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Wellness Tip of the Month

October is the National Heart Education Month

Pot Belly May Signal Diseased Arteries Waist-to-Hip Ratio May Be More Telling Than BMI, Study Shows

By: Miranda Hitti
WebMD Medical News

The tape measure may beat the scale as a low-tech indicator of atherosclerosis, new research shows.

Atherosclerosis means the hardening of the arteries, which makes heart attacks and stroke more likely.

Doctors have sophisticated tools to search for signs of atherosclerosis, but a tape measure may give you a rough idea of your risk... if you have a pot belly, watch out.

So say James de Lemos, MD, FACC, and colleagues at the University of Texas Southwestern Medical Center at Dallas.

"We think the key message for people is to prevent accumulation of central fat early on in their lives," de Lemos says in a news release. "To do so, they will need to develop lifelong dietary and exercise habits that prevent the development of the 'pot belly’.'"

Pot Belly or Flat Abs?

The new study included 2,744 Dallas residents who were in their mid-40s, on average (age range: 30-65).

Participants got noninvasive scans to check for evidence of atherosclerosis, which can start years before a heart attack or stroke. They also got their height, weight, waist circumference, and hip circumference measured. Based on those measurements, de Lemos and colleagues calculated participants' BMI (which relates height to weight) and waist-to-hip ratio (waist circumference divided by hip circumference).

BMI vs. Waist-to-Hip Ratio

BMI (body mass index) is often used to gauge obesity, but BMI can be misleading. BMI can not tell muscle from flab; it also does not show where body fat is located. Carrying extra fat around your waist may be unhealthier than having extra fat around your hips. Because of BMI's drawbacks, some experts prefer the waist-to-hip ratio to gauge obesity. In the Dallas study, waist-to-hip ratio trumped BMI as a marker of atherosclerosis.

That is, participants' waist-to-hip ratio was more sensitive than BMI at indicating who had scans showing evidence of atherosclerosis. Abdominal fat may play an active role in promoting heart disease, warn de Lemos and colleagues. Their study, published in August's edition of the Journal of the American College of Cardiology, did not directly test that theory. Looking to lose a pot belly? Your doctor can give you pointers on doing so safely -- and on maintaining your progress.

Interactive Tool: Is Your Weight Increasing Your Health Risks?

What does this tool measure?

This interactive tool estimates your risk of weight-related diseases by using your body mass index (BMI) along with your waist measurement and other factors. BMI is an estimate of body fat. The higher the BMI, the greater the risk of some diseases, including high blood pressure, coronary artery disease, stroke, osteoarthritis, some cancers, and type 2 diabetes.

Click here to find out whether your weight increases your health risks.

Body Fat Distribution

Health care providers are concerned not only with how much fat a person has, but also where the fat is located on the body. Women typically collect fat in their hips and buttocks, giving them a "pear" shape. Men usually build up fat around their bellies, giving them more of an "apple" shape. Of course, some men are pear-shaped and some women become apple-shaped, especially after menopause.

Excess abdominal fat is an important, independent risk factor for disease. Research has shown that waist circumference is directly associated with abdominal fat and can be used in the assessment of the risks associated with obesity or overweight. If you carry fat mainly around your waist, you are more likely to develop obesity-related health problems. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with lower waist measurements because of their body fat distribution.

What causes obesity?

Obesity occurs when a person consumes more calories from food than he or she burns. Our bodies need calories to sustain life and be physically active, but to maintain weight we need to balance the energy we eat with the energy we use. When a person eats more calories than he or she burns, the energy balance is tipped toward weight gain and obesity. This imbalance between calories-in and calories-out may differ from one person to another. Genetic, environmental, and other factors may all play a part.

Genetic Factors

Obesity tends to run in families, suggesting a genetic cause. However, families also share diet and lifestyle habits that may contribute to obesity. Separating genetic from other influences on obesity is often difficult. Even so, science does show a link between obesity and heredity.

Environmental and Social Factors

Environment strongly influences obesity. Consider that most people in the United States alive today were also alive in 1980, when obesity rates were lower. Since this time, our genetic make-up has not changed, but our environment has.

Environment includes lifestyle behaviors such as what a person eats and his or her level of physical activity. Too often Americans eat out, consume large meals and high-fat foods, and put taste and convenience ahead of nutrition. Also, most people in the United States do not get enough physical activity.

Environment also includes the world around us—our access to places to walk and healthy foods, for example. Today, more people drive long distances to work instead of walking, live in neighborhoods without sidewalks, tend to eat out or get “take out” instead of cooking, or have vending machines with high-calorie, high-fat snacks at their workplace. Our environment often does not support healthy habits.

In addition, social factors including poverty and a lower level of education have been linked to obesity. One reason for this may be that high-calorie processed foods cost less and are easier to find and prepare than healthier foods, such as fresh vegetables and fruits. Other reasons may include inadequate access to safe recreation places or the cost of gym memberships, limiting opportunities for physical activity. However, the link between low socio-economic status and obesity has not been conclusively established, and recent research shows that obesity is also increasing among high-income groups.

Although you cannot change your genetic makeup, you can work on changing your eating habits, levels of physical activity, and other environmental factors. Try these ideas:

Other Causes of Obesity

Some illnesses may lead to or are associated with weight gain or obesity. These include:

A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult.

Lack of sleep may also contribute to obesity. Recent studies suggest that people with sleep problems may gain weight over time. On the other hand, obesity may contribute to sleep problems due to medical conditions such as sleep apnea, where a person briefly stops breathing at multiple times during the night. You may wish to talk with your health care provider if you have difficulty sleeping.

Certain drugs such as steroids, some antidepressants, and some medications for psychiatric conditions or seizure disorders may cause weight gain. These drugs may slow the rate at which the body burns calories, stimulate appetite, or cause the body to hold on to extra water. Be sure your doctor knows all the medications you are taking (including over-the-counter medications and dietary supplements). He or she may recommend a different medication that has less effect on weight gain.

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