Why should I lose belly fat?
I got a lot of responses to my newsletter from last month when I talked about my own menopausal journey and how my metabolism is changing and how I’m experimenting with some different things. I talked a lot about belly fat and “getting a gut”.
I don’t talk about weight loss very often for a reason. It’s not the focus of my practice and frankly, it’s a bit of a loaded topic for me. But MANY people who come to see me have weight loss as one of their goals.
So let’s talk about this focus on belly fat for a minute. First of all, the actual phrase is one I chose because it’s colloquial. It’s familiar. But it might not be clear. So let’s zoom in on fat today, belly fat specifically. What I’m really talking about is visceral adipose tissue or VAT. But let’s back up and define some terms.
What are the types of fat?
Essential fat: This is just like it sounds. It’s essential for the proper function of things. You know your brain? Mostly fat. All of your cell membranes? Also fat. Good stuff. Gotta have it.
Subcutaneous fat (the kind right under the skin): We store fat here for later use. A certain amount of it is healthy. Too much is not as healthy.
Visceral adipose tissue (VAT): This is what I mean by “belly fat”. It’s the fat deep in the abdominal cavity sitting around the organs like the liver. It’s that hard “beer belly”. High levels of fat stored here are associated with a higher risk of metabolic diseases and higher inflammation.
Research has shown that VAT accumulation is associated with an increased risk of metabolic diseases such as type 2 diabetes, fatty liver, heart disease, stroke, and cancer.
Why is only my stomach fat?
This is an “apple shape”. When we see someone who is slim everywhere else, but their abdominal area, VAT is likely the cause and the reason is likely insulin resistance.
An “apple shape” is more at risk for metabolic disorders like diabetes.
This is why a person’s waist circumference (WC) is used to determine a person’s risk for diabetes and those other metabolic diseases. It’s not a sure thing, as I’ll elaborate on. As a nutrition professional, I find it to be one of the more useful metrics to track when a person is implementing dietary strategies. More so than the number on the scale. (More on this further down.)
So I use VAT (aka belly fat) as a simple marker for metabolic health. For myself, it’s not an area where I have tended to store fat (signifying good metabolic health) but that has changed in recent years. I know that as we age we tend to become less insulin-sensitive and menopause can change that as well. My recent accumulations (in addition to menopause) indicated my declining metabolic health and a need to change my method of eating and exercising to respect my body’s changing needs.
Research has shown that VAT accumulation is associated with an increased risk of metabolic diseases such as type 2 diabetes, fatty liver, heart disease, stroke, and cancer.
What is “skinny fat”?
Skinny fat is another (somewhat crass) phrase from the past that we use to describe someone who appears slim, but their body composition is skewed towards a higher fat percentage AND they have poor metabolic health. They tend to be low in muscle.
I bring this up because people who have “skinny fat” can fly under the radar and not get the health care they need. This is because a “skinny fat” person will have a low BMI, but be at higher risk for metabolic disease. For these folks particularly, testing with a DEXA scan can be very helpful.
What is BMI?
BMI stands for body mass index, which is a factor of weight divided by height ( BMI = kg/m2). BMI is helpful for looking at population studies, but much less helpful for individuals. For example, a very athletic person with lots of muscle mass could register as obese using the BMI because all those muscles are HEAVY. It’s simply not a good tool for the individual assessing their disease risk. Another problem with it is the whole “skinny fat” problem. Someone who is “skinny fat” will have a low BMI because their weight is “normal”. Neither the individual nor their provider would think to screen them for diabetes or heart disease risk. But look below the surface and you might find an excess of VAT, low muscle mass, elevated blood sugar and insulin levels, and high triglycerides. In other words… prediabetes.
People of certain racial/ethnic backgrounds have different tendencies here. This feels important to highlight because most of our charts tend to be very white/European-centric. From the literature I reviewed, African-American people had LESS VAT at a similar BMI/WC compared to white/Europeans. People of white/European backgrounds had LESS VAT at similar BMI/WC than people of Asian descent. This is particularly true for those of South Asian descent. This means that people of Asian descent (especially South Asian) should get screened for diabetes EARLIER and at a lower BMI and WC than others.
Excess VAT can be a sign of metabolic syndrome. Like any other syndrome, it’s really a collection of symptoms connected by a common cause. In this case, dysregulated blood sugar and insulin resistance. You can learn more about metabolic syndrome in this article and download an ebook on the topic below.
Not sure if you have prediabetes or metabolic syndrome?
It’s important to find out because it can help you know how to prevent chronic disease NOW. This link gets you a free e-book describing it and helps you talk to your doctor about it.
A DEXA scan is a reliable way to test your body composition and may offices and gyms are offering it for around $100.
How do I check my body fat percentage?
First… test, don’t guess. There are a variety of ways to assess your own body composition and metabolic health. They vary in cost and accuracy. I do think it’s a good idea to see where you are at and the trajectory you’re on. Chronic health conditions can really creep up on you when you are busy working or parenting or both. Most of us wake up in our 50’s and wonder how we got so old and sick. It’s really never too late to take stock and turn the ship around.
The scale: This tells us the total weight of our body. It includes bones, water, fat, muscle, etc. You might remember that muscle is more dense than fat. When we are focused on building muscle, we are going to be adding pounds. When we are inactive or poorly nourished, we lose muscle and also pounds. So the scale isn’t always a helpful tool. It’s a blunt instrument, but it’s a start and most of us have one.
Waist circumference (WC): I like this metric when we use it to monitor CHANGE. The actual distance around your belly will still be impacted by other factors like muscle and how bloated you might be. So I don’t like to compare one person to another. And remember how racial/ethnic factors can play a role? But for a single individual over time, it is an effective way of measuring improvements in body composition. Generally, when we increase muscle, lose fat, and improve our insulin sensitivity, our WC goes down even when the number on the scale does not. This can be informative and helpful to confirm our strategy is effective (ie, keep doing what you’re doing!)
DEXA scan: This can give a more precise picture of total body composition. Both in terms of total fat and lean mass and their LOCATIONS!! It can tell you your total VAT, body fat %, lean mass, and can break down each area in your body. A DEXA can be had for around $100 and will also give you a reading on your bone density. Underwater weighing used to be the gold standard for determining body composition, but DEXA has an advantage over it.
Labs: Other metrics of metabolic health include labs. Fasting blood glucose, HA1c, fasting insulin, and glucose tolerance tests can help us look at the health of our glucose metabolism.
Lipid panels and liver enzyme tests can also help us check our metabolic health. Liver enzymes like ALT and AST will start to rise when fatty liver is becoming really problematic. Cholesterol and triglyceride levels will also start to rise when metabolic health is compromised.
Continuous glucose monitor (CGM): The short-term use of a continuous glucose monitor is also a very useful tool, as we can get a fuller picture of our glucose metabolism over time in response to a variety of factors. Unlike the snapshot you get when fasting in the morning, this type of monitor looks at your glucose levels throughout the day and night. I mention this because VAT tends to increase in response to insulin resistance which is very much influenced by blood sugar control.
Stop guessing and learn exactly how your food affects your blood sugar.
We like to combine the use of a continuous glucose monitor (CGM) with education because it provides us with 24/7, real-time data telling us exactly how our food, exercise, stress and sleep impact our blood sugar levels. No more guessing. It’s a tool that helps us quickly personalize a strategy and get fast results.
By adding strength training and adequate protein to your diet, muscle loss can be prevented or reversed.
So when we bring this back around to our health goals, I hope you remember a few things…
Regardless of your goals, body composition is important to take into account because it impacts your disease risks.
Anytime you are embarking on a diet or exercise program, find a way to confirm that you are not losing lean body mass either by waist circumference or DEXA a few months in, and not just going by the number on the scale.
Do get screened for prediabetes even if your BMI doesn’t indicate it. Remember, BMI might not be a good indicator for you.