Bust Your Belly for a Healthier Heart

Health Hazards Associated with Growing Waists

If your abdomen looks like an apple (or a beach ball), it’s a sign that something hazardous lies beneath.

What’s a telltale sign of potential health problems? Look down. Whether you call it a potbelly or spare tire, this noticeable bulge can be more dangerous than you realize.

“It’s common for men to put on a few extra pounds every year as they age, but they really should pay attention to increasing waist size,” says Dr. Jody Dushay, an endocrinologist with Harvard-affiliated Beth Israel Lahey Health. “Any extra weight around the waist can be especially detrimental to your health.”


Why do men get these bellies? As you age, your metabolism naturally slows and you burn calories at a slower rate. But many men continue to eat like they did in their 30s and 40s — and are less active as well. “When you consume extra calories and don’t burn them off, they get stored as fat,” says Dr. Dushay. Testosterone levels also drop as men age, which leads to less muscle mass and therefore a higher percent of body fat.

But it’s where you accumulate this fat that is the real problem.

There are two kinds of fat: subcutaneous and visceral. Subcutaneous fat is located just under the skin, most obviously around the belly, thighs, and buttocks. This is the visible kind you can feel with a pinch.

In comparison, you cannot see or feel visceral fat, as it lies deep within the abdominal cavity and pads the spaces between your abdominal organs.

About 90% of body fat is subcutaneous, while visceral fat makes up the remaining 10%. Even though visceral constitutes a smaller percentage, it has the biggest impact on your health. How can you tell if you have too much visceral fat? Your waist size offers a clue. “The fat that you can see and feel around your waist is also a sign that you have higher amounts of visceral fat that surrounds and even infiltrates your organs,” says Dr. Dushay.

A tape measure is a simple way to keep tabs on visceral fat. Place the bottom of the tape at the top of your right hipbone, then pull the tape around at navel level (not the narrowest part of your torso). Do not suck in your gut or pull the tape tight enough to compress the area. For men, a waist circumference of 40 inches or more is considered a sign of excess visceral fat. But you don’t have to focus only on numbers. Monitor whether your pants get snug. This also can be a sign you are gaining visceral fat.


This hidden fat can mean trouble for your heart. For instance, an analysis in the September 2016Journal of the American College of Cardiology found that people with higher amounts of visceral fat have a greater heart disease risk.

Scientists looked at studies that used CT scans to assess how much subcutaneous and visceral fat had accumulated in 1,106 participants from the Framingham Heart Study. The people’s average age was 45, and 56% were men.

Over the six-year follow-up period, participants had an average increase of 22% in subcutaneous fat and a 45% increase in visceral fat. While both were linked to a greater overall cardiovascular disease risk, people with the greatest increase in visceral fat had the most adverse changes in metabolic risk factors, such as high blood sugar and high triglycerides (a type of fat found in blood). They also had lower levels of HDL (good) cholesterol.


What is the best way to fight the fat you cannot see? It is the same for fat you can see — intense aerobic exercise.
“Following a high-quality diet is necessary if you want to lose belly fat, but physical activity may do even more to reduce visceral fat,” says Dr. Dushay.

The kind of aerobic exercise doesn’t matter — for instance, brisk walking, running, swimming, cycling — as long as the intensity raises your heart rate enough that it is uncomfortable to maintain a conversation, says Dr. Dushay.

Some workouts also should include high-intensity interval training (HIIT). With HIIT, you exercise at a higher intensity for a brief time followed by a period to catch your breath, and then you repeat the cycle for the entire workout. For example, instead of walking at a normal pace on the treadmill, do a few minutes at a greater speed or incline (or both) followed by a period of similar or longer duration at your regular pace.

If you walk outside, pick a landmark like a mailbox or telephone pole and walk to it as fast as you can. Then walk normally for a few minutes, pick another landmark, and repeat for the duration of your walk.

Your fat-burning workouts should be 20 to 30 minutes, at least three days a week. You can gradually build up to an hour. However, always check with your doctor before adopting any new workout. You may also want to enlist a personal trainer to help design a personalized HIIT program. Many gyms and fitness centers offer specific HIIT classes, too.

Even if you don’t have a belly yet, you should keep an eye out for its appearance. “Your waist size can be a good indicator of your current and future health,” says Dr. Dushay. “It is an important sign, just like blood pressure. Monitor it and focus on keeping it around the same size.”