Centre spread

Abdominal obesity is being linked with more and more diseases – but it’s not an inevitable part of middle age, says Karen Williamson. Here’s why you should take tummy fat seriously, and what to do about it

So your tummy’s larger than it used to be, and your dress size has slowly crept up – but your clothes can hide the bulge, so what have you got to worry about? Quite a lot, say medical experts. ‘Some 20 per cent of adults have an increased risk of serious health problems like heart disease, type 2 diabetes and cancer due to abdominal obesity,’ says Dr Ian Campbell of Weight Concern. Worryingly, more women are suffering from abdominal obesity than ever before, so we could be sitting on a health time bomb. ‘Traditionally, men were more at risk of these diseases – but changing body shapes are now putting women at risk,’ he says. ‘Men and women tend to store fat in different ways – men around the middle, a classic apple shape, which leads to serious health problems, and women on the thighs and hips, a pear shape, which is less of a health risk.’ But as more women put on weight around their middle many older women will be at risk of illnesses associated with men.

Good vs bad fat
And it’s not the inches you can pinch that are the problem – the scary fat is the abdominal or visceral fat which wraps around the internal organs. Visceral fat reduces the body’s ability to handle insulin and this is what leads to heart disease, high cholesterol, high blood pressure, stroke and type 2 diabetes. ‘As you become obese, fat cells increasingly produce inflammatory proteins,’ says Dr Campbell. ‘These proteins, in a way we don’t yet know, cause the body to become resistant to the effects of insulin. As a result, more fat is taken into the walls of the blood vessels leading to narrowed arteries, reduced blood flow and heart disease.’
Links have been made with breast and colorectal cancer, too, but the reasons aren’t fully understood. ‘We do know, though, that one third of cancers are clearly linked to exercise and diet,’ says Dr Campbell. Other research, published in Neurology, found that people with the most abdominal fat in their 40s were nearly four times more likely to develop dementia than those with the least belly fat.
Cruelly, at a time when belly fat is getting seriously bad for our health, our bodies seem to be trying their hardest to hang on to it. For a start, our metabolic rate decreases as we age so we need fewer calories just to stay the same weight. And after the age of 40, women lose about half a pound of muscle a year. The more muscle we have the more calories we burn at rest, so once we start to lose muscle, we burn fewer calories.
Odd as it may sound, our bodies may not actually want to lose weight. ‘There’s a theory that we have a set point where weight stabilises – when we’re young, we don’t think about it and are naturally regulated by our appetites,’ says Dr Campbell. But as we get older, stressful life events such as divorce mean we eat more and put on weight. Over time our bodies get used to being bigger so our body then fights to be this new heavier weight. ‘The set point has been reset and it’s harder to lose weight,’ says Dr Campbell.
According to Dr Marilyn Glenville, author of Fat Around the Middle (Kyle Cathie, £9.99), the stress of children leaving home or divorce can also have a hormonal effect. During stress, the body releases cortisol – called the fight or flight response – which in the past would have helped us flee from danger. ‘This cortisol tends to trigger cravings for fatty, sugary foods because the body thinks you should refuel after all this fighting or fleeing,’ says Dr Glenville.
But if you don’t use this energy, your body deposits the fat and glucose as fat – around the middle of your body. ‘This is because it’s closer to the liver where it can most quickly be converted back to energy if needed,’ she says.
During the menopause, many women find their body shape changes and gets bigger around the waist. ‘This can be due to genetics, but it can also be because of the drop in oestrogen levels,’ says Dr Glenville.

Take action
Measure your waist
If you think you may need to tackle your belly bulge, work out your hip to waist ratio – the test currently favoured by experts – by dividing your waist figure in cm or inches by your hip figure. If the result is greater than 0.8 you need to take action. For men, the figure is 0.95. ‘A simple waist measurement is often enough to detect a problem,’ says Dr Campbell. ‘Women with a waist size over 35 inches have the same level of risk of type 2 diabetes and heart disease as clinically obese people.’
Although it can be harder to shift this weight as you get older the good news is that, when we start to lose weight, it’s the unhealthy visceral fat that we lose first.

Set goals
‘The best way to lose weight is to have a good reason to lose it – a long-term goal like having enough energy for your grandchildren rather than just a short-term one like losing half a stone for a wedding,’ says Dr Campbell.

Eat well
Avoid very low calorie diets – they will slow down your metabolism to hold on to your fat stores, says Dr Glenville. And don’t cut out fat either – you need a certain amount of fat, particularly good fats found in olive oil and oily fish, to remain healthy. ‘Don’t diet at the expense of getting the nutrients you need – calcium, iron and vitamin D, for instance,’ says Claire Williamson of the British Nutrition Foundation. ‘As we get older the absorption of vitamins is affected, so it’s even more important to get these from your diet.’ Dr Glenville suggests eating little and often to keep blood sugar levels stable and prevent the roller coaster highs and cravings for sweet foods.

Deal with stress
By cutting down on stress, you’ll help reduce the cortisol levels that encourage your body to store fat around the middle, says Dr Grenville. ‘Try supplements – in particular vitamin C, magnesium, zinc and the B vitamins, which tackle the deficiencies stress may have caused,’ she says. ‘They’ll help your body cope with future stress, too.’ She also suggests giving yourself a stress MOT – look at work and home life and learn a few coping strategies such as prioritising, exercising regularly and putting yourself first. Research from the Fred Hutchinson Cancer Research Centre found that yoga – great for stress as well as toning – helps prevent middle age spread and aids weight loss in 45-55 year olds.

Be active
A study from Johns Hopkins University, in the US, found that older people who take even moderate exercise dramatically lower their risk of heart disease and diabetes specifically by lowering their abdominal fat. Start by walking for at least half an hour a day, five to seven times a week. Initially, this can be broken down to three blocks of 10 minutes. To increase your stamina, you can introduce interval training where you alternate between two paces – for instance two minutes fast walking, followed by two minutes slow.
See a GP or trainer for a weightlifting programme – building muscle means you use more energy, even at rest. Perform a daily tummy toner to attack those deeper muscles. Get down on all fours and draw in your bellybutton up towards your spine, hold for 10 seconds, then relax for 10 seconds. Repeat this 15 times every morning.