Melt your middle

Philip J. Goscienski, M.D.

October 2010

All body fat might look the same from the outside but not much in nature is really that simple. As they say in the real estate business it's location, location, location.

The fat that women accumulate on their hips and thighs poses little risk as long as it's not really excessive. It melts away slowly even with careful dieting and vigorous exercise because it's supposed to be a source of energy during pregnancy and breastfeeding. It's even possible that a woman's lower body fat can protect her against heart disease.

In both women and men the most dangerous fat is that which accumulates around the waist because it's an outward sign of visceral fat accumulation. Visceral fat collects inside the abdomen around the coils of the intestines and it is not inert, by any means. It acts like a chemical factory, producing substances that promote inflammation. Known as cytokines, these substances damage the lining of blood vessels within the heart and the brain. The end result is heart attack and stroke, respectively.

Inflammation also plays a role in type 2 diabetes. Almost all type 2 diabetics have excess body fat, although it may not be obvious because it's hidden within the abdomen or in between shrinking bundles of formerly well-toned muscle.

Because fat in different locations of the body can have very different health effects, keeping tabs on your overall weight or even your body fat percentage may not be very helpful. What really matters is your waist circumference because that's where the unhealthiest fat is located. The good news is that reducing your waist size by even a few inches can diminish the load of inflammatory chemicals and lower your risk of heart disease and stroke.

Even better news: the fat around your waist melts away faster than that in other parts of your body. After only 3 or 4 weeks those who lower their calorie intake and increase their physical activity can decrease the burden of those inflammatory chemicals.

A man's waist should be no larger than 35 inches; for a woman the number is 32 inches. Your ultimate goal should be a waist circumference that is smaller than your hip circumference. Rather than aiming for a specific waist measurement, try to lose a couple of inches first. Cut about 500 calories from your daily diet and start walking 30-60 minutes at least 4 times a week. And watch your middle melt away.

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