
sweets. After 14 weeks, she lost 16 pounds and 2
inches around her waist. Her visceral fat
dropped by 37%.
"We're not going to find a magic pill in a
bottle" that will decrease waist size and
increase fitness, Ross says. "I can't imagine a
better solution to lifestyle-based disease than
physical activity."
Blackburn says, "We can't keep stuffing our
faces with fat and take a little stroll and
think we are doing ourselves any good."
People have to walk briskly and break a sweat,
he says. They need to be active for 60 minutes a
day. And they have to cut back on junk food, he
says.
"If from one checkup to another, you put on a
few pounds, go up a notch on the body mass index
chart or gain an inch or two around the waist,
then you need to put the brakes on it,"
Blackburn says.
You need to adopt "a new lifestyle that reduces
your caloric intake, improves the quality of the
food in your diet and increases the amount of
daily exercise."
Tracy Johnson
> They've discovered that people with wide girths
> are more likely to have large amounts of
> deep-hidden belly fat around their organs. It
> might be the most dangerous kind of fat and
> could increase a person's risk of diabetes,
> heart disease, stroke and some types of cancer.
>
> This fat, which is called visceral or
> intra-abdominal fat, is linked to high
> cholesterol, high insulin, high triglycerides,
> high blood pressure and other problems.
> Researchers are investigating whether visceral
> fat secretes more inflammatory molecules that
> are linked to diseases than other types of fat.
>
This is interesting, and I believe the connection to the apple shape
body type has long been established with regard to diabetes in
particular. But the inflammatory thing? I don't know... I lost all of my
"visceral fat" and THEN got PA. I guess maybe my PA would've been worse
if I hadn't already lost that fat, but who knows. I'm a little skeptical.
Tracy