The human body is made up of muscle, bone, water and fat. Fat can be located subcutaneously, i.e. under the skin – a disposition specific to women, in the circulation, in the form of cholesterol, cholesterol fractions and triglycerides – specific to both sexes, but predominantly male, and viscerally, i.e. on the internal organs – specific to men and menopausal women. A person may also have subcutaneous fat in various parts of the body.
Why do women and men gain weight differently?
Abdominal fat in normal-weight people
Why is it so hard to get rid of belly fat?
What is central obesity?
Central obesity is excess fat (adipose tissue) in the abdominal area and predisposes to cardiovascular and metabolic diseases such as high blood pressure and diabetes.
The problem of central obesity is not new, more than 60 years ago, the French doctor Jean Vague noted that patients with fat accumulation in the abdominal area had a higher risk of premature cardiovascular disease and death than patients with a normal waistline. The term central (abdominal) obesity was popularized in the late 1980s, introduced by Professor Gerald Reaven, who studied the link between central obesity, hyperlipidemia (excess fat in the blood in the form of cholesterol and triglycerides) and insulin resistance.
Over the years, the scientific community has agreed on the negative health effects of abdominal fat.
Regarding the health risks of central obesity – first of all, obesity is a disease with major physical, emotional and social effects, and central/abdominal obesity predisposes to cardiovascular diseases such as heart attack and stroke. Currently, cardiovascular disease is the leading cause of mortality in Romania and worldwide.
For this reason, the approach to the patient with central/abdominal obesity is a medical one, through nutritional intervention, multidisciplinary management of complications and medical nutritional therapy, not just weight loss.
Why do women and men gain weight differently?
According to the World Health Organization report on regional obesity (2022), fat accumulation in the waist area is more common in women. So do women and men tend to get fat differently?
The main female hormone is estrogen, which also determines female secondary sexual characteristics. The female body composition contains more fat than the male body. Estrogen produces and maintains fat, and fat produces small amounts of estrogen. Women also experience weight variations during their lives, both physiological, hormonally dependent – PMS, pregnancy or menopause, and pathological – obesity and associated pathologies such as gonarthrosis, coxarthrosis, osteoporosis, etc.
The female-specific fat distribution in the lower abdomen and thighs ‘protects’ against cardiovascular disease. The central or truncal (torso) fat distribution predisposes both sexes to cardiovascular disease.
The main male hormone is testosterone, and it promotes the development of muscle mass. Also, it is the male sex that is prone to cardiovascular disease, as testosterone is responsible for the ‘stiffness’ of blood vessels. When you add a metabolic pathology such as diabetes, gout, dyslipidemia, fatty liver, and/or obesity, the risk of experiencing cardiovascular disease is real.
Abdominal fat in normal-weight people
Many people are confused by situations where the number of pounds displayed on the scale does not indicate an obesity problem, but they have excess fat in the abdominal area that they consider unsightly, without even thinking that there might be a health problem at stake.
In these cases, in addition to body mass index (BMI), abdominal circumference is a criterion for assessing the degree of obesity.
In the modern approach to the obese patient, it is no longer sufficient to interpret the kg/hip ratio squared, and abdominal circumference provides additional information to the specialist about the degree and type of obesity. Also, in the nutritional medical therapeutic approach, the Body Fat Index matters.
When the number of kilograms is apparently optimal, but the disposition of excess fat is abdominal, we discuss the “spider” or “batrachian abdomen” appearance. That’s why in the personalized approach of the #MetodaDrBalanica we don’t only talk about kilos, but predominantly about the muscle/bone/fat/fat ratio and lifestyle change.
BMI Calculator
The Body Mass Index (BMI) is interpreted as follows:
- BMI 18.49 or less – Underweight
- BMI between 18.50 and 24.99 – Normal weight
- BMI between 25.00 and 29.99 – Overweight
- BMI between 30.00 and 34.99 – Obesity Grade I
- BMI between 35,00 and 39,99 – Obesity grade II
- BMI 40.00 or more – Obesity grade III (morbid)
Central obesity values
The assessment of central obesity is a check-up test that anyone can do. The only instrument needed is a centimeter to measure your waist and hips. If the values obtained put you in the risk category, we recommend a specialist consultation with your doctor and routine tests including a lipid profile.
The lipid profile is a standard set of measurements of lipid (fat) levels in the blood:
- HDL cholesterol
- LDL cholesterol
- Total cholesterol
- Triglycerides
It is also important to note that recommendations for normal and risk values for waist circumference may vary according to population groups – Caucasians, African-Americans, etc. Thus, the values considered normal for the Caucasian population are:
- Abdominal circumference below 80 cm for women
- Abdominal circumference under 94 cm for men.
Regarding the waist/hip ratio, the figures are as follows:
- Females < 0.85
- Men < 0.9
To get the waist/hip ratio result, measure the abdominal and hip circumference, then divide the abdominal circumference by the hip circumference.
Why is it so hard to get rid of belly fat?
In general, weight loss is a stress on the body, and the brain “resists” weight loss, thinking it is protecting us! That’s why weight loss is best done under medical supervision.
It is a long-term process and not a one-off event. The most difficult to reduce is visceral fat, i.e. fat deposited on the internal organs, but the most visible fat distribution is abdominal/central fat.
One of the reasons why abdominal fat is harder to eliminate is also due to the fact that the abdominal muscles are not constantly used in daily activities, compared to the muscles of the legs, hands, etc.
The approach to weight loss, when there is excess fat, must be a medical one, studies have shown that no diet or regimen in the world is healthy and does not work in the long term. The results show that the option that works for obesity is medical nutritional therapy.
Learn more:
- Treatment of cellulite: Part I. Pathophysiology, Misbah H. Khan, Frank Victor, Babar Rao, Neil S. Sadick, Science Direct – https://www.sciencedirect.com/science/article/abs/pii/S0190962209014492
- Treatment of cellulite: Part II. Advances and controversies, Misbah H. Khan, Frank Victor, Babar Rao, Neil S. Sadick, Science Direct – https://www.sciencedirect.com/science/article/abs/pii/S0190962209014480
