Introduction
Obesity has medical and social impacts on individuals and many diseases prevail in the face of general obesity. Diabetes, hypertension, cancer and other diseases are more prone to occur in obese persons than non-obese persons. Social stigmas such as body shaming occur for obese individuals. Unlike general obesity, central obesity can occur in non-obese person and obese persons but the impending pathology for central obesity is much more insidious and more damaging.
Central obesity
Central obesity, also known as abdominal obesity, is different from general obesity because of excessive abdominal fat accumulation around the stomach and abdomen which may occur in both obese and non-obese patients. There is strong correlation between central obesity and cardiovascular disease, Alzheimer’s disease, Type 2 diabetes, metabolic and vascular diseases. This article will discuss the different types of body fat visceral, abdominal in women and men), visceral adiposity, ethnic diversity and related health risks.
Visceral fat
Organ fat or intra-abdominal fat is located inside the peritoneal cavity, packed between internal organs and torso. Subcutaneous fat is found underneath the skin and intramuscular fat and is interspersed in skeletal muscle.
Belly fat in women
Getting older for women, especially after menopause, is associated with the accumulation of belly fat. This is further worsened with getting little exercise and eating too much. As estrogen levels decrease, fat accumulation increase with the altered fat distribution to the abdominal area. Belly fat is composed of both subcutaneous and visceral fat and is linked with the following health problems:
- Heart disease
- Type 2 diabetes
- High blood pressure
- Abnormal cholesterol
- Breathing problems
Furthermore, increased waistline (more than 35 inches/89 centimeters) indicates an unhealthy concentration of belly with greater risk of dying from cardiovascular disease.
How to get rid of belly fat
Doing belly exercises alone is not enough. The program includes:
- Eating a healthy diet
o Plant based foods, fruits, vegetables, whole grains, lean sources protein and low-fat dairy products. Limit added sugar, saturated fat (no cheese or butter). Monosaturated and polyunsaturated fats (fish, nuts and certain vegetable oils) will do. - Replace sugary beverages
o Drink water, artificial sweetener. - Keep each meal portion size in check
o Eat half of your normal portion size in every meal
o At restaurants, share meals - Physical activity
o Moderate aerobic activity at least 150 minutes a week (brisk walking)
o Vigorous aerobic activity for at least 75 minutes a week (jogging)
o 10,000- 15,000 steps per day
o Strength training exercise at least twice a week - To lose excessive fat and maintain weight loss, a slow and steady weight loss of 1-2 pounds a week is recommended
Waist circumference
Research studies which included 650,000 adults demonstrate a link between larger waist circumference and greater risk of premature death of decreasing life expectancy of three years for men and five years for women. The study looked data from 650 000 adults. This effect was independent of other risk factors such as age, body mass index, physical activity, smoking history and alcohol use.
Specific data comparison
How to measure waist circumference
- At the level of hipbone, wrap a measuring tape around your body at this level and parallel to the floor. Do not press into the skin.
- Relax, exhale and read the measurement
Belly fat in men
Regardless of overall weight, high amount of belly fat increases health risk for men and is linked to:
- Premature death from any cause
- Cardiovascular diseases
- Type 2 diabetes
- colorectal cancer
- Sleep apnea
- High blood pressure
Aging and genes play a role in fat accumulation.
As men age, they lose muscle and lack of physical activity causes further muscle loss. As you age, you lose muscle. Men in their 50s need about 200 fewer calories daily (2015-2020 Dietary guidelines for Americans) and without eating less, excess calories are consumed. The intake of any type of alcohol can cause “beer belly” which is increased belly fat. Moderate alcohol intake is two drinks per day (65 years and younger) and one drink per day (over 65 years). A waist measurement of more than 40 inches/102 centimeters indicates unhealthy belly fat accumulation. Detection of visceral adiposity needs complicated and hi-tech investigative techniques. However, it can be obtained by waist circumference, a simple and inexpensive measurement.
Visceral adiposity
Visceral fat cells release metabolic by-products (excessive triglycerides and fatty acids) into the portal circulation which is carried directly to the liver where is it stored, causing lipotoxicity. The prevalence of abdominal obesity is increasing in western populations, possibly due to a combination of low physical activity and high calorie diets and in developing countries, due to urbanization.
Some researchers do not accept waist circumference alone as the central obesity index and some include:
(1) waist hip ratio ( >0.9 for men and > 0.85 for women).
(2) Saggital abdominal diameter
SAD is the distance from the small of the back to the upper abdomen. SAD is measured standing or supine, taking at any point from the narrowest point between the last rib and the iliac crests to the midpoint of the iliac crests.SAD is a strong predictor of coronary disease; higher values indicating increased risk independent of BMI.
(3) Waist circumference divided by their height. A ratio over 0.5 is critical and signifies an increased risk of premature death.
<40: critical value 0.5
40-50: critical value (0.5 to 0.6)
>50: critical value 0.6
Ethnic diversity
The National Cholesterol Education Program Adult Treatment Panel III suggested cut off point of 102 cm (40 in) and 88 cm (35 in) for male and females as a marker of central obesity.
There are suggestions that these cutoffs are not applicable among Indians and the cutoff be lowered to 90 cm (35 in) and 80 cm(31 in) for males and females.
Myanmar Picture
According to National Survey carried out in 2009, 17.7 % in males and 30.25 in females are overweight in Myanmar (Tint-Swe-Latt et el, 2011). The corresponding obesity prevalence was 4.27% and 8.37%.
BMI is used to determine obesity.
BMI=body wt in Kg/ ht in meter2
Obesity itself is to be taken care of. In terms of pathological processes, involved, central obesity is more important. Central obesity may be the causative agent for metabolic syndrome.
Central obesity is related to many things. Involved in this plethora are inflammation, chronic psychosocial stress, hormones, etc.
Central obesity and health risks
Although obesity is hazardous to health, central obesity is thought to be the causative agent for metabolic syndrome.
Central obesity is associated with higher risk of:
heart disease, hypertension, insulin resistance and type 2 Diabetes, Metabolic syndrome, blood lipid disorders, inflammation, insulin resistance, full blown diabetes, lipodystrophies, Cushing’s syndrome, polycystic ovarian syndrome, glucose intolerance, dyslipidemia, insulin sensitivity and increased risk of developing cardiovascular disease.
Diabetes
Central obesity predisposes individuals for insulin resistance because abdominal fat produces adipokines which impair glucose tolerance.
Asthma
Abdominal obesity leads to asthma development. Obese people breathe quickly and often, inhaling small volumes of air. By breathing at low lung volume, the muscles become tighter and airways get narrower. An emergency roof study showed that seven-five percent of patients treated for asthma were either overweight or obese; an emergency room study showed.
Alzheimer’s disease
Evidence now indicates that higher volumes of visceral fat, regardless of overall weight, are associated with small brain volumes and increased risk of dementia. Alzheimer’s disease and abdominal obesity has a strong correlation. There is a 10 fold increase risk of Alzheimer’s disease in abdominal adiposity cases.
Obesity and risk of cancer
Results from epidemiological research studies have shown the increased risk or the following cancers and obesity:
Adenocarcinoma of the esophagus, colon, breast, endometrial, kidney, gall bladder, liver pancreas, prostrate, and hematopoietic. Central, not general obesity seems to be linked with breast cancer in premenopausal women (Harvie et al., 2003; www.ncbi.nlm.nih.gov). No association is seen between obesity and lung cancer.
Ref:
- Kyi Kyi Myint (2018). Serum copeptin level and high sensitivity C reactive protein in centrally obese middle-aged male subjects. M Med Sc (Physiology) Thesis.
- https://en.m.wikipedia.org: Abdominal obesity
- https://www.ncbi.nlm.noh.gov: Central obesity and breast cancer risk.
- https://www.ncbi.nlm.nih.gov>pubmed: Overall and central obesity and risk of lung cancer.
- https://www.mayoclinic.org: Belly fat in men: Why weight loss matters.
Dr. Ye Win
MBBS, MMedSc (Physiology)
