San Juan Regional Medical Center nurse: Marlene Betonie
Waist Watching and Heart Health
When you go to your doctor for whatever reason, the nurse probably asks you to step on the scale. That’s because weight is a good measure of your overall health. You may then be asked your height, and that is used to calculate your body mass index (BMI), an even better measure of health because it takes account of different body types.
But there is yet another, even better, measure that you can and should use yourself to monitor your health: waist circumference. If you have had to ratchet up your pants size a notch or two over the past few months, you should start thinking about a new diet and exercise plan because the one you’re on is putting you at risk of cardiovascular disease and premature sickness and death.
It’s all about fat, no matter how you measure it, but doctors know that fat is not created equal. Those loose-fitting saddle bags that bug you so much when you look in the mirror are probably just under the surface, known as subcutaneous fat. It’s there to keep you from getting cold and is very hard to lose, as you have probably discovered.
But it’s relatively harmless compared to the fat that’s making your belly bulge out. Known as abdominal or visceral fat, this semi-fluid fat is packed deep in your abdominal cavity, wrapped around your stomach, kidneys, liver, heart, and intestines.
The International Diabetes Federation tagged central obesity as the unifying factor in the metabolic syndrome, a precursor of type 2 diabetes and cardiovascular disease. It has also been linked to hypertension, high cholesterol, and coronary artery disease.
Waist circumference may be an indicator
Because of sex hormones, men are more likely than women to have belly fat while women tend to store subcutaneous fat in their hips, buttocks, and thighs. After menopause, when estrogen levels decline, women may notice fat migrating from their buttocks and thighs to their belly. And women become more vulnerable to heart disease at about the same time.
Persons who have abdominal fat are likely to be overweight as well. But even women with a BMI of 25 or less (considered normal weight) but a thick waist circumference had a two-fold increased risk of early death from heart disease or cancer, according to a Harvard study of 44,000 female nurses.
One reason for the increased risk is the crowding of internal organs by the excess bulk. The added pressure hinders circulation and causes blood pressure to rise. When fat becomes wrapped around the portal vein, free fatty acids can enter this vein and travel to the liver, influencing the production of cholesterol. If your cholesterol has been climbing, one reason could be that bulging belly you’re carrying.
Abdominal fat is also believed to be more metabolically active, producing hormones such as estrogen, leptin (which affects appetite), and immune system chemicals such as tumor necrosis factor and interleukin-6 that, in turn, can affect other organs in the body. Visceral fat is associated with higher levels of chronic inflammation, now believed to be a factor in many heart attacks.
How thick can you let your waist get before you start to worry? Current guidelines say 35 inches for a woman and 40 for a man, but most experts believe health risks begin three to five inches earlier. What’s important is the trend; if you find yourself buying bigger and bigger pant sizes, it’s time to spring into action.
But don’t depend on clothing manufacturers to let you know if you’re in safe territory. They’re out to flatter you so you’ll keep on buying their line of clothing. Get a tape measure and find out for yourself.
Clear your abdomen of all clothing and stand facing a mirror with your feet shoulder-width apart. Breathe out, relax, and wrap the tape around your middle just above the pelvis. Align the bottom edge of the tape with the top of the pelvis on both sides, making sure the tape is parallel to the floor and not twisted. The tape should be comfortably taut and snug without depressing the skin. Results of the Nurses’ Health Study showed that subjects with the largest waist circumference (35 inches or larger) were twice as likely to die of a heart-related cause than subjects with the smallest waist lines (28 inches or less).
If your girth is too large, you’re probably overweight as well. Even modest weight loss might be enough to trim several inches off your waist line. According to one study of obese adults, a calorie-restricted diet that produced a 19 percent reduction in BMI resulted in a 23 percent loss of waist circumference. And imaging studies showed a 32 percent drop in fat layers around the heart.
The best diet for waist reduction is high fiber. One study found that subjects who ate 10 grams a day of soluble fiber, without any other changes, built up less visceral fat than other subjects. Simple carbohydrates such as white bread and sugary drinks should be avoided.
To reduce waist size, though, physical activity is crucial. One British study found that persons who stayed thin through dieting alone were more likely than others of similar weight to have unhealthy levels of visceral fat. Moderate exercise, if performed regularly, is effective at keeping visceral fat from forming on your body. This means raising your heart rate at least slightly for 30 minutes at a time three days or more a week.
If you want to get rid of abdominal fat you already have, you probably have to step up the intensity. This means half an hour of vigorous exercise four or more days a week. If you’re not fit enough for running or jogging, you should walk briskly on the treadmill at an incline in order to get the necessary intensity. Or you can get a good workout on an elliptical trainer, exercise bike, or rowing machine. Sit ups may strengthen your abdominal muscles, but it won’t get rid of your visceral fat unless you lose weight and raise your level of overall fitness
For more exercise and heart healthy tips visit our online health library at sanjuanregional.com.