The Abs Plan That Can Save Your Health

Whether you call it middle-age spread, a beer belly, or a spare tire, thickness around the waist is more than a cosmetic issue. It can be a lethal health problem.

Excess belly fat, even in a person of normal weight, nearly doubles a person's risk of premature death from heart disease, hypertension, stroke, and cancer, according to the results of a European study of 360,000 people in nine countries. The report, released in November, said that determining risk is simple. Waist circumference should be no larger than 40 inches in men and 34 inches in women. An increase of just 2 inches raises the risk by 17 percent in men.

"This study is very important," says Dr. JoAnn Manson, chief of preventive medicine at Harvard’s Brigham and Women’s Hospital and a noted obesity researcher. "It means that a tape measure is better than a bathroom scale for assessing your risk."

Belly fat is so dangerous because it functions as what Dr. Manson calls "an endocrine factory." The fat that accumulates around the hips and legs, creating a pear shape, is subcutaneous fat (just under the skin), and it's unattractive but relatively safe. But the visceral fat that lies deep inside the abdomen, surrounding the liver and intestines, acts as "an active endocrine organ, secreting hormones and chemicals that cause chronic inflammation throughout the body," says Dr. Manson. "It interferes with cell communication and drains into the liver, affecting liver metabolism and insulin resistance and setting the stage for type 2 diabetes and heart disease."

Abdominal fat also seems to increase the risk of developing dementia, according to a study conducted last year by the Kaiser Permanente Division of Research in Oakland, Calif. It found that excess belly fat tripled the risk of dementia in a group of 6,500 patients.

While some people are prone to belly fat because of heredity or hormonal changes, they still can shrink those fat cells. "If you lose weight," says Dr. Michael D. Jensen, an endocrinologist and obesity researcher at the Mayo Clinic, "the cells get smaller and seem to work a lot better."

The fitness Rx

Exercise is the most effective way to burn visceral fat. A study at Wake Forest University found that participants who solely dieted lost weight but not belly fat. Dieters who also exercised decreased the size of their abdominal fat cells by 18 percent. "The message is clear," says Tongjian You, the instructor of geriatric medicine who conducted the study. "Exercise is important to reducing the size of these cells and may one day be part of a prescription for treating the health complications associated with abdominal fat." Cardio exercises, which burn calories and fat, are the best way to shrink your middle. Researchers at Duke University Medical Center concluded that about 30 minutes a day is optimum. While spot exercises will not reduce a spare tire, keeping ab muscles toned will give you a strong core and back.

The right diet

Many books and Web sites tout "miracle foods" as belly-fat panaceas, but the marketing is way ahead of the science, says Christine Rosenbloom, a professor of nutrition at Georgia State University in Atlanta. "There isn't enough evidence to make conclusions about foods and belly fat," she adds. "In general, a diet rich in fruits and vegetables, whole grains, and lean protein but low in sugar is recommended for everyone."

Other research indicates that trans fats, which are found in some margarines and some prepared foods, may contribute to an increase in belly fat. Beyond these findings, "there's some promising data on vitamin D," says Dr. Manson, "and some limited evidence that refined carbohydrates may be associated with abdominal fat."

A recent study conducted by Dr. Steven F. Bolling, a professor of cardiac surgery at the University of Michigan, found that tart cherries reduced belly fat in rats. And now Dr. Bolling eats up to a cup of tart cherries every day. "But I also run 40 to 60 miles a week," he says.

Though cherries certainly can't hurt, until some magic bullet is discovered, diet and exercise are still the only sure way to improve your middle—and your health.