The other day I was riding around in the sunshine on my Harley waiting at a stop sign for some crossing pedestrians and a guy walked by in what had to be the largest T-shirt size ever made and still had no chance of covering a huge beer belly that was hanging out well below the bottom of his shirt. It even had a clever little slogan with an arrow pointing down to the bottom of the shirt. It said, “This isn’t a beer belly, it’s a liquid grain storage facility.” I guess that might be funny to some but not really, especially with all the recent medical research that shows that being overweight is unhealthy but more specifically, having a huge beer belly is especially bad for your health, principally cardiac health. So, if your belly looks like it’s storing some beer, but still in the keg and not in a six-pack, read on.
The medical term for what we all call “beer belly” is “visceral adipose tissue central obesity” and has a specific definition. It’s measured in the medical world as the ratio of waist circumference to hip circumference or waist-to-hip ratio (WHR). The exact numbers are usually given as a percent of the two, and a healthy abdominal girth is defined as less than 0.85 — meaning that your belly should be less than 85% circumference of your hips. We all know that too much fat accumulation is defined as obesity and as we’ve talked about in these pages before, obesity has risen worldwide in the last few decades largely related to dietary and lifestyle choices. Obesity is traditionally defined as body mass index, BMI, but lately there's data that suggests BMI alone is not the best metric of health. It’s important to take into account where you have accumulated excess fat, and the worst place is having a beer belly, “central obesity.”
Recent population-based studies demonstrated a strong association, independent of BMI, between central obesity, adverse cardiovascular events, and increased all-cause early mortality. Specifically, central obesity measures were found to be more reliable predictors of cardiac disease and dysfunction than traditional obesity measures alone. Even “normal weight” central obesity (WHR > 0.85) portends almost twice the cardiac risks as patients with similar weight but no beer belly. Diving deeper into the numbers, central obesity carries a 25%-55% higher risk of all-cause mortality; risks of dying from any cardiovascular event are doubled and having a heart attack is about 150% times more likely; and dying from a stroke or having heart failure is 125% times more common than in patients with normal abdominal girth. Then add in diabetes, which is 165% more common than in those without central obesity. It’s a problem in kids too; central obesity increases the risks of childhood hypertension and asthma, both of which portend poor adulthood health.
One of the reasons central obesity is particularly bad for your health is that you store the same excess adipose tissue (fat) inside surrounding your intra-abdominal organs as you have outside. That’s one of the factors that makes it really hard to shed central abdominal fat even if you manage to lose weight. Belly fat isn’t just about calories in and calories out, it’s influenced by a complex network of hormones, genes, stress levels, sleep patterns, and even your emotional state. It always comes down to genetics, and it’s no different with central obesity, since genetics has a big influence on how and where you store excess body fat, as a recent review shows. These results suggest that genetic effects on abdominal obesity may be even more pronounced than those on general obesity. Another genetic factor that links central obesity that we’ve talked about in this space before is the science of ill health and aging that hinges on those chromosome caps called “telomeres.” There’s recent research specifically linking one of the effects of central obesity that triggers telomere length shortening. Shorter telomere length is “associated with numerous maladies and patients in the highest category oftelomere length had 3.72 cm lower waist circumference (WC) compared with those in the lowest category.”It’s true the other way around also; those in the highest telomere length category had 0.02 lower waist to hip ratio (WHR) compared with those in the lowest category.
An added frustration about central obesity is that it can persist even as you lose overall weight. All the sit-ups you grunt through won’t turn that beer keg under your T-shirt into a six-pack because the muscles (rectus abdominus) you use to exercise are beneath the fat layers, so you may gain strength but you can’t see the improvement until your beer belly goes away. A new study published in Nature reveals some other reasons why it’s hard to lose belly fat. It’s related to our caveman days and it turns out that storing energy as belly fat provided a genetic advantage that helped our ancestors survive hard times, bad hunts, and famine. When our ancestors faced prolonged cold or food scarcity, burning through fat reserves too quickly could be fatal, and from an evolutionary standpoint, a braking mechanism that held on to our energy reserves makes sense. The process that evolved to avoid losing too much central abdominal fat reserves uses our inflammation mechanism. It turns out that the same white blood cells that rush to fight infection seem to have a second job. This study showed that within hours of the stress signal from hunger, immune cells flood into visceral fat stores and release specific chemicals (interleukin-1-beta) that tell fat cells to slow down burning lipid stores (lipolysis) and slow down energy production. This secondary inflammatory reaction helped our ancestors be really efficient at storing energy for lean times. Unfortunately for us modern folks who can run to the fridge or the corner convenience store at the first hint of hunger, this partnership between the immune system and fat tissue process remains in place and works against us to shed those pounds, especially abdominal stores. It’s a vicious cycle—further fasting leads to further inflammation, release of white blood cells, and belly fat retention. But there’s more bad news about this ancient process.
The inflammatory cells that are liberated are also one of the reasons that central obesity is specifically harmful to heart health. A recent consensus paper published by the American College of Cardiology states that it's become a basic concept in modern medicine that hardening of the coronary arteries—atherosclerosis—is now best understood as a chronic inflammatory disease. This is based on inflammatory damage done to the lining cells of blood vessels (known as the endothelial cells). The inflammatory chemicals released by white cells injure delicate endothelial cells, making the vascular walls susceptible to atherosclerotic plaque formation and narrowing of the vascular channel. Once the process begins, it further stokes the inflammation, hastening the narrowing and ultimate closure of the vessels that results in a heart attack. This is the same inflammatory process triggered by hunger in the old times and modern-day dieting.
So, no matter where you live, down here in the sunshine or up north where you have to bundle up and you get to cover your waistline all winter, your belly matters. We’ve talked about all kinds of healthy lifestyle options in these pages and the internet is full of many more, but if you’re starting to feel snug when you pull back on the yoke to rotate and take off at the end of the runway, take it seriously, it’s a bad omen. Hang in there; belly fat is the hardest body fat to control, but you can do it. Don’t starve yourself, just make good lifestyle and eating habit choices. Get some exercise during the day and sleep at night. Cut back on the calories and beer, cut out junk food and ultra-processed stuff. Make a real effort to change your diet to only eat good, healthy, natural, whole foods. Don’t give up on it; there are many risks to your heart health and longevity when your T-shirt won’t reach your belt anymore.
