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While excess belly fat may allow for a more impressive splash when flopping into the pool, it also packs some not so stellar abilities, like leading to higher cholesterol levels and increased risks for cardiovascular disease. What’s more, belly fat—also known as visceral fat, abdominal fat, or central adiposity—can lead to type 2 diabetes, a disease that causes blood sugar levels to rise dangerously high.

The good news? Some types of midsection weight are less worrisome than others.

Tubby Tummies—Why It Matters

So why aren’t jelly bellies and thunder thighs equally bad? Of course, excess fat anywhere on the body can contribute to cardiovascular disease and diabetes, but not all fat is created equal: Geography matters Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Fox, C., Massaro, J., Hoffman, U., et al. National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Mass, USA. Circulation,  2007 Jul 3;116(1):39-48.. Abdominal fat is stored in two different ways. First, there is subcutaneous fat (the pinchable stuff!), which sits between the skin and the abdominal wall. This fat is more of a holding tank for extra calories, and is less of a health threat since it does not directly surround organs and the blood vessels that keep them healthy Beneficial effects of subcutaneous fat transplantation on metabolism. Tran, T., Yamamoto, Y., Gesta, S. et al. Joslin Diabetes Center and Harvard Medical School, Boston, MA. Cell Metabolism, 2008 May;7(5):410-20.. Visceral fat, however, sits deeper in the stomach and blankets the abdominal organs Metabolic obesity: the paradox between visceral and subcutaneous fat. Hamdy, O., Porramatikul, S., Al-Ozairi, E. Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA. Current Diabetes Review, 2006 Nov;2(4):367-73..

Now, everyone has some amount of visceral fat, but concerns surface when this inner fat exceeds normal levels. In some cases, the fat can invade the organs themselves (a common occurrence in the liver) Obesity, Visceral Fat, and NAFLD: Querying the Role of Adipokines in the Progression of Nonalcoholic Fatty Liver Disease. Mirza, M. SpR Surgery, Ninewells Hospital, Dundee, UK. ISRN Gastroenterology, 2011;2011:592404.. The organ-swaddling visceral fat negatively affects organ function and integrity by increasing inflammation, clogging blood supplies (which prevents nutrient and oxygen delivery to organs), and eventually causing insulin resistance.

Insulin resistance, a pre-cursor to diabetes, is a condition by which the body’s muscle, fat, and liver no longer respond properly to circulating insulin supplies Brown fat lipoatrophy and increased visceral adiposity through a concerted adipocytokines overexpression induces vascular insulin resistance and dysfunction. Gomez-Hernandez, A., Otero, Y., de las Heras, N., et al. Biochemistry and Molecular Biology Department, School of Pharmacy, Complutense University of Madrid, Madrid, Spain. Endocrinology, 2012 Mar;153(3):1242-55.. This means that insulin—a hormone made in the pancreas that tells glucose to enter the body’s cells to fulfill their energy needs—can’t do its job. The result? The body’s cells starve while the excess glucose accumulates in the blood, ultimately damaging organs and vessels throughout the body. What’s more, visceral fat cells also produce hormones that regulate weight and appetite, sometimes leading to further weight gain or increased feelings of hunger Adipose tissue as an endocrine organ. Galic, S., Oakhill, J., and Steinberg, G. St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia. Molecular and Cellular Endocrinology, 2010 Mar 25;316(2):129-39..

Getting Waisted—The Answer/Debate

The Best Way to Burn Belly Fat and Get Healthy

They say America is a melting pot, but let’s think of it as a fruit basket. Different body shapes are associated with each gender and type of fat A weight shape index for assessing risk of disease in 44,820 women. Rimm, A., Hartz, A., and Fischer, M. Department of Medicine, Medical College of Wisconsin, Milwaukee. Journal of Clinical Epidemiology, 1988;41(5):459-65.. Pear-shaped women have more padding around the butt and thighs (hence, apple bottom jeans—not be confused with apple shape!). These areas harbor mostly subcutaneous fat. Apple-shaped men and women, or those with fat around the middle, have more visceral fat (the dangerous kind). Banana-shaped are relatively thin throughout, or have a more equal distribution of fat. And we can’t forget beer bellies! Beer guzzlers beware—tummies full of Budweiser also count as dangerous visceral fat The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort. Bergmann, M., Schutze, M., Steffen, A., et al. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany. European Journal of Clinical Nutrition, 2011 Oct;65(10):1079-87. Relationship of abdominal obesity with alcohol consumption at population scale. Scroder, H., Morales-Molina, J., Bermejo, S., et al. Lipids and Cardiovascular Epidemiology Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. European Journal of Nutrition, 2007 Oct;46(7):369-76..

While calculating body mass index (BMI) is a helpful tool to assess the overall health of an individual’s weight, determining a waist-to-hip ratio with a measuring tape is a better method to pinpoint belly fat Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk--a review of the literature. Huxley, R., Mendis, S., Zhelezyakov, E., et al. Renal and Metabolic Division, The George Institute for International Health, The University of Sydney, Sydney, Australia. European Journal of Clinical Nutrition, 2010 Jan;64(1):16-22.. Calculate waist-to-hip ratio by dividing the waist’s circumference at its narrowest point (use the belly button as a guide) by the hips’ circumference at their widest points (near the top of the bony protrusions). Ratios of 0.8 and below are healthy, and those above 0.8 suggest an increased risk for heart disease and diabetes. Some studies have found waist circumference to be a better determinant and to better express the amount of belly fat present Waist circumference in children and adolescents correlate with metabolic syndrome and fat deposits in young adults. Spolidoro, JV, Pitrez Filho, ML, Vargas LT, et al. Medical School of the Pontifficia Universidade Catolica do RS, Moinhos de Vento Hospital, Porto Alegre, Brazil. Clinical Nutrition, 2012 Jul 28.. Measure waist circumference at the spot right above the hip bones right afer breathing out. Risk for developing obesity-related health problems (like cardiovascular disease) increases in women with waists larger than 35 inches and in men with a circumference larger than 40 inches.

Ready to battle the bulge? Thankfully visceral fat typically surrenders to diet and exercise. Trim the fat with the four pillars of a healthy middle: exercise, diet, sleep, and stress management. While core exercises such as the plank and crunches will firm up abs, they won't blast the belly fat that lies underneath. Instead, try moderate or vigorous intensity aerobic activity—recent research suggests that sprinting is the best way to lose the love handles A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat. Ismail, I., Keating, S., Baker, M., et al. Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia. Obesity Reviews, 2012 Jan;13(1):68-91. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Slentz, C., Bateman, L., Willis, L., et al. Div. of Cardiology, Dept. of Medicine, Duke Univ. Medical Center, Durham, NC, USA. American Journal of Physiology: Endocrinology and Metabolism, 2011 Nov;301(5):E1033-9. The effect of high-intensity intermittent exercise on body composition of overweight young males. Heydari, M., Freund, J., Boutcher, S.H. School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia. Journal of Obesity, 2012;2012:480467.. Complement aerobics with diets low in saturated fat, cholesterol, and carbohydrates (beer lovers, beware), and consider protein-rich meals and low-fat snacks Relationship between bread consumption, body weight, and abdominal fat distribution: evidence from epidemiological studies. Bautista-Castano, I. and Serra-Marjem, L. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. Nutrition Reviews, 2012 Apr;70(4):218-33.. And don’t forget to manage life stressors and catch plenty of zzzs—increased cortisol levels (the stress hormone) and lack of sleep are both tied to abdominal weight gain Stress-induced cortisol response and fat distribution in women. Moyer, A., Rodin, J., Grilo, C., et al. Department of Psychology, Yale University, New Haven, CT, USA. Obesity Research, 1994 May;2(3):255-62. Obesity and metabolic syndrome: Association with chronodisruption, sleep deprivation, and melatonin suppression. Reiter, R., Tan, D., Korkmaz, A., et al. Department of Cellular and Structural Biology, UT Health Science Center , San Antonio, Texas USA. Annals of Medicine, 2011 Jun 13..

The Takeaway

Belly (aka visceral) fat can be more harmful than other types in terms of leading to bigger health issues. The good news? It also surrenders more easily to improved fitness and diet than other types!

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