Big waist, brain waste

Philip J. Goscienski, M.D.

November 2010

Extra pounds creep up on us so stealthily as we age that we fail to notice that they are affecting our health and robbing us of memory and intellect that should last as long as we do. Scattered population groups around the planet prove that brain function does not diminish until very old age. From Okinawa to California, Costa Rica to Sardinia, centenarians of widely differing genetic makeup provide proof that lifestyle, not aging, determines how well the very elderly are able to play Scrabble or remember the names of their great-grandchildren. One characteristic that they do share is that obesity is rare among them.

All fat is not the same. The good news (for women) is that the fat that they carry on their hips and thighs is not a risk factor for heart disease or for dementia. We cannot say the same for visceral fat, which lurks among the coils of intestine and that is the source of heart- and brain-damaging inflammatory chemicals.

Visceral fat is hard to measure but researchers have come up with a technique that not only correlates well with the likelihood that a person will develop dementia later in life but is easy to perform. It is known as Sagittal Abdominal Diameter, the distance from your back to the front of your belly. The standard reference that the researchers used was the point half way between the lowest edge of the rib cage and the top of the pelvic bone, which is about the level of the belly button.

The study population consisted of more than 6,500 individuals of diverse ethnicity who were followed for an average of 36 years. Among overweight persons whose SAD — such an appropriate acronym! — was more than 10 inches at the first measurement, the risk of dementia more than 3 decades later was 2.3 times as high as persons whose weight and measurement were normal. Among persons who were obese at the start of the study, the risk of developing dementia by the end of the study was 3.6 times as high.

Would liposuction help? Not likely, since that procedure only removes the fat between the skin and the muscles of the abdomen. There is no practical surgical procedure that eliminates visceral fat. That is possible, however, with a daily brisk, i.e., sweat-producing, walk or other form of physical activity and replacing pasta and potatoes with vegetables most days of the week.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at