The Dangers of Belly Fat – Jane E. Brody


If you do nothing else today to protect your health, consider taking an honest measurement of your waist. Stand up straight, exhale (no sucking in that gut!) and with a soft tape measure record your girth an inch or two above your hip bones.

The result has far greater implications than any concerns you might have about how you look or how your clothes fit. In general, if your waist measures 35 or more inches for women or 40 or more inches for men, chances are you’re harboring a potentially dangerous amount of abdominal fat.

Subcutaneous fat that lurks beneath the skin as “love handles” or padding on the thighs, buttocks or upper arms may be cosmetically challenging, but it is otherwise harmless. However, the deeper belly fat — the visceral fat that accumulates around abdominal organs — is metabolically active and has been strongly linked to a host of serious disease risks, including heart disease, cancer and dementia.

You don’t even have to be overweight or obese to face these hazards if you harbor excess fat inside your abdomen. Even people of normal weight can accumulate harmful amounts of hidden fat beneath the abdominal wall. Furthermore, this is not fat you can shed simply by toning up abdominal muscles with exercises like situps. Weight loss through a wholesome diet and exercise — activities like walking and strength-training — is the only surefire way to get rid of it.

Until midlife, men usually harbor a greater percentage of visceral fat than women do, but the pattern usually reverses as women pass through menopause. Few females seem to escape a midlife waistline expansion as body fat redistributes and visceral fat pushes out our bellies. Even though in my eighth decade I weigh less than I did at age 13, my waist is many inches bigger.

Here’s why visceral fat cells are so important to your well-being. Unlike the cells in subcutaneous fat, visceral fat is essentially an endocrine organ that secretes hormones and a host of other chemicals linked to diseases that commonly afflict older adults. One such substance is called retinol-binding protein 4 (RBP4) that was found in a 16-year study of nurses to increase the risk of developing coronary heart disease. This hazard most likely results from the harmful effects of this protein on insulin resistance, the precursor to Type 2 diabetes, and development of the metabolic syndrome, a complex of cardiac risk factors.

The Million Women Study conducted in Britain demonstrated a direct link between the development of coronary heart disease and an increase in waist circumference over a 20-year period. Even when other coronary risk factors were taken into account, the chances of developing heart disease were doubled among the women with the largest waists. Every additional two inches in the women’s waist size raised their risk by 10 percent.

Cancer risk is also raised by belly fat. The chances of getting colorectal cancer were nearly doubled among postmenopausal women who accumulate visceral fat, a Korean study found. Breast cancer risk increases as well. In a study of more than 3,000 premenopausal and postmenopausal women in Mumbai, India, those whose waists were nearly as big as their hips faced a three- to four-times greater risk of getting a breast cancer diagnosis than normal-weight women.

A Dutch study published last year linked both total body fat and abdominal fat to a raised risk of breast cancer. When the women in the study lost weight — about 12 pounds on average — changes in biomarkers for breast cancer, like estrogen, leptin and inflammatory proteins, indicated a reduction in breast cancer risk.

Given that two-thirds of American women are overweight or obese, weight loss may well be the single best weapon for lowering the high incidence of breast cancer in this country.

Perhaps most important with regard to the toll on individuals, families and the health care system is the link between abdominal obesity and risk of developing dementia decades later. A study of 6,583 members of Kaiser Permanente of Northern California who were followed for an average of 36 years found that those with the greatest amount of abdominal obesity in midlife were nearly three times more likely to develop dementia three decades later than those with the least abdominal fat.

Having a large abdomen raised dementia risk in the women even if they were of normal weight overall and lacked other health risks related to dementia like heart disease, stroke and diabetes.

Among other medical problems linked to abdominal fat are insulin resistance and the risk of Type 2 diabetes, compromised lung function and migraine headaches. Even asthma risk is raised by being overweight and especially by abdominal obesity, a study of 88,000 California teachers found.

Over all, according to findings among more than 350,000 European men and women published in The New England Journal of Medicine, having a large waist can nearly double one’s risk of dying prematurely even if overall body weight is normal.

All of which raises the question: How best to shed abdominal fat and, even more important, how to avoid accumulating it in the first place?

Chances are you’ve periodically seen ads on the internet for seemingly magical ways to reduce belly fat. Before you throw good money after bad, let it be said that no pill or potion has been scientifically shown to dissolve abdominal fat. You have to work at it. And that means avoiding or drastically limiting certain substances in your diet, controlling overall caloric intake and engaging in exercise that burns calories.

Perhaps the worst offender is sugar — all forms and especially fructose, which makes up half of sucrose and 55 percent of high-fructose corn syrup. One of the best ways to reduce your sugar intake is to stop drinking sodas and other sweet drinks, including fruit juices. Limiting alcohol, which may suppress fat-burning and add nutritionally empty calories, and avoiding refined carbohydrates like white bread and white rice are also helpful.

Make sure your diet contains adequate amounts of protein and dietary fiber, including vegetables, beans and peas and whole grains.

Get enough sleep — at least seven hours a night. In a study of 68,000 women followed for 16 years, those who slept five hours or less were a third more likely to gain 32 pounds.

Finally, move more. In a major national study, inactivity was more closely linked to weight gain and abdominal obesity than caloric intake.

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Gel, Wand, Belly, Ultrasound: The Moment Life As I Knew It Ended – Phillipa McGuinness


t’s late 2001 and Crown Princess Masako of Japan is having a baby. Her husband, Crown Prince Naruhito, is heir to the Chrysanthemum Throne, the world’s oldest hereditary monarchy. Sinking into its fourth recession in a decade, Japan hungers for good news and hopes Masako might have a boy. The Imperial Household Law of 1947 decreed that only men could assume the throne as emperor.

The doubleness of the term “confinement” – imprisonment and childbirth – seems especially apt for Masako. Though she lives secluded in a palace, she is such an object of scrutiny that she may as well reside in a glass cube at the centre of Shibuya crossing.

Nine months pregnant myself, I watch this fertility saga of a woman caught between medieval dynasties and 21st century celebrity unfold from Singapore, where we are living. It’s so humid there, I don’t feel as if I have a mini oven inside me; I am the oven. But, I think, at least I’m not going through this with millions of eyes upon me, like Princess Masako.

Looking back now, I would have given birth on the Shibuya crossing if doing so would have changed the outcome for my baby.

People always ask me if there were any warning signs. But everything seemed fine. A few days before Christmas I’d gone to the obstetrician, who measured the baby’s position and heartbeat, and my vitals. I lay down with a band around my enormous middle for 20 minutes and left with reassurances that everything was as normal as it could be. Not long till the baby came now.

Later, in a taxi on the way to the airport to meet my sister and her son, the baby seemed to be going berserk in utero. Super-active, in the way that books said sometimes babies behaved when they were getting ready to be born. And the way I remember Isabella being before I went into labour with her. Looking back, though, I wonder if what I was feeling were convulsions.

I woke the next morning crushed by tiredness. I wanted to sleep for a thousand years. I could hardly move. And I hadn’t felt the baby move. I lay in bed waiting for one of the kicks, usually like clockwork, but there was nothing. It was odd. Adam, my husband, said before he went to work – as anyone in that situation would because it nearly always is – “Don’t worry, I’m sure it’s fine.” All I could do was go back to sleep. I woke mid-morning. Still nothing. My sister gave sensible advice: ring the obstetrician, go to the hospital, get reassured, and then let’s do whatever we are doing today with the kids. But it was going to be the day life as I knew it ended.

We sisters and our children headed off, geared up for a quick scan at the Mount Elizabeth hospital, in and out and on our way. I was shown into one of the ultrasound rooms, all very matter-of-fact. A nurse I’d met before drew the short straw. Gel, wand, belly. Here we go. Nothing. She smiled and said the baby must be asleep so she would try a different position. Nothing. No more smiling as she tried and tried, the wand pressing into my belly from every angle. I could see my baby on the screen. I heard that zhoosh-ing sound but not the chugga chugga chugga of the heartbeat. The nurse went to get help.

I lay there alone, alone with the baby inside me, desperate. “Please please please baby, please move. If you’re ever going to kick again, do it now.” All was still. So still, this baby I had felt grow for nine months, had loved and couldn’t wait to meet. This would be the moment to pray, I remember thinking, as tears ran down my cheeks.

My obstetrician appeared. They had told me she was away but here she was. I felt a flicker of hope now that the big guns were here. She could fix this. But when I saw her face and the glazed look of her offsider, hope receded. She tried to find a heartbeat but there was no heartbeat in my body but my own.

Anyone who has had a baby, or has watched a baby being born, knows that the gap between life and death narrows throughout labour. Sometimes the gap is as thin as a membrane. The mother is alive, the baby is alive, but will both emerge alive? When women say the pain is killing them, they don’t mean it metaphorically. Babies are rushed for tests within minutes of emerging into the world – will they make it? Women haemorrhage to death after giving birth. These things aren’t confined to pre-modern times or the developing world. It’s not for nothing that the standard phrase of the joyous birth announcement is “mother and baby are both well”. Because often they aren’t.

Death was in me. In shock, I could barely form thoughts. Someone handed me tissues. How could this be?

I had to call Adam. You can never predict where you will be when you get the worst news of your life. It was lunchtime and he was at a busy crossing on Orchard Road, about to grab a sandwich with colleagues. I told him bluntly, as I would tell my poor parents a few hours later. “The baby is dead.” I hope I prefaced it with, “Sit down, prepare yourself, I have bad news.” But how else to say it?

Usually when a person is felled by bad news they don’t have to get up and run a marathon. But the business of giving birth had to happen. I could choose my starting time. The doctor said we could let labour start naturally but it might take days. Or I could be induced. That night. That’s what we chose.

We went home to pack. I chose the only outfit my baby would ever wear from a cupboard full of tiny baby clothes.

Mum told me later, or told one of my siblings who told me, that she thought I was going to die. That never occurred to me but I was in such a state that if a giant crater had opened up and swallowed central Singapore I wouldn’t have been surprised. I might have stepped towards one of the fissures.

Phillipa McGuinness
‘It has taken me 17 years to write this.’ Photograph: Mel Koutchavlis/Penguin Books

At the hospital they hooked me up to the drugs to induce labour. I sat up in bed and Adam and I watched Survivor. I remember thinking, through my hysteria, “I’ll show you a fucking survivor, you bandana-wearing, gruel-eating, mud-dwelling, wannabe-celebrity idiots. The tribe has spoken all right. I’ll vote you right off your island.”

On it went. The baby wouldn’t be born for 24 hours. Labour is long, whether your baby is alive or not. I ate winter melon soup served out of an actual winter melon. Hospital food is better in Singapore. Finally, they sent me to the labour ward. There was a band around my belly designed to measure my contractions and a baby’s heartbeat.

On the monitor you could see what was going on in all the other rooms of labouring women. Their babies all had heartbeats. They must have thought, “What the hell is going on in room six?” I would hear their babies crying when they were born.

Contractions kicked in on waves of pain. Some epidural magic meant I fell asleep. When I woke up there was a flurry because the baby was about to be born. I had to push. The baby emerged. It was Daniel. I didn’t know what to expect but he was perfect. I remember the doctor saying in her calm voice, he looks good, he has the right number of toes and fingers, he’s 3.5kg. The placenta looked OK. Everything about him was right. Except, in the most fundamental way of all, it wasn’t.

Then we were alone. The three of us. Adam and I held Daniel. We talked to him. His little lifeless body. But he was ours and we loved him. And then they took our son away. I don’t ever want to feel so sad again.

There was no social worker, no grief counsellor. Just us. That night, lying in my hospital bed with my husband next to me in a camp bed, my son somewhere in the hospital (in the morgue, I guess) and my daughter with her aunty and cousin in our apartment 500 metres away, my thoughts raced. They had offered me a sleeping tablet but for some reason I refused, thinking I had to remember. Bereft was the word that kept popping into my head. I am bereft. I lack what I most want. Death had come for my own child. But not for me. I wondered, why not?

The next morning I lied about the bodily functions I was supposed to have performed; we signed the discharge papers and walked out of the hospital. “But where’s the baby?” asked my little nephew when we arrived home. Some things are too hard to explain. Indeed, it has taken me 17 years to write this.

All life’s big events involve paperwork. Adam had to go to the police station; a person had died and it had to be reported. There was no box on the form that covered our situation. I don’t know about Singapore but now it is possible to get a birth certificate for a stillborn baby in Australia. We had to do something about a funeral or a burial, the demands of the rituals of death. Adam had to choose a coffin. I found myself staring into my wardrobe wondering what to wear to my son’s funeral. The cruel joke was that it had to be a maternity dress.

Adam and I went back to the hospital to meet the hearse and go out to Choa Chu Kang cemetery. We rode in the hearse, with Daniel in his tiny white coffin in the back. The driver said to us that the only good thing about babies’ funerals was that they are cheaper.

A young Sri Lankan priest met us, giggling and smiling because he was nervous. We were all out of our depth. Blah blah into the earth blah blah commend his spirit. Our small group stood around a tiny plot in the tropical cemetery. The miracle was that I remained upright. My body was wrecked. “My child is dead,” I thought, thinking it must be the saddest line in the saddest scene imaginable and wishing I wasn’t in it.

Flowers and messages had been arriving for days from family, friends and neighbours. Most of the blooms were white lilies, Lilium candidum, and I would happily never lay eyes on a single stem again. How I hate those flowers. One reason might be because they’re called Madonna lilies. Another might be because they are said to symbolise innocence restored to the soul of the departed after death. But mainly I hate them because our house was full of flowers for the worst reason. What should have been a celebration was mourning, raw and untrammelled. I didn’t know where it would take us. All I could smell was those flowers.

Friends in holiday mode read the email about Daniel we sent to everyone in the wrong order – after they’d wished us happy new year. For it was New Year’s Eve. Daniel had finished his year as a statistic: in Australia one in 135 births is a stillbirth – six babies a day – and the numbers are similar in Singapore. No cause was found for his death. But he wasn’t a statistic for us. 2001 was over but in all the years to follow we wouldn’t forget him.

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