All Fat is Created Equal. Or Maybe Not? By Dr. W

We have come a long way in our understanding of obesity. We now characterize “fat people” as apples or pears, having love handles or beer bellies, and more aptly as having subcutaneous versus abdominal or visceral obesity. Are these just terms or are there scientific distinctions? What’s it all about and why is it important?

We are in the midst of a major health epidemic. Although the U.S. leads the world with the highest percentage of obese people, the rest of the western world is fast catching up. imagesWalk down the street and you see person after person with protuberant abdomens. Where we once grew accustomed to holding on to love handles in our spouses, we now have a world of people who can no longer see there umbilicus (belly buttons) and parts further south. So why care? The fat has moved more centrally into the abdomen No big deal? However, that forward movement to the abdomen is the core of the problem.

We now understand that those intra-abdominal fat deposits surround important tissues – liver, pancreas, and spleen. Those deposits are associated with type II diabetes mellitus, hypertension, cardiovascular disease and even cancers. The wells of fat within your abdomen behave differently than subcutaneous fat in your hips, thighs or calves. They produce insulin resistance, hypertriglyceridemia, low HDL (good cholesterol), small particle LDL, and fat deposits within the liver all leading to the aforementioned diseases, and most blatantly and glaringly, to the alarming increase of diabetic insulin resistant patients. What’s worse is that it is affecting younger and younger people – our kids and grandkids. It is no less widespread than the great influenza epidemic of the 1920’s, the “great flu pandemic” that affected millions upon millions of people worldwide. That pandemic led to the death of over 20 million people.

No one is really sure of the cause of widespread obesity. Is it the easy availability of food? Our slackening off in activity? Genetic propensity for obesity? All probably contribute to the present situation we find ourselves in. To a certain extent we fell victim to the poor advice of the “medical establishment” and the food industry who for decades advised limiting fat in our daily calorie intake and substituting a higher percentage of carbohydrates in our diets.

Years of packaging and marketing “low cholesterol” and “no trans-fat” foods was the wrong advice.


America, and the rest of the world has woken up. We now recommend lower consumption of carbs and more liberal fat intake.

strict-vegg-400x299Can we reverse the damage? With change in diet, calorie restriction, and exercise we can reverse visceral or abdominal obesity. For the morbidly obese bariatric surgery – gastric bypass procedures are the only effective answer. We, in medicine, have no magic bullets or effective medications to offer. Some medications can work in a limited manner but frequently with side effects.

There is no cure. First step is to see your doctor and let him measure your BMI (Body Mass Index) and do a hip to waist ratio. Let him measure your triglycerides, fasting blood sugar, and hemoglobin A1C. He will probably provide standard regimens of low carbohydrate diet and caloric restrictions, frequent or daily exercise and reduced stress and plenty of sleep. That’s right sleep. For those of you who think getting up at 5:00AM and going to the gym on only 5-6 hours of sleep is wise, think again. You need those 7-8 hours of sleep every night. And it is true that stomach crunches make no difference.

Bottom line. To reduce abdominal fat, you need to work hard. However, it is well worth the effort if you can fight off the consequences.

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