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Fat (adipose) is an intriguing organ system due to its multitude of bodily functions. The body contains several types of adipose tissue that vary by function and location. Most of the fat tissue humans possess is comprised of white adipocytes which are primarily responsible for secretion of special fat-derived hormones called adipokines, such as leptin.

The other (much less abundant) type of fat tissue humans possess is brown fat, which is actually a “healthy” fat in that it is metabolically demanding and tends to be higher in lean individuals.[1] The roles of brown fat extend beyond the scope of this article so we’ll save that for a future installment.

Back on point, visceral fat is fat tissue that surrounds the internal organs and lies on the dorsal side of the abdominal wall; this fat differs in form and function from subcutaneous fat tissue which lays underneath the dermal layers. An overabundance of visceral fat tissue (which comprises the majority of ‘belly fat’) appears to be the major culprit of the health woes associated with obesity (i.e. excess white adipose tissue).[2]

Anatomical Complications of Excess Belly Fat

As noted above, visceral fat tissue presents not only anatomical contradictions but physiological contradictions as well. Visceral/belly fat, in excess, is largely responsible for three rather unappealing phenomena colloquially termed “skinny-fatness”, “growth-hormone (GH)/insulin gut”, and “protruding gut syndrome”. In all three instances, what happens is the proportion of subcutaneous fat to visceral fat becomes greatly askew, in favor of the latter. In turn, this results in a large accumulation of fat tissue behind the abdominal wall and literally “pushes” the abs and internal organs outward. In severe cases, this can result in a hernia and ‘pop’ the belly button outward.

Physiological Ramifications of Excess Belly  Fat

Where to begin here…Well, for starters, excessive visceral/belly fat has consistently been associated with elevated levels of blood triglycerides (i.e. hypertriglyceridemia), which is a major risk factor for cardiovascular disease.[3] Moreover, organ (especially the pancreas and liver) inflammation, decreased levels of high-density lipoproteins (HDLs) and concomitant increases in very-low-density lipoproteins (VLDLs), as well as secretion of proinflammatory adipokines have all also been associated with an overabundance of belly fat.

One of the more disconcerting complications, however, is the development of insulin resistance (which eventually can manifest itself into type-II diabetes).[4] The other endocrine and metabolic woes that excess belly fat presents are just as worrisome, including, but not limited to: lower levels of testosterone (specifically in males), decreased growth hormone (and thus lower levels of IGF-1) production, elevated cortisol levels, and leptin resistance. [5,6]

Adipokine Dysfunctions Present in Central Adiposity

Essentially, if your health, longevity and aesthetics mean much to you, then carrying a lot of belly fat is likely antagonizing your goals.  So what can be done to get rid of that belly fat that’s hiding your prized six-pack abdominals? Hours of ab training and crunches? Nope, quite the contrary actually. Read on as there is a myriad of rather simple solutions to this conundrum.

Keys to Losing Belly Fat

While I’m actually partial to the advancement of pharmaceuticals in the war on belly fat, I don’t feel drugs and/or supplements should be relied upon to “do all the work” for you because they almost never take care of everything (but they can help, nonetheless). Thus, it’s more pertinent to focus on the things we can do without drugs (e.g. dietary and lifestyle modifications) to eradicate belly fat once and for all..

High-Intensity Exercise

Naturally, exercise plays a large role in the equation to reduce belly fat. But not just any type of exercise, I’m talking more about vigorous anaerobic training (e.g. lifting weights and sprints). In fact, a study by Yamaguchi et. al found a significant negative correlation between visceral fat tissue and serum growth hormone levels among individuals in who train to their anaerobic threshold.[7] In layman’s terms, the more intense you train, the more growth hormone (GH) you secrete (which is a potent fat loss hormone).

Therefore, the rationale for doing hours of low-intensity cardio to lose belly fat seems to lose a lot of ground given that long, endurance-type training does not significantly boost GH levels, and may actually decrease it in certain cases.

Furthermore, a different study by Irving et. al found that “High-intensity Exercise Training (HIET)”, which is described as exercise performed at or above lactate threshold, actually raised the basal metabolic rate and significantly decreased waist circumference in overweight individuals. Not surprisingly, “Low-intensity Exercise Training (LIET)” and no exercise both actually decreased basal metabolic rate.[8]

This is yet another demonstration of the benefits of high-intensity interval training (HIIT) and resistance training, and most importantly, the significant reduction in belly fat when compared to low-intensity exercise.

Dietary Modifications

It shouldn’t come as much of a shock that if you want to get rid of that big ole pot belly you’re going to need to restrict your calorie intake a bit. The thing to keep in mind is that weight/fat loss can’t really be “targeted”, so reduction of caloric intake won’t get rid of solely visceral fat tissue. That being said, studies suggest that lowering caloric intake to a level that is about 20% below total energy expenditure can significantly reduce waist circumference (and improve internal health).[9,10]

My advice, especially for very overweight individuals, is not to focus so much on one specific macronutrient (ahem, carbohydrates), but rather start small and just work on reducing your total calorie intake by about 20%.

Bear in mind that low-carb diets inherently help cut calorie intake (assuming one isn’t loading up on fats in lieu of carbohydrates). Cutting carbs helps, but it’s not a cookie-cutter solution for losing belly fat..

I also have to assume that if you’re reading this article you are at least somewhat up to speed on the necessity of proteins and fats in the human diet. Again, the focus for getting rid of excessive belly fat is to control total calorie intake. As methodical as I like to be, it only adds to the stress of lowering calorie intake by telling individuals they have to completely cut out certain foods and/or severely limit a certain macronutrient. Plenty of athletes and gym goers can reveal their six-pack without harsh, restrictive dieting. If you’re a competitive bodybuilder, then obviously there is a little more to getting under 6% body fat than just calorie control, but I digress...

Lifestyle Modifications

This is sort of the “other” category and the suggestions herein will probably seem rather intuitive, but there’s a reason for that–they flat out work for cutting belly fat!

Limit Alcohol Consumption

You’re likely familiar that limiting alcohol intake is a rather important lifestyle modification if you’re looking to reduce your belly girth. If you must keep alcohol in your lifestyle/regimen, then try and keep intake reasonable; a beer or two every week or so won’t kill your progress, and may, in fact, be somewhat beneficial.

Avoid Tobacco

Studies have found that cigarette smokers who are obese and then give up the tobacco habit lose (and keep off) more weight than those who continue to puff away.[9,11,12] Frankly speaking, I don’t really see how cigarette smoking could ever really accompany someone looking to optimize their health, so if you’re a smoker looking to lose the gut I’d try and kick that habit.

Get Plenty of Sleep

Sleep is an interesting part of the weight-loss equation in that it appears even acute losses of sleep can significantly alter insulin sensitivity and food intake.[13,14] Findings show that individuals who consistently lack nominal amounts of sleep are at higher risk for obesity and type-II diabetes, and this seems to stem from the psychological desire to eat more throughout the day and simultaneous impairment of insulin sensitivity. On the flipside, oversleeping is not a good thing either, so try and find your “sweet spot” for a duration (likely between 6-8 hours per night) and stay consistent (i.e. avoid erratic sleep patterns).

Increase Your Non-Exercise Activity Thermogenesis (NEAT)

In a nutshell, NEAT entails the activities you do throughout the day that aren’t considered diligent physical exercise. So essentially NEAT is things like your walk up the stairs to the office or to the cafeteria for lunch, brushing your teeth, cooking, and so on. While I’m not going to suggest you start being super finicky and track your every movement, it is certainly worth your while to at least get up and move for a few minutes every 45 minutes to an hour or so if you live a sedentary lifestyle. People who sit behind a desk for eight hours a day may stand to benefit from switching to a standing desk not just for posture purposes, but because this also appears to turn on fat-burning enzymes, specifically lipoprotein lipase (LPL).[15]

Bringing It All Together

This is a lot to take in, but it’s a complex topic and I’d rather be too thorough as opposed to abbreviated. Belly fat is arguably the driving force behind why many people join a gym in the first place. It’s never fun to look in the mirror and wish you could finally see those six-pack abs you know are hiding in there. The good news is that there’s not much mystery in the fat-loss process; more than anything, it’s all about consistency and patience.

References:

  1. Saito, M., Okamatsu-Ogura, Y., Matsushita, M., Watanabe, K., Yoneshiro, T., Nio-Kobayashi, J., … & Tsujisaki, M. (2009). High incidence of metabolically active brown adipose tissue in healthy adult humans effects of cold exposure and adiposity. Diabetes, 58(7), 1526-1531.
  2. Fontana, L., Eagon, J. C., Trujillo, M. E., Scherer, P. E., & Klein, S. (2007). Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes, 56(4), 1010-1013.
  3. Tchernof, A., & Després, J. P. (2013). Pathophysiology of human visceral obesity: an update. Physiological reviews, 93(1), 359-404.
  4. Azuma, K., Heilbronn, L. K., Albu, J. B., Smith, S. R., Ravussin, E., & Kelley, D. E. (2007). Adipose tissue distribution in relation to insulin resistance in type 2 diabetes mellitus. American Journal of Physiology-Endocrinology And Metabolism, 293(1), E435-E442.
  5. Seidell, J. C., Björntorp, P., Sjöström, L., Kvist, H., & Sannerstedt, R. (1990). Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels. Metabolism, 39(9), 897-901.
  6. Mårin, P., Kvist, H., Lindstedt, G., Sjöström, L., & Björntorp, P. (1993). Low concentrations of insulin-like growth factor-I in abdominal obesity. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity, 17(2), 83
  7. Yamaguchi, T., Saiki, A., Endo, K., Miyashita, Y., & Shirai, K. (2011). Effect of exercise performed at anaerobic threshold on serum growth hormone and body fat distribution in obese patients with type 2 diabetes. Obesity Research & Clinical Practice, 5(1), e9-e16.

8.Irving, B. A., Davis, C. K., Brock, D. W., Weltman, J. Y., Swift, D., Barrett, E. J., … & Weltman, A. (2008). Effect of exercise training intensity on abdominal visceral fat and body composition. Medicine and science in sports and exercise,40(11), 1863.

  1. Hu, F. B., Manson, J. E., Stampfer, M. J., Colditz, G., Liu, S., Solomon, C. G., & Willett, W. C. (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. New England Journal of Medicine, 345(11), 790-797.

10.Fontana, L., & Klein, S. (2007). Aging, adiposity, and calorie restriction. JAMA: the journal of the American Medical Association, 297(9), 986-994.

11.Brown, J. K. (1993, April). Gender, age, usual weight, and tobacco use as predictors of weight loss in patients with lung cancer. In Oncology nursing forum (Vol. 20, No. 3, p. 466).

12.Kayman, S., Bruvold, W., & Stern, J. S. (1990). Maintenance and relapse after weight loss in women: behavioral aspects. The American journal of clinical nutrition, 52(5), 800-807.

13.Vgontzas, A. N., Papanicolaou, D. A., Bixler, E. O., Hopper, K., Lotsikas, A., Lin, H. M., … & Chrousos, G. P. (2000). Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. Journal of Clinical Endocrinology & Metabolism, 85(3), 1151-1158.

14.Spiegel, K., Knutson, K., Leproult, R., Tasali, E., & Van Cauter, E. (2005). Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes.Journal of applied physiology, 99(5), 2008-2019.

15.Judson, O. (2010). Stand Up While You Read This!. New York Times, 23.