By Eduardo Gonzales, MD
I read a newspaper article that says that obesity is only bad if your excess fat is in your belly. Is this true? Is it, therefore, okay to be overweight as long as your excess fat is not in your belly?—firstname.lastname@example.org
First, let me make one thing clear, excess weight or obesity, in whatever form, is not okay. It has long been established that overweight and obese people, compared to the rest of the population, have a higher risk for a variety of chronic metabolic and cardiovascular conditions including type 2 diabetes mellitus, hypertension, and atherosclerosis, which are the major predisposing factors for coronary artery disease—which is the number one cause of heart attacks—and strokes. But there is a new twist to this subject, and this is evidently what you read about. Long-term follow-up studies have shown that the chronic health conditions associated with obesity correlate better with excess weight around the belly, a phenomenon called abdominal or central obesity, than excess weight in other parts of the body. In short, obesity is bad, but it is worse if the excess fat is in and around the belly. Why is this so?
Not all fat cells are the same
Fat consists of fat cells or adipocytes, whose main function is to store, in the form of fat, the excess food that a person consumes. Fat that is stored by adipocytes can be mobilized as energy source when the person does not eat enough. Fat cells are present all over the body. A person does not run out of these cells because new ones can be generated if more are needed. Hence, if a person keeps consuming more food than what their body needs, they will keep getting fatter.
We use to think that adipocytes are all the same and that they are simply storage sites for fat, but not anymore. We now know that adipocytes have other functions and that not all adipocytes are the same. Recent studies have shown that adipocytes produce a variety of substances called adipocytokines. There are good and bad adipocytokines. Bad adipocytokines are detrimental to health. They propagate obesity, induce the development of diabetes, and increase the risk for atherosclerosis and coronary heart disease. In contrast, good adipocytokines are beneficial to the body. They help prevent the development of type 2 diabetes and protect against atherosclerosis and coronary heart disease.
The type of adipocytokines that adipocytes produce depends on their location in the body. The adipocytes that are around the waist are double whammies: they produce a lot of bad adipocytokines and very little good adenocytokines.
Waist size is more important than body mass index
Experts agree that in the light of latest findings, the circumference of a person’s waist—which indirectly measures the amount of excess fat a person has in and around the belly—is really a more sensitive gauge and determinant of the metabolic and cardiovascular complications of obesity than body mass index (BMI), the current yardstick preferred by most physicians and researchers in determining obesity. Incidentally, BMI is equal to the person’s weight in kilograms divided by height in meters squared (BMI=kg/m2). An adult who has a BMI of 30 or above is considered obese.
How small should you keep your waistline?
According to the World Health Organization Asia-Pacific Guidelines for central obesity, Filipino women should have a waist circumference of no more than 80 cm (31.5 inches) while Filipino men should have no more than 90 cm (35.5 inches).
The waist circumference should be measured at the midpoint between the highest point of the hip bones and the lowest abdominal ribs. Also, measure your waist just after you breathe out.
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