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Abdominal obesity

March 04, 2023

Abdominal obesity, also known as central obesity and truncal obesity, is a condition when excessive visceral fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health. Abdominal obesity has been strongly linked to cardiovascular disease,[1] Alzheimer's disease, and other metabolic and vascular diseases.[2]

Abdominal obesity
Other namesCentral obesity, truncal obesity; see also § Colloquialisms
An abdominous obese male
Weight: 182 kg/400 lbs
Height: 185 cm/6 ft 1 in.
Body mass index: 53
SpecialtyEndocrinology
ComplicationsHeart disease, asthma, stroke, diabetes
CausesSedentary lifestyle, Overeating, Cushing's syndrome, Alcoholism, Polycystic ovarian syndrome, Prader-Willi syndrome

Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes.[3]

Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat, which is found underneath the skin, and intramuscular fat, which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue (EWAT), and perirenal fat. An excess of adipose visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped" in which fat is deposited on the hips and buttocks.

Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease, diabetes, and dyslipidemia. Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity. In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-abdominal fat and subcutaneous fat.[4]

Health risks

Heart disease

Abdominal obesity is typically associated with a statistically higher risk of heart disease, hypertension, insulin resistance, and type 2 diabetes (see below).[5] With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well.[6] Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, full-blown diabetes, and increased risk of developing cardiovascular disease.[7][8][9][10] It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.[4][11]

Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio-vascular risk.[12]

Diabetes

There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. But adiponectin, an anti-inflammatory adipokine, which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus (T2DM).[13][14]

Insulin resistance is a major feature of diabetes mellitus type 2, and central obesity is correlated with both insulin resistance and T2DM itself.[15][16] Increased adiposity (obesity) raises serum resistin levels,[17][18][19][20] which in turn directly correlate to insulin resistance.[21][22][23][24] Studies have also confirmed a direct correlation between resistin levels and T2DM.[17][25][26][27] And it is waistline adipose tissue (central obesity) which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin.[28][29] Conversely, serum resistin levels have been found to decline with decreased adiposity following medical treatment.[30]

Asthma

Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. Obesity causes decreased tidal volumes due to reduced in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragms.[31] It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air.[32] People with obesity are also more likely to be hospitalized for asthma. A study has stated that 75% of patients treated for asthma in the emergency room were either overweight or obese.[33]

Alzheimer's disease

Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear.[2] A study by Debette et al. (2010) examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of dementia.[34][35][36] Alzheimer's disease and abdominal obesity has a strong correlation and with metabolic factors added in, the risk of developing Alzheimer's disease was even higher. Based on logistic regression analyses, it was found that obesity was associated with an almost 10-fold increase risk of Alzheimer's disease.[2]

Other health risks

Central obesity can be a feature of lipodystrophies, a group of diseases that is either inherited, or due to secondary causes (often protease inhibitors, a group of medications against AIDS). Central obesity is a symptom of Cushing's syndrome[37] and is also common in patients with polycystic ovary syndrome (PCOS). Central obesity is associated with glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.[citation needed]

Ghroubi et al. (2007) examined whether abdominal circumference is a more reliable indicator than BMI of the presence of knee osteoarthritis in obese patients.[38] They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. (2007) concluded that a high abdominal circumference is associated with great functional repercussion.[38]

Causes

Diet

See also: Diet and obesity

The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination. Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity,[39] is related to the excessive consumption of fructose.[40][41][42] Some evidence shows that in regards to juveniles, when free fructose is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar glucose consumption.[43]

Intake of trans fat from industrial oils has been associated with increased abdominal obesity in men[44] and increased weight and waist circumference in women.[45] These associations were not attenuated when fat intake and calorie intake was accounted for.[46][47] Greater meat (processed meat, red meat, and poultry) consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories.[48][49] Conversely, studies suggest that oily fish consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant.[50][51] Similarly, increased soy protein consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.[52][53]

Numerous large studies have demonstrated that ultraprocessed food(UPF)[54] has a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women. Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among American,[55] Canadian,[56] Latin American,[57] Australian,[58] British,[59] French,[60] Spaniard,[61] Swedish,[62] South Korean,[63] Chinese[64] and Sub-Saharan African[65] populations.

Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high-carbohydrate diets.[66][unreliable source?] It has also been shown that quality protein intake during a 24-hour period and the number of times the essential amino acid threshold of approximately 10 g[67] has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.[68]

Visceral fat cells will release their metabolic by-products in the portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there. In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'.[69]

Alcohol consumption

A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women. After controlling for energy under-reporting, which have slightly attenuated these associations, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants – but not in the small number of female participants (2.13%) with elevated alcohol consumption, even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol. Further research is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol.[70]

A systemic review and meta-analysis failed to find data pointing towards a dose-dependent relationship between beer intake and general obesity or abdominal obesity at low or moderate intake levels (under ~500 mL/day). However, high beer intake (above ~4 L/wk) appeared to be associated with a higher degree of abdominal obesity specifically, particularly among men.[71]

Other factors

The prevalence of abdominal obesity is increasing in Western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.[72][73]

Other environmental factors, such as maternal smoking, estrogenic compounds in the diet, and endocrine-disrupting chemicals may be important also.[74]

Hypercortisolism, such as in Cushing's syndrome, also leads to central obesity. Many prescription drugs, such as dexamethasone and other steroids, can also have side effects resulting in central obesity,[37] especially in the presence of elevated insulin levels.

Diagnosis

 
Silhouettes and waist circumferences representing normal, overweight, and obese

There are various ways of measuring abdominal obesity including:

 
Overweight teenage boy holding his excess abdominal fat

In those with a body mass index (BMI) under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat.[77] Intra-abdominal or visceral fat has a particularly strong correlation with cardiovascular disease.[1]

BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. Waist measurement (e.g., for BFP standard) is more prone to errors than measuring height and weight (e.g., for BMI standard). BMI will illustrate the best estimate of one's total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease.[78] It is recommended to use both methods of measurements.[79]

 
An adult man with abdominal obesity

While central obesity can be obvious just by looking at the naked body (see the picture), the severity of central obesity is determined by taking waist and hip measurements. The absolute waist circumference 102 centimetres (40 in) in men and 88 centimetres (35 in) in women and the waist–hip ratio (>0.9 for men and >0.85 for women)[1] are both used as measures of central obesity. A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating. In the cohort of 15,000 people participating in the National Health and Nutrition Examination Survey (NHANES III), waist circumference explained obesity-related health risk better than BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant. In other words, excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI.[80] Another measure of central obesity which has shown superiority to BMI in predicting cardiovascular disease risk is the Index of Central Obesity (waist-to-height ratio, WHtR), where a ratio of >=0.5 (i.e. a waist circumference at least half of the individual's height) is predictive of increased risk.[81] Another diagnosis of obesity is the analysis of intra-abdominal fat having the most risk to one's personal health. The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman (1998) review.[4] An increasing acceptance of the importance of central obesity within the medical profession as an indicator of health risk has led to new developments in obesity diagnosis such as the Body Volume Index, which measures central obesity by measuring a person's body shape and their weight distribution. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.

Index of central obesity

Index of Central Obesity (ICO) is the ratio of waist circumference and height first proposed by a Parikh et al. in 2007[82] as a better substitute to the widely used waist circumference in defining metabolic syndrome.[83] The National Cholesterol Education Program Adult Treatment Panel III suggested cutoff of 102 cm (40 in) and 88 cm (35 in) for males and females as a marker of central obesity.[75] The same was used in defining metabolic syndrome.[84] Misra et al. suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm (35 in) and 80 cm (31 in) for males and females.[85] Various race specific cutoffs were suggested by different groups.[86] The International Diabetes Federation defined central obesity based on these various race and gender specific cutoffs.[87] The other limitation of waist circumference is that it the measurement procedure has not been standardized and in children there are no, or few, comparison standards or reference data.[88]

Parikh et al. looked at the average heights of various races and suggested that by using ICO various race- and gender-specific cutoffs of waist circumference can be discarded.[83] An ICO cutoff of 0.53 was suggested as a criterion to define central obesity. Parikh et al. further tested a modified definition of metabolic syndrome in which waist circumference was replaced with ICO in the National Health and Nutrition Examination Survey (NHANES) database and found the modified definition to be more specific and sensitive.[83]

This parameter has been used in the study of metabolic syndrome[89][90] and cardiovascular disease.[91]

Central obesity in individuals with normal BMI is referred to as normal weight obesity.

Sex differences

There are sex-dependent differences in regional fat distribution.

Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.[92] When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women.[93][94]

In women, estrogen is believed to cause fat to be stored in the buttocks, thighs, and hips.[95] When women reach menopause and the estrogen produced by ovaries declines, fat migrates from their buttocks, hips, and thighs to their belly.[96][97]

50% of men and 70% of women in the United States between the ages of 50 and 79 years now exceed the waist circumference threshold for central obesity.[98]

Central obesity is positively associated with coronary heart disease risk in women and men. It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk.[99] Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women.[100]

Management

A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity.[101] A single pound of fat yields approximately 3500 calories of energy (32 000 kJ energy per kilogram of fat), and weight loss is achieved by reducing energy intake,[102] or increasing energy expenditure, thus achieving a negative balance. Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine, although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the US,[103] the UK,[104] the EU,[105] Australia,[106] Canada,[107] Hong Kong,[108] and Thailand.[109]

A 2006 study published in the International Journal of Sport Nutrition and Exercise Metabolism,[110] suggests that combining cardiovascular (aerobic) exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat. An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol, a hormone that leads to more belly fat deposits and leptin resistance.[111]

Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics. In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat. As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer. Specifically it's the deepest layer of belly fat (the fat that cannot be seen or grabbed) that poses health risks, as these "visceral" fat cells produce hormones that can affect health (e.g. increased insulin resistance and/or breast cancer risk). The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity. For example, fat next to the liver drains into it, causing a fatty liver, which is a risk factor for insulin resistance, setting the stage for type 2 diabetes. However, visceral fat is more responsive to the circulation of catecholamines.

In the presence of type 2 diabetes, the physician might instead prescribe metformin and thiazolidinediones (rosiglitazone or pioglitazone) as antidiabetic drugs rather than sulfonylurea derivatives. Thiazolidinediones may cause slight weight gain but decrease "pathologic" abdominal fat (visceral fat), and therefore may be prescribed for diabetics with central obesity.[112] Thiazolidinedione has been associated with heart failure and increased cardiovascular risk; so it has been withdrawn from the market in Europe by EMA in 2010.[113]

Low-fat diets may not be an effective long-term intervention for obesity: as Bacon and Aphramor wrote, "The majority of individuals regain virtually all of the weight that was lost during treatment."[114] The Women's Health Initiative ("the largest and longest randomized, controlled dietary intervention clinical trial"[114]) found that long-term dietary intervention increased the waist circumference of both the intervention group and the control group, though the increase was smaller for the intervention group. The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.2 kg (P<.001) and was 2.2 kg less than the control group change from baseline at year 1. This difference from baseline between control and intervention groups diminished over time, but a significant difference in weight was maintained through year 9, the end of the study.[115]

Society and culture

Myths

There is a common misconception that spot exercise (that is, exercising a specific muscle or location of the body) most effectively burns fat at the desired location, but this is not the case. Spot exercise is beneficial for building specific muscles, but it has little effect, if any, on fat in that area of the body, or on the body's distribution of body fat. The same logic applies to sit-ups and belly fat. Sit-ups, crunches and other abdominal exercises are useful in building the abdominal muscles, but they have little effect, if any, on the adipose tissue located there.[116]

Colloquialisms

A large central adiposity deposit has been assigned many common use names, including "spare tire", "paunch", and "potbelly".[117] Several colloquial terms used to refer to central obesity, and to people who have it, refer to beer drinking. However, there is little scientific evidence that beer drinkers are more prone to central obesity, despite its being known colloquially as "beer belly", "beer gut", or "beer pot". One of the few studies conducted on the subject did not find that beer drinkers are more prone to central obesity than nondrinkers or drinkers of wine or spirits.[118][119] Chronic alcoholism can lead to cirrhosis, symptoms of which include gynecomastia (enlarged breasts) and ascites (abdominal fluid). These symptoms can suggest the appearance of central obesity.

Deposits of excess fat at the sides of one's waistline or obliques are commonly referred to as "love handles".

Economics

Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31,840 subjects aged 50–64 years of age with different waist circumferences. Their study showed that an increase in just an additional centimetre above normal waistline caused a 1.25% and 2.08% rise in health care costs in women and men respectively. To put this in perspective, a woman with a waistline of 95 cm (approx 37.4 in) and without underlying health problems or co-morbidities can incur economic costs that are 22%, or US$397, higher per year than a woman with a normal waist circumference.[120]

See also

  • Bariatrics, the branch of medicine that deals with the causes, prevention, and treatment of obesity
  • Lipoatrophy, the term describing the localized loss of fat tissue
  • Normal weight obesity, normal BMI with excessive fat, usually centrally localized
  • Panniculus, hanging belly fat
  • Steatosis, also called fatty change, fatty degeneration or adipose degeneration
  • Muffin top

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Further reading

 
Wikimedia Commons has media related to Abdominal obesity.
  • Griesemer RL (July 25, 2008). "Index of Central Obesity as a Parameter to Evaluate Metabolic Syndrome for White, Black, and Hispanic Adults in the United States" (Master's thesis). Public Health Theses. Georgia State University. doi:10.57709/1062268.
  • Lee K, Song YM, Sung J (April 2008). "Which obesity indicators are better predictors of metabolic risk?: healthy twin study". Obesity. 16 (4): 834–40. doi:10.1038/oby.2007.109. PMID 18239595. S2CID 1633972.
  • Shao J, Yu L, Shen X, Li D, Wang K (November 2010). "Waist-to-height ratio, an optimal predictor for obesity and metabolic syndrome in Chinese adults". The Journal of Nutrition, Health & Aging. 14 (9): 782–5. doi:10.1007/s12603-010-0106-x. PMID 21085910. S2CID 11187741.

External links

March 04, 2023
abdominal, obesity, also, known, central, obesity, truncal, obesity, condition, when, excessive, visceral, around, stomach, abdomen, built, extent, that, likely, have, negative, impact, health, been, strongly, linked, cardiovascular, disease, alzheimer, diseas. Abdominal obesity also known as central obesity and truncal obesity is a condition when excessive visceral fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health Abdominal obesity has been strongly linked to cardiovascular disease 1 Alzheimer s disease and other metabolic and vascular diseases 2 Abdominal obesityOther namesCentral obesity truncal obesity see also ColloquialismsAn abdominous obese maleWeight 182 kg 400 lbsHeight 185 cm 6 ft 1 in Body mass index 53SpecialtyEndocrinologyComplicationsHeart disease asthma stroke diabetesCausesSedentary lifestyle Overeating Cushing s syndrome Alcoholism Polycystic ovarian syndrome Prader Willi syndromeVisceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes 3 Visceral fat also known as organ fat or intra abdominal fat is located inside the peritoneal cavity packed in between internal organs and torso as opposed to subcutaneous fat which is found underneath the skin and intramuscular fat which is found interspersed in skeletal muscle Visceral fat is composed of several adipose depots including mesenteric epididymal white adipose tissue EWAT and perirenal fat An excess of adipose visceral fat is known as central obesity the pot belly or beer belly effect in which the abdomen protrudes excessively This body type is also known as apple shaped as opposed to pear shaped in which fat is deposited on the hips and buttocks Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease diabetes and dyslipidemia Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra abdominal fat and subcutaneous fat 4 Contents 1 Health risks 1 1 Heart disease 1 2 Diabetes 1 3 Asthma 1 4 Alzheimer s disease 1 5 Other health risks 2 Causes 2 1 Diet 2 2 Alcohol consumption 2 3 Other factors 3 Diagnosis 3 1 Index of central obesity 3 2 Sex differences 4 Management 5 Society and culture 5 1 Myths 5 2 Colloquialisms 5 3 Economics 6 See also 7 References 8 Further reading 9 External linksHealth risks EditHeart disease Edit Abdominal obesity is typically associated with a statistically higher risk of heart disease hypertension insulin resistance and type 2 diabetes see below 5 With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well 6 Metabolic syndrome is associated with abdominal obesity blood lipid disorders inflammation insulin resistance full blown diabetes and increased risk of developing cardiovascular disease 7 8 9 10 It is now generally believed that intra abdominal fat is the depot that conveys the biggest health risk 4 11 Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio vascular risk 12 Diabetes Edit There are numerous theories as to the exact cause and mechanism in type 2 diabetes Central obesity is known to predispose individuals for insulin resistance Abdominal fat is especially active hormonally secreting a group of hormones called adipokines that may possibly impair glucose tolerance But adiponectin an anti inflammatory adipokine which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus T2DM 13 14 Insulin resistance is a major feature of diabetes mellitus type 2 and central obesity is correlated with both insulin resistance and T2DM itself 15 16 Increased adiposity obesity raises serum resistin levels 17 18 19 20 which in turn directly correlate to insulin resistance 21 22 23 24 Studies have also confirmed a direct correlation between resistin levels and T2DM 17 25 26 27 And it is waistline adipose tissue central obesity which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin 28 29 Conversely serum resistin levels have been found to decline with decreased adiposity following medical treatment 30 Asthma Edit Developing asthma due to abdominal obesity is also a main concern As a result of breathing at low lung volume the muscles are tighter and the airway is narrower Obesity causes decreased tidal volumes due to reduced in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragms 31 It is commonly seen that people who are obese breathe quickly and often while inhaling small volumes of air 32 People with obesity are also more likely to be hospitalized for asthma A study has stated that 75 of patients treated for asthma in the emergency room were either overweight or obese 33 Alzheimer s disease Edit Based on studies it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer s disease Recent studies have also shown an association between mid life obesity and dementia but the relationship between later life obesity and dementia is less clear 2 A study by Debette et al 2010 examining over 700 adults found evidence to suggest higher volumes of visceral fat regardless of overall weight were associated with smaller brain volumes and increased risk of dementia 34 35 36 Alzheimer s disease and abdominal obesity has a strong correlation and with metabolic factors added in the risk of developing Alzheimer s disease was even higher Based on logistic regression analyses it was found that obesity was associated with an almost 10 fold increase risk of Alzheimer s disease 2 Other health risks Edit Central obesity can be a feature of lipodystrophies a group of diseases that is either inherited or due to secondary causes often protease inhibitors a group of medications against AIDS Central obesity is a symptom of Cushing s syndrome 37 and is also common in patients with polycystic ovary syndrome PCOS Central obesity is associated with glucose intolerance and dyslipidemia Once dyslipidemia becomes a severe problem an individual s abdominal cavity would generate elevated free fatty acid flux to the liver The effect of abdominal adiposity occurs not just in those who are obese but also affects people who are non obese and it also contributes to insulin sensitivity citation needed Ghroubi et al 2007 examined whether abdominal circumference is a more reliable indicator than BMI of the presence of knee osteoarthritis in obese patients 38 They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects Ghroubi et al 2007 concluded that a high abdominal circumference is associated with great functional repercussion 38 Causes EditDiet Edit See also Diet and obesity The currently prevalent belief is that the immediate cause of obesity is net energy imbalance the organism consumes more usable calories than it expends wastes or discards through elimination Some studies indicate that visceral adiposity together with lipid dysregulation and decreased insulin sensitivity 39 is related to the excessive consumption of fructose 40 41 42 Some evidence shows that in regards to juveniles when free fructose is present as children s fat cells mature it makes more of these cells mature into fat cells in the abdominal region It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin These effects were not attenuated when compared to similar glucose consumption 43 Intake of trans fat from industrial oils has been associated with increased abdominal obesity in men 44 and increased weight and waist circumference in women 45 These associations were not attenuated when fat intake and calorie intake was accounted for 46 47 Greater meat processed meat red meat and poultry consumption has also been positively associated with greater weight gain and specifically abdominal obesity even when accounting for calories 48 49 Conversely studies suggest that oily fish consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant 50 51 Similarly increased soy protein consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled 52 53 Numerous large studies have demonstrated that ultraprocessed food UPF 54 has a positive dose dependent relationship with both abdominal obesity and general obesity in both men and women Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk lower waist circumference and less chronic disease These findings are consistent among American 55 Canadian 56 Latin American 57 Australian 58 British 59 French 60 Spaniard 61 Swedish 62 South Korean 63 Chinese 64 and Sub Saharan African 65 populations Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high carbohydrate diets 66 unreliable source It has also been shown that quality protein intake during a 24 hour period and the number of times the essential amino acid threshold of approximately 10 g 67 has been achieved is inversely related to the percentage of central abdominal fat Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein 68 Visceral fat cells will release their metabolic by products in the portal circulation where the blood leads straight to the liver Thus the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there In the liver most of it will be stored as fat This concept is known as lipotoxicity 69 Alcohol consumption Edit A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men but not in women After controlling for energy under reporting which have slightly attenuated these associations it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants but not in the small number of female participants 2 13 with elevated alcohol consumption even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol Further research is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol 70 A systemic review and meta analysis failed to find data pointing towards a dose dependent relationship between beer intake and general obesity or abdominal obesity at low or moderate intake levels under 500 mL day However high beer intake above 4 L wk appeared to be associated with a higher degree of abdominal obesity specifically particularly among men 71 Other factors Edit The prevalence of abdominal obesity is increasing in Western populations possibly due to a combination of low physical activity and high calorie diets and also in developing countries where it is associated with the urbanization of populations 72 73 Other environmental factors such as maternal smoking estrogenic compounds in the diet and endocrine disrupting chemicals may be important also 74 Hypercortisolism such as in Cushing s syndrome also leads to central obesity Many prescription drugs such as dexamethasone and other steroids can also have side effects resulting in central obesity 37 especially in the presence of elevated insulin levels Diagnosis Edit Silhouettes and waist circumferences representing normal overweight and obese There are various ways of measuring abdominal obesity including Absolute waist circumference gt 102 cm 40 in in men and gt 88 cm 35 in in women 75 Waist hip ratio the circumference of the waist divided by that of the hips of gt 0 9 for men and gt 0 85 for women 1 Waist stature ratio waist circumference divided by their height gt 0 5 for adults under 40 and gt 0 6 for adults over 50 Sagittal Abdominal Diameter 76 Overweight teenage boy holding his excess abdominal fat In those with a body mass index BMI under 35 intra abdominal body fat is related to negative health outcomes independent of total body fat 77 Intra abdominal or visceral fat has a particularly strong correlation with cardiovascular disease 1 BMI and waist measurements are well recognized ways to characterize obesity However waist measurements are not as accurate as BMI measurements Waist measurement e g for BFP standard is more prone to errors than measuring height and weight e g for BMI standard BMI will illustrate the best estimate of one s total body fatness while waist measurement gives an estimate of visceral fat and risk of obesity related disease 78 It is recommended to use both methods of measurements 79 An adult man with abdominal obesity While central obesity can be obvious just by looking at the naked body see the picture the severity of central obesity is determined by taking waist and hip measurements The absolute waist circumference 102 centimetres 40 in in men and 88 centimetres 35 in in women and the waist hip ratio gt 0 9 for men and gt 0 85 for women 1 are both used as measures of central obesity A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating In the cohort of 15 000 people participating in the National Health and Nutrition Examination Survey NHANES III waist circumference explained obesity related health risk better than BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant In other words excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI 80 Another measure of central obesity which has shown superiority to BMI in predicting cardiovascular disease risk is the Index of Central Obesity waist to height ratio WHtR where a ratio of gt 0 5 i e a waist circumference at least half of the individual s height is predictive of increased risk 81 Another diagnosis of obesity is the analysis of intra abdominal fat having the most risk to one s personal health The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman 1998 review 4 An increasing acceptance of the importance of central obesity within the medical profession as an indicator of health risk has led to new developments in obesity diagnosis such as the Body Volume Index which measures central obesity by measuring a person s body shape and their weight distribution The effect of abdominal adiposity occurs not just in those who are obese but also affects people who are non obese and it also contributes to insulin sensitivity Index of central obesity Edit Index of Central Obesity ICO is the ratio of waist circumference and height first proposed by a Parikh et al in 2007 82 as a better substitute to the widely used waist circumference in defining metabolic syndrome 83 The National Cholesterol Education Program Adult Treatment Panel III suggested cutoff of 102 cm 40 in and 88 cm 35 in for males and females as a marker of central obesity 75 The same was used in defining metabolic syndrome 84 Misra et al suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm 35 in and 80 cm 31 in for males and females 85 Various race specific cutoffs were suggested by different groups 86 The International Diabetes Federation defined central obesity based on these various race and gender specific cutoffs 87 The other limitation of waist circumference is that it the measurement procedure has not been standardized and in children there are no or few comparison standards or reference data 88 Parikh et al looked at the average heights of various races and suggested that by using ICO various race and gender specific cutoffs of waist circumference can be discarded 83 An ICO cutoff of 0 53 was suggested as a criterion to define central obesity Parikh et al further tested a modified definition of metabolic syndrome in which waist circumference was replaced with ICO in the National Health and Nutrition Examination Survey NHANES database and found the modified definition to be more specific and sensitive 83 This parameter has been used in the study of metabolic syndrome 89 90 and cardiovascular disease 91 Central obesity in individuals with normal BMI is referred to as normal weight obesity Sex differences Edit There are sex dependent differences in regional fat distribution Males are more susceptible to upper body fat accumulation most likely in the belly due to sex hormone differences 92 When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre menopausal women 93 94 In women estrogen is believed to cause fat to be stored in the buttocks thighs and hips 95 When women reach menopause and the estrogen produced by ovaries declines fat migrates from their buttocks hips and thighs to their belly 96 97 50 of men and 70 of women in the United States between the ages of 50 and 79 years now exceed the waist circumference threshold for central obesity 98 Central obesity is positively associated with coronary heart disease risk in women and men It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk 99 Even with the differences at any given level of central obesity measured as waist circumference or waist to hip ratio coronary artery disease rates are identical in men and women 100 Management EditThis section needs expansion You can help by adding to it January 2019 A permanent routine of exercise eating healthily and during periods of being overweight consuming the same number or fewer calories than used will prevent and help fight obesity 101 A single pound of fat yields approximately 3500 calories of energy 32 000 kJ energy per kilogram of fat and weight loss is achieved by reducing energy intake 102 or increasing energy expenditure thus achieving a negative balance Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the US 103 the UK 104 the EU 105 Australia 106 Canada 107 Hong Kong 108 and Thailand 109 A 2006 study published in the International Journal of Sport Nutrition and Exercise Metabolism 110 suggests that combining cardiovascular aerobic exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat An additional benefit to exercising is that it reduces stress and insulin levels which reduce the presence of cortisol a hormone that leads to more belly fat deposits and leptin resistance 111 Self motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics In addition understanding the health issues linked with abdominal obesity can help in the self motivation process of losing the abdominal fat As mentioned above abdominal fat is linked with cardiovascular disease diabetes and cancer Specifically it s the deepest layer of belly fat the fat that cannot be seen or grabbed that poses health risks as these visceral fat cells produce hormones that can affect health e g increased insulin resistance and or breast cancer risk The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity For example fat next to the liver drains into it causing a fatty liver which is a risk factor for insulin resistance setting the stage for type 2 diabetes However visceral fat is more responsive to the circulation of catecholamines In the presence of type 2 diabetes the physician might instead prescribe metformin and thiazolidinediones rosiglitazone or pioglitazone as antidiabetic drugs rather than sulfonylurea derivatives Thiazolidinediones may cause slight weight gain but decrease pathologic abdominal fat visceral fat and therefore may be prescribed for diabetics with central obesity 112 Thiazolidinedione has been associated with heart failure and increased cardiovascular risk so it has been withdrawn from the market in Europe by EMA in 2010 113 Low fat diets may not be an effective long term intervention for obesity as Bacon and Aphramor wrote The majority of individuals regain virtually all of the weight that was lost during treatment 114 The Women s Health Initiative the largest and longest randomized controlled dietary intervention clinical trial 114 found that long term dietary intervention increased the waist circumference of both the intervention group and the control group though the increase was smaller for the intervention group The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2 2 kg P lt 001 and was 2 2 kg less than the control group change from baseline at year 1 This difference from baseline between control and intervention groups diminished over time but a significant difference in weight was maintained through year 9 the end of the study 115 Society and culture EditMyths Edit There is a common misconception that spot exercise that is exercising a specific muscle or location of the body most effectively burns fat at the desired location but this is not the case Spot exercise is beneficial for building specific muscles but it has little effect if any on fat in that area of the body or on the body s distribution of body fat The same logic applies to sit ups and belly fat Sit ups crunches and other abdominal exercises are useful in building the abdominal muscles but they have little effect if any on the adipose tissue located there 116 Colloquialisms Edit A large central adiposity deposit has been assigned many common use names including spare tire paunch and potbelly 117 Several colloquial terms used to refer to central obesity and to people who have it refer to beer drinking However there is little scientific evidence that beer drinkers are more prone to central obesity despite its being known colloquially as beer belly beer gut or beer pot One of the few studies conducted on the subject did not find that beer drinkers are more prone to central obesity than nondrinkers or drinkers of wine or spirits 118 119 Chronic alcoholism can lead to cirrhosis symptoms of which include gynecomastia enlarged breasts and ascites abdominal fluid These symptoms can suggest the appearance of central obesity Deposits of excess fat at the sides of one s waistline or obliques are commonly referred to as love handles Economics Edit Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31 840 subjects aged 50 64 years of age with different waist circumferences Their study showed that an increase in just an additional centimetre above normal waistline caused a 1 25 and 2 08 rise in health care costs in women and men respectively To put this in perspective a woman with a waistline of 95 cm approx 37 4 in and without underlying health problems or co morbidities can incur economic costs that are 22 or US 397 higher per year than a woman with a normal waist circumference 120 See also EditBariatrics the branch of medicine that deals with the causes prevention 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ups will make your abdominal muscles stronger sure And you may look thinner by building your abdominal muscles because you can hold in your belly fat better But strengthening your stomach muscles alone will not specifically reduce belly fat spare tire Merriam Webster Retrieved August 2 2021 paunch Merriam Webster Retrieved August 2 2021 potbelly Merriam Webster Retrieved August 2 2021 Bobak M Skodova Z Marmot M October 2003 Beer and obesity a cross sectional study European Journal of Clinical Nutrition 57 10 1250 3 doi 10 1038 sj ejcn 1601678 PMID 14506485 Staff writer 2003 10 12 Why the beer belly may be a myth BBC News Economic costs of abdominal obesity Hojgaard Betina and Olsen Kim Rose and Sogaard Jes and Sorensen Thorkild I A and Gyrd Hansen Dorte Obesity facts ISSN 1662 4025 2008 Volume 1 Issue 3 pp 146 154 Further reading Edit Wikimedia Commons has media related to Abdominal obesity Griesemer RL July 25 2008 Index of Central Obesity as a Parameter to Evaluate Metabolic Syndrome for White Black and Hispanic Adults in the United States Master s thesis Public Health Theses Georgia State University doi 10 57709 1062268 Lee K Song YM Sung J April 2008 Which obesity indicators are better predictors of metabolic risk healthy twin study Obesity 16 4 834 40 doi 10 1038 oby 2007 109 PMID 18239595 S2CID 1633972 Shao J Yu L Shen X Li D Wang K November 2010 Waist to height ratio an optimal predictor for obesity and metabolic syndrome in Chinese adults The Journal of Nutrition Health amp Aging 14 9 782 5 doi 10 1007 s12603 010 0106 x PMID 21085910 S2CID 11187741 External links Edit Retrieved from https en wikipedia org w index php title Abdominal obesity amp oldid 1141416805 Colloquialisms, wikipedia, wiki, book, books, library,

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