If you’re serious about living to a ripe old age (and staying healthy) your tape measure has just become your new best friend.
‘There is a simple test to determine the shape you’re in,’ says Professor Tessa van der Merwe, endocrinologist and honorary secretary of the International Association for the Study of Obesity (London). And it has nothing to do with what you see in the mirror.
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Chunky thighs and bulging hips may have you sighing in dismay, but the real yardstick is the circumference of your waist. ‘If it’s below 80cm, you’re fine,’ says Van der Merwe, who is also attached to the Molecular and Metabolic Research Unit at the University of Pretoria.
‘If it’s between 80cm and 88cm, you’re moving in the wrong direction and should take action. But if it’s above 88cm, you’re in trouble. You’ve hit the red zone. Real danger. And you need to seek professional help, now!’
Two forms of fat
To understand the hype about having a tummy tyre, you need to know a little about abdominal fat and its dangers.
‘There are two forms of fat,’ says Van der Merwe. ‘The first is subcutaneous fat, which sits immediately under the skin – in the arms, thighs, buttocks and abdomen. It’s the kind of fat you’re at war with when you try to get into those tight jeans. The second type is visceral fat, which sits inside, directly around the organs, and has a different anatomy to subcutaneous fat.
In disease management, clinicians worry about the amount of visceral fat you have around your organs because this is what makes you far more likely to suffer from serious chronic illnesses such as diabetes, hypertension and heart disease.
‘In the past,’ she continues, ‘we believed that this fat used to sit there innocuously and inertly; today we know this is not the case.
Studies of activity at cellular level have proved that not only does visceral fat negatively affect the normal functionality of organ cells but eventually kills them off. Also, fat cells have an inflammatory cross-talk – if there is an inflammatory reaction in a fat cell, it is likely to create an inflammatory reaction elsewhere in the body.
Health hazards
Doctors agree that the major associated risks include:
heart attacks;
infertility;
gout;
depression;
sleep apnoea (breathing stops or becomes very shallow while sleeping);
polycystic ovarian syndrome;
hormone-dependent cancers, such as breast and uterine cancers;
non-alcoholic fatty liver disease, which can lead to cirrhosis of the liver, end-stage liver disease and death.
We’re all at risk
So are we all prone to middle-age spread? ‘Almost certainly,’ says Van der Merwe. ‘But if you ask whether it’s inevitable, the answer is a definite no.
If you take preventive measures and you understand what happens to your body as you age, you can avoid it. But if you leave it until the day you enter menopause, it may be too late and you could be in trouble.
‘This is because certain hormonal changes take place in every woman’s life around menopause,’ she explains.
‘One is the loss of the two main female hormones: oestrogen and progesterone. Both these have an action that protects muscle bulk in the body, which is what determines whether your metabolic rate is good or bad. Part of the menopausal package is the loss of these hormones, which leaves you wide open to middle-age spread.’
Take stock
The first step is to get out that tape measure and take stock, and to seek immediate professional help if you fall into those unhealthy parameters.
If you’re lucky and haven’t developed a co-morbid disease associated with obesity, it’s possible to start afresh. And what you need to do first is to get moving. According to Till, the World Health Organisation (WHO) estimates that about 60 percent of the world’s population doesn’t meet the minimum requirement for exercise, which is 45 to 60 minutes five days a week.
You also need to start making wise food choices. ‘By following a low insulin-producing diet you’ll promote fat oxidation (fat burning) and reduce abdominal fat storage.’
Work it!
‘Regular exercise will reduce unseen intra-abdominal fat – the most dangerous type of fat – even if the scale does not show weight loss,’ says Dr Franciska Venter, national fitness manager for Virgin Active SA.
‘Start with moderate low-impact cardiovascular exercise (brisk walking, cycling, swimming or gardening) to lose weight and build strength, and make lifestyle changes like using the stairs and parking further away from the office and walking,’ says Venter.
‘Then you need to build muscle because muscle burns more energy than fat. Weight-bearing exercises and basic resistance exercises (such as the circuit at the gym) build muscle, and then you can start with your tummy crunches for toning: Pilates, aqua classes and body-conditioning workouts are perfect.’
Lose it!
Till offers these suggestions for fighting abdominal flab:
Avoid fad diets and adopt a healthier way of eating for life.
Don’t skip meals. If you do, you may end up with hypoglycaemia (low blood sugar), which is a potent appetite stimulant that can promote uncontrolled eating behaviour and sugar cravings.
Limit your intake of high-insulin producing foods: sugar and sugary foods and beverages; refined starchy foods made with white flour, such as white bread, biscuits, cakes and pastries; hard cheese; alcohol; saturated fat, such as butter; and trans fats such as those found in some margarines and in food fried in hydrogenated vegetable oil.
Increase your consumption of low-insulin producing foods: lots of fruit and vegetables; fish; unsaturated fats such as those in olive oil, nuts and seeds (eat small amounts to control your calorie intake); lean protein-rich foods such as skinless chicken and eggs; wholegrain starches such as whole oats, whole rye, corn on the cob and brown rice. (Make sure you keep the portions small.)
Other fat factors
There are other factors that contribute to obesity. Some evidence-based causes include:
Sleep deprivation (less than seven to eight hours of sleep a night) causes hormonal deregulation and obesity.
Fifteen to 20 percent of the world’s population suffer metabolic consequences caused by stress. Their unusual susceptibility to chronic stress results in disproportionate amounts of visceral fat distribution and could be genetically determined. The reasons for this are still being researched and it’s being suggested that the stress hormone cortisol could be a culprit.
It is a fact that depression is on the increase worldwide and there is convincing evidence that confirms a strong correlation between depression and obesity. The reason for this is thought to be the fact that the pituitary gland in the brain, one of the glands that controls appetite regulation, is very closely linked to mood. There is now enough evidence to support the belief that people who have serious mood deregulation may have appetite deregulation too.
Useful contact numbers
The South African Society for Obesity and Metabolism, 0861 102 011, can provide advice and referrals to endocrinologists, physicians and nutritionists.
Anne Till & Associates, 011 463 4663
[This is an edit of an article by Lynne Gidish which originally appeared in Femina magazine, August 2007. The current edition of Femina is on sale now.]
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