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Belly Fat
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This is quite long and I'm sorry about that.
Nellie

Belly fat in women: How to keep it off
Belly fat hasn't always been your problem — you've worried more about hips and thighs. Now your midsection's making up for lost time. What's up?
By Mayo Clinic staff

Whether it's because of heredity, hormonal changes or aging-related weight gain, many women notice an increase in belly fat as they grow older — and especially after menopause. Gaining fat in your abdomen is particularly unhealthy when compared with other locations in your body. Excess belly fat increases your risk of cardiovascular disease, diabetes and certain types of cancers. The good news is that a few lifestyle changes and some targeted abdominal exercises can help you battle your belly bulge.

When fat gathers in your abdomen
CLICK TO ENLARGE Belly fat
As you age and your metabolism slows down, the amount of fat in your body slowly increases. Women experience an even greater fat percentage increase than men do. Then after menopause, your body fat distribution tends to shift — less in your arms, legs and hips, and more in your abdomen.

You may think belly fat is limited to the stuff out front that you can grab with your hand — but it's the fat you can't see that's really a cause for concern. Visceral fat lies deeper inside the abdomen, surrounding the abdominal organs. Gaining this type of fat has been linked to cardiovascular disease, diabetes and other health problems. Subcutaneous fat, located between the skin and the abdominal wall, is more visible but also less likely to be a health risk.

While a slowing metabolism and decreased physical activity contribute to overall weight gain as you age, those factors don't influence visceral fat accumulation directly. Heredity may be the culprit — you may simply have inherited a tendency to gain weight in your midsection. Hormones also play a role. Hormonal changes after menopause may change the way that your body breaks down and stores fat, leading to more fat accumulating in your belly.

Some women even experience a widening waist without gaining any weight. Although you may not be gaining extra fat, your abdominal fat is increasing as limb and hip fat decreases. Even in women of a normal weight, too much fat concentrated in the midsection is unhealthy.

The midsection matters
Gaining weight in your abdomen does more harm than simply making your waistband too tight. While putting on weight in general can have negative effects on your health, abdominal weight gain is particularly unhealthy. Too much belly fat increases your risk of:

Heart disease
Breast cancer
Diabetes
Metabolic syndrome
Gallbladder problems
High blood pressure
Colorectal cancer
Researchers also have found that abdominal fat cells aren't just dormant energy waiting to be burned up. The cells are active, producing hormones and other substances that can affect your health. For example, some fat-cell-produced hormones can promote insulin resistance, a precursor to type 2 diabetes; others can produce estrogen after menopause, which may increase your breast cancer risk. Researchers are still sorting out how the excess hormones affect overall health, but they do know that too much visceral fat can disrupt the body's normal hormonal balance.

Measuring your middle
You know you've gained some inches around your torso, but how can you know whether it's an unhealthy amount? You can calculate your body mass index (BMI) or waist-hip ratio, but researchers have found that simply measuring your waist can tell you whether you have an unhealthy amount of belly fat. In fact, BMI may not be an accurate measure of body fat percentage or fat distribution, particularly after menopause.

To measure your waist, run a tape measure around your midsection at about the level of your navel. Breathe normally, don't hold your tummy in, and don't pull the tape so tight that it presses your skin down. In a woman of healthy weight, a waist measurement of 35 inches or more indicates an unhealthy concentration of abdominal fat. Some research has shown that a measurement of 33 inches or more, no matter what your weight, increases your health risks.

Fight back the bulge
CLICK TO ENLARGE Belly fat exercises
Since visceral fat is buried deep in your abdomen, it may seem like a difficult target for spot reduction. As it turns out, visceral fat responds well to a regular exercise routine and a healthy diet. Targeted tummy exercises can help to firm the abdominal muscles and flatten the belly.

Exercise. Daily, moderate-intensity exercise is the best way to lose belly fat — when you lose weight and tone your muscles, your belly fat begins shrinking, too. In fact, you may notice that your tummy bulge is the first area to shrink when you start exercising. The amount and type of exercise you should get varies depending on your current activity level and your health goals. Talk to your doctor about the right exercise program to promote good health and specifically combat abdominal fat.

Strength training. Some research has shown that exercising with weights is effective in trimming tummy fat. Talk to your doctor about how to incorporate strength training in your exercise routine.

Healthy diet. Changing unhealthy eating habits can help fight belly fat. Read nutrition labels, and replace saturated fats with polyunsaturated fats. Increase portions of complex carbohydrates such as fruits and vegetables, and reduce simple carbohydrates like white bread and refined pasta. If you need to lose weight, reduce your portion sizes and daily calorie intake.

Tone your tummy. While you can't "spot-burn" belly fat, you can firm up your abdominal muscles and get a flatter belly. Traditional sit-ups aren't the most effective way to firm your tummy, however. Instead, use these exercises to target both deeper and lower abdominal muscles:

Deeper abdominal muscles. Target deeper abdominal muscles by doing "abdominal hollowing" or "drawing in the bellybutton." First, get down on all fours. Let your tummy hang down as you take a deep breath. Let your breath out, and at the end of your exhalation, gently draw your bellybutton inward and upward toward your spine. You should feel a slight tightening around your waist — think of it as trying to squeeze through a partially closed door. Hold for 10 seconds, then rest for 10 seconds. Work up to 10 repetitions. During each effort, your spine position shouldn't change and you should breathe freely. Eventually, you'll be able to do this exercise standing up. It's so subtle, no one should be able to tell you're doing it.
Lower abdominal muscles. Tone your lower abdomen by doing pelvic tilts and pelvic lifts. To do a pelvic tilt, lie on your back on the floor with your knees bent. Flatten your back against the floor by tightening your abdominal muscles and bending your pelvis up slightly. Hold for five to 10 seconds. Repeat five times and work up to 10 to 20 repetitions.

For pelvic lifts, lie on your back with your knees bent up toward your chest and your arms relaxed by your sides. Tighten your lower abdomen and lift your buttocks up off the floor, with your knees aimed toward the ceiling. Hold for five to 10 seconds. Repeat five times and work up to 10 to 20 repetitions.

Hormone therapy. Although there are good reasons for some women to try hormone replacement therapy (HRT) after menopause, fending off belly fat isn't one of them. It's true that some studies have demonstrated that postmenopausal women who take HRT are less likely to accumulate abdominal fat than are postmenopausal women who forgo HRT. Other studies, however, found no difference. Meanwhile, questions about the risks and benefits of HRT persist. Talk to your doctor in detail about the risks and potential benefits of hormone therapy before trying it.

References
Abdominal fat and what to do about it. Harvard Women's Health Watch. 2006;14:1.
Kontogianni MD, et al. Does body mass index reflect adequately the body fat content in perimenopausal women? Maturitas. 2005;51:307.
Ferrara CM, et al. Differences in adipose tissue metabolism between postmenopausal and perimenopausal women. Journal of Clinical Endocrinology & Metabolism. 2002;87:4166.
Eliassen AH, et al. Adult weight change and risk of postmenopausal breast cancer. Journal of the American Medical Association. 2006;296:193.
Gozansky WS, et al. Mitigating the menopausal middle. Obesity Management. 2007;3:267.
Dubnov-Raz G, et al. Diet and lifestyle in managing postmenopausal obesity. Climateric. 2007;10(suppl):38.
Teixeira PJ, et al. Resistance training in postmenopausal women with and without hormone therapy. Medicine & Science in Sports & Exercise. 2003;35:555.
Green JS, et al. The effects of exercise training on abdominal visceral fat, body composition, and indicators of the metabolic syndrome in postmenopausal women with and without estrogen replacement therapy: The HERITAGE family study. Metabolism. 2004;53:1192.
Chen Z, et al. Postmenopausal hormone therapy and body composition — A substudy of the estrogen plus progestin trial of the Women's Health Initiative. American Journal of Clinical Nutrition. 2005;82:651.

See Also
Video: Ovulation

Menstrual cup: What is it?

Hot flashes: Minimize discomfort during menopause

Water retention before your period: How to stop the swelling

Fitness tips for menopause: Why physical activity matters

Delaying your period through oral contraceptives

Weight gain after menopause

Diabetes and menopause: A twin challenge

Headaches and hormones: What's the connection?

Menstrual cramps

Menorrhagia (heavy menstrual bleeding)

Menopause

Premenstrual syndrome (PMS)

Perimenopause

Testosterone therapy in women: Does it boost sex drive?

WO00128
April 16, 2009

© 1998-2009 Mayo Foundation for Medical Education and Research (MFMER). All rights
Posted on 04/21/09, 06:05 pm
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