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The Post 40 Belly Bulge and All Associated Middle Aged Issues

Malini Rao's picture
Belly Bulge

How many of us - past the age of 40 - have looked down at our expanding waistlines and fondly remembered the time when we didn’t have to look down at our spare tire. Envious glances at millennials with their smooth skin and perfect tummies and everything we remembered before children and the home and the mortgage.


There are tons and tons of stuff that Plastic Surgery / Cosmetic surgery may fix – confirmed with the wealth of information on the pamphlet from your corner surgeons’s office. Not to mention the inundation of Facebook / Twitter / Radio / Billboard advertising that is common to most American Life in 2019 – topics to be addressed in a follow up article concerning plastic surgery. Back to the topic of the disturbing spare tire we have around our abdomen.

Truncal obesity is the “spare tire”, the fat that accumulates around the abdomen. A simple definition is in men – if the waist circumference exceeds 40 inches, and in women greater than 35 cm – you have are probably truncally obese, or apple shaped obese. The problem with truncal obesity is because of the unique distribution of the abdominal fat – you are at risk of developing a syndrome known as metabolic syndrome.

A word about body fat. Whatever we don’t consume (excess calories) will eventually be converted by the body and our metabolism into fat. One form is subcutaneous fat -felt best in our upper arms, armpits, thighs, buttocks. Eventually with time, stress, and hormones, the fat goes and distributes everywhere. Thunder Thighs, double chin, larger breast size, and the tummy are the most likely culprits. However – the deposition of fat into the abdomen is particularly distressing and has its own nomenclature – visceral fat. The abdomen, below the diaphragm, is largely a large peritoneal lined cavity containing vital organs (notably the liver, the gastrointestinal track, the spleen, and other genitourinary organs specific to both sexes). Because it is an expandable container (think of how much the Uterus must expand to hold that term 9 pound baby!) it may expand or shrink to accommodate various conditions. In one extreme – starvation / malnutrition – the abdomen fat reserves will be completely depleted. Think of the sunken scaphoid tummies of malnourished children.

However – much more common to American Life in 2019 – we tend to see the absolute opposite. Think of all that visceral fat storage around all your vital organs, accumulating with time, and expanding to the extent that one does notice the spare tire in the mid section. Visceral fat is very different from subcutaneous fat. It tends to accumulate more when one has increased steroid production (cortisol) made under stress. The fight-or-flight response of the sympathetic nervous system triggers excess corticosteroid production from the adrenal glands, triggering the body to accumulate more visceral fat around vital organs. This visceral fat reacts differently to breakdown (ie, it is more resistant). When one starves, they will lose subcutaneous fat before they lose visceral fat. Furthermore, once it accumulates beyond a certain value (think waist size 35 in non pregnant females and 40 in males), it is associated with a host of conditions known as Metabolic Syndrome.

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Metabolic Syndrome is troublesome. In addition to metabolic fat / truncal obesity being a known risk factor for Diabetes mellitus / pre-diabetes, it is a known cause of hardening of the arteries (arteriosclerosis) that is a precursor to hypertension, stroke, and CVA. It also is an established risk factor for Heart Disease and Coronary Artery Disease. In fact, the hip to waist ratio has been established as a definitive risk factor for coronary artery disease.

That’s the biggest problem with truncal obesity. It causes metabolic syndrome, which may cause a host of other medical conditions later. Lets reflect on these conditions – Diabetes mellitus, Hypertension, CVA (stroke), Heart and Coronary Disease. We will be discussing all of them in my upcoming articles. But what must be brought in mind is – (i) all are largely preventable if picked up early enough, (ii) the morbidity (loss of functional Life) and mortality (death) from these conditions maybe reversed / prevented if these diseases are treated early in life. Yes folks. Preventable. Lifestyle / Diet. We will be talking about all these changes in the upcoming articles.

How many of us have gone to a Funeral where someone passed of, say – lung cancer – and we wondered what they may have done to prevent the premature death. How many of us have seen a 40 something develop coronary artery disease and wonder – was this really necessary?

Now we know. Truncal obesity isn’t good. Its terrible actually. Visceral fat is known to be harder to lose than subcutaneous fat. Once the body resets itself to elevated blood pressure or blood sugar – its an automatic conversion to pre-hypertensive or pre-diabetic state.

Both of these conditions are highly preventable. And that will be the focus of future articles this week. How to make our lives better.

1. Changes in truncal obesity and fat distribution. Corrigan et al. J. of Clinical Lipidology 2017 Nov-Dec 11(6) 1354-1360
2. The Cortisol Response in Policemen: Intraindividual variation, not concentration level predicts truncal obesity
3. Assessing Central Obesity: Waist Circumference. My Virtual Medical Center (www.myvmc.com)
4. Waisted: Abdominal Obesity and Your Health. Harvard Health Publishing (online publication)