Abdominal obesity is an accumulation of excess fat in your abdomen. It is also called visceral obesity because fat deposits round your organs inside the abdomen. Central obesity is another name for it which denotes obesity of the central part of your body – your abdomen. Phrases such as “belly fat”, “spare tire”, “love handles” are also used to describe what is abdominal obesity.
Once a disease of the industrialized world, abdominal obesity is now prevalent in the developing countries as well. It is a true pandemic of our times! What is even more alarming is that more and more children are becoming obese. For example, in the US, central obesity is projected to reach 55.6% in men, 80.0% in women, 47.6% among girls and 38.9% among boys by the year 2030 (1).
What is considered abdominal obesity?
Abdominal obesity is defined as a waistline more than 35 inches (88 cm) in females or 40 inches (102 cm) in males, according to the guidelines from American Heart Association and National Heart, Lung and Blood Institute. (2)
Abdominal obesity among Asians
Among Asians, abdominal obesity is defined as a waist-line more than 31.5 inches (80 cm) for women and 35.5 inches (90 cm) for men, according to the World Health Organization (WHO) and International Diabetes Federation. (3)
At the Jamila Diabetes and Endocrine Center, most of our Asian Type 2 diabetics are non-obese, according to American Heart Association and National Heart, Lung and Blood Institute criteria. But, they are obese according to WHO criteria for abdominal obesity.
Waistline versus BMI for abdominal obesity
Waistline is more accurate assessment of the abdominal obesity as compared to body mass index ( BMI) which is more specific for subcutaneous obesity.(4)
What Type of Obesity is More Harmful?
Abdominal obesity is more harmful than subcutaneous obesity. Why? Because abdominal obesity is a risk factor for the Metabolic Syndrome. (5) Various components of Metabolic syndrome include prediabetes, diabetes, cholesterol disorder and high blood pressure. Individuals with Metabolic Syndrome are at high risk for heart disease, stroke and cancer.
What are the Effects of Abdominal Obesity?
1. Abdominal obesity leads to Metabolic Syndrome
As mentioned above, abdominal obesity leads to Metabolic Syndrome and its consequences.
How does Abdominal Obesity lead to Metabolic Syndrome?
In normal individuals, one of the actions of insulin is to keep fat inside the fat cells. But, in the presence of abdominal obesity there is resistance to this action of insulin. Consequently, there is an accumulation of fat (free fatty acids) in the blood. As a result, you end up having an elevated triglycerides and low HDL cholesterol (the good cholesterol).
People with abdominal obesity usually have low HDL cholesterol (good cholesterol), below 55mg/dl in females and less than 45 mg/dl in males, and a high triglycerides level (above 150 mg/dl).
Elevated triglycerides and low HDL cholesterol lead to narrowing of the blood vessels. Narrowed blood vessels puts you at high risk for heart attack, stroke, dementia , and amputation of legs due to peripheral vascular disease.
In addition, these free fatty acids accumulate in the liver and give rise to Fatty liver.(6)
Another action of insulin is to keep blood glucose in the normal range all the time. People with abdominal obesity develop resistance to this action of insulin. Consequently, the body produces large amounts of insulin in order to keep blood glucose in the normal range.
After a number of years, the body is unable to keep up with the insulin resistance. At this point, your blood glucose starts to rise. Initially, blood sugar gets elevated only after the meals, but your fasting blood glucose stays normal. Later on, your blood glucose gets high even in the fasting state. At this point, you are labeled as having Pre-Diabetes, which eventually leads to Diabetes. in most cases.
A high level of insulin also increase your blood pressure and consequently you may develop hypertension.
2. Abdominal Obesity Increases your Risk of Cancer
Abdominal obesity also increases your risk of dying from any cancer. While exact mechanism is not clearly known, but insulin resistance due to abdominal obesity seems to play a significant role. For example, in a landmark clinical study – Nurses’ Health Study – associations of abdominal fat with all-cause and cause-specific mortality were examined in 44,636 women. During 16 years of follow-up, there were 3507 deaths, including 751 cardiovascular deaths and 1748 cancer deaths. Researchers concluded that abdominal fat was strongly and positively associated with all-cause, cardiovascular, and cancer mortality. (7)
Abdominal obesity can cause following horrendous health consequences:
- Type 2diabetes
- Low HDL cholesterol level
- High Triglycerides level
- High blood pressure
- Heart disease
- Peripheral vascular disease – increase risk of leg amputation
- Fatty liver
What Causes Abdominal Obesity?
1. Eating Habits
Overeating- especially sugar-rich and fat-laden foods – is the main reason for abdominal obesity. However, there are some medical disorders which can increase your weight gain, which are discussed below.
2. Under-active thyroid
Thyroid hormone controls the metabolism of the body. Therefore, if you are low in thyroid hormone, you can easily gain weight and you will have difficulty losing weight.
3. Insulin resistance
Insulin resistance is, in part, genetic in nature. In the presence of insulin resistance you develop high insulin levels in the blood. Excess insulin causes water retention, accelerated growth of the tissues, and an increase in your craving for sugars. All these factors increase your weight. Then, weight gain leads to worsening of insulin resistance. Thus, a vicious cycle sets in: insulin resistance → weight gain → insulin resistance → further weight gain.
Chronic stress causes an increase in cortisol production by the adrenal glands – two tiny structures sitting on top of your kidneys. An increase in cortisol hormone leads to an increase in weight, worsening of insulin resistance, an elevation in blood pressure and blood glucose, and a deterioration of the immune system. All of these consequences of excess cortisol make you frustrated, which leads to more cortisol production and a vicious cycle sets in: stress → excess cortisol → weight gain → elevation in blood pressure, blood sugar, and weakened immune system → more stress → more cortisol and further weight gain.
Instead of getting to the root cause of your stress, you blame everyone else. That’s how you remain trapped in the dungeon of chronic stress. In addition, stress of daily living often causes “comfort eating,” which also adds to your weight.
A number of medications can cause weight gain. Some of these medications are: steroids, birth control pills, some anti-depression medications, some anti-epilepsy medications and some anti-diabetes medications.
Treatment of Abdominal Obesity
Treatment of abdominal obesity is difficult and challenging. The main reason why people have such a hard time losing weight is a psychological one. Most People are not willing to change their eating habits, even though they sincerely want to lose weight. Therefore, they seek out escapes, alternatives and short term quick fixes, all of which sooner or later fail.
At the Jamila Diabetes and Endocrine Medical Center, I have helped thousands of obese people. An overview of my approach to the management of obesity includes:
- Medical evaluation, which includes proper evaluation of thyroid function, high blood pressure, waist-circumference, HDL cholesterol, triglycerides, and hemoglobin A1C.
- An in-depth review of the current drugs and stopping unnecessary medications.
- Proper treatment of under-active thyroid, if this is the case.
- Proper counseling about the Metabolic Syndrome.
- Psychological evaluation, which includes a person’s eating habits, stress of daily living and personal psychological burden.
- Proper counseling on how to change eating habits. Guidance about what foods to eat and what foods to avoid.
- Exercise choices, according to age and life-style.
- Proper vitamin supplementation.
- Consider lap band and bariatric surgery of the stomach as a last resort.
To learn more about abdominal obesity, its consequences and treatment, please refer to “How to Reverse Your Type 2 Diabetes Scientifically”
If you are serious about getting rid of your stress, please read ” Stress Cure Now”
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