Overall, the main reason for understanding a person’s visceral fat measurement is not to “stay within the numbers.” It is merely to let a person know if he or she has a problem with intra-abdominal fat, and then decide what to do if the fat needs to be reduced. This knowledge, in turn, will usually help the person lower his or her risk of such conditions as cardiovascular disease, and diabetes.
What do the terms “apple-shaped” and “pear-shaped” indicate in terms of health?
In terms of health, and abdominal fat, the terms apple-shaped and pear-shaped have certain meanings.
Both terms are associated with how a person’s waistline often seems to grow as the person gets older, which also means a possible increase in a variety of health problems. (These terms usually refer to intra-abdominal fat, not the subcutaneous fat.) The big difference is that people who have subcutaneous fat that accumulates in the abdominal area are considered apple-shaped; people who have fat that accumulates in the lower body are considered to be pear-shaped.
Thus, apple-shaped people seem to have more health problems associated with their intra-abdominal fat than pear-shaped people, including a higher risk of developing type 2 diabetes.
Apple- (left) or pear-shaped bodies are the result of too much fat being stored in the abdomen or hips, respectively.
Do some races seem to have more intra-abdominal fat than others?
Yes, there appear to be certain connections between a person’s race and intra-abdominal fat. Many studies have shown that Asians have more intra-abdominal fat than Caucasians. And Caucasians have more of the fat than African Americans. But because most of the studies of intra-abdominal fats stress Caucasian populations, it is difficult to determine any more possible racial differences.
What are two of the best and most healthful ways to lose intra-abdominal fat to reduce the risk of developing such diseases as diabetes?
Most research suggests there are two major ways that a person can lose intra-abdominal fat and reduce the risk of developing diseases such as diabetes (especially type 2).
These are exercise (individuals who are more physically active have lower amounts of intra-abdominal fat) and reducing calories.
Both are considered equally effective in producing moderate weight loss.
In addition, although weight loss is the desired outcome of exercise in overweight people, research suggests that even when the person’s body mass does not change, regular exercise can still reduce intra-abdominal fat and shrink the waist size. (For more about exercise and weight loss, see the chapter “Exercise and Diabetes.”)
For example, some studies showed that, if an overweight or obese person exercises around 20 minutes a day for three months, intra-abdominal fat can be reduced by 10 percent. If an overweight or obese person exercises around 60 minutes a day for around that same amount of time, it can translate to a 30 percent reduction in intra-abdominal fat. In addition, the amount of intra-abdominal fat that is lost is, in general, greater than abdominal subcutaneous fat lost.
Can performing sit-ups help get rid of intra-abdominal fat?
F or most people, doing sit-ups is good for tightening abdominal muscles.
But such spot exercise will not get rid of intra-abdominal (visceral or organ) fat, or what is often referred to in the media as a “beer belly” or “spare tire.” This is because this type of fat lies under the abdominal muscles and within the organs, not just below the surface of the skin as with subcutaneous fat.
Thus, doing sit-ups will strengthen abdominal muscles, but unless visceral fat is reduced, the “six-pack abs” won’t be noticed.
In fact, it is difficult to do any spot exercise to target fat loss in the body.
This is because the body stores fat in a random way, and those locations are usually dictated by the person’s genetics.
And, according to some studies, as a person loses weight, the body will most often lose fat in the reverse order in which it was put on.
When it comes to calories, if a person (subject to an individual’s overall health and doctor’s advice) reduces his or her caloric intake by 400 to 700 calories a day, it can mean a 15 to 30 percent reduction in intra-abdominal fat. By focusing on energy intake (calories in), an overweight or obese person can often lower intra-abdominal fat.
Although it is possible to drastically restrict calorie intake, it is often not practical or healthful to do so.
Thus, most researchers suggest a more moderate approach to reducing calories.
In most overweight or obese people, reducing calories often leads to a reduction in body weight and intra-abdominal fat.
The total percentage of loss depends on many factors, but on the average, there is often not only a weight loss but also a reduction in intra-abdominal fat that ranges from 15 to 30 percent.
Do overweight or obese males and females differ in their ability to lose weight and intra-abdominal fat?
Although both males and females can be overweight and obese, there are thought to be some gender differences when it comes to intra-abdominal fat reduction and weight loss.
For example, some studies suggest that exercise and/or diet reductions to get rid of intraabdominal fat may not work as well for women as for men.
Yet other research indicates that women can significantly reduce intra-abdominal fats though exercise and diet.
Thus, many researchers believe that the studies may be confounded by gender differences involving exercise and expended energy, differences in exercise intensity, and duration of the activity.
They also cite the fact that women generally have less intra-abdominal fat than men.
All of this means that no one truly knows whether males or females have more trouble reducing intra-abdominal fat, and more studies, of course, are needed.
Why doesn’t liposuction work in terms of visceral fat?
Liposuction is the surgical procedure that uses a suction technique to remove fat from various places on the body.
Most people who choose to have the procedure wish to enhance and change the contours of their body, including the abdomen, arms, buttocks, calves and ankles, chest and back, hips and thighs, and neck.
It is purely cosmetic and is in no way a weight-loss method or treatment for obesity.
This is because the fat that is removed is subcutaneous, and the procedure does not reach the inside of the abdominal wall.
In other words, liposuction will not get rid of intra-abdominal (visceral) fat.
It is interesting to note that people who have the procedure are permanently getting rid of fat cells, or those cells that they have had all their lives.
They cannot be replaced, and if the person does not lead a healthful lifestyle after the operation, there is a risk that the remaining fat cells will grow bigger and he or she will gain weight.
This is because when a person gains weight, it’s actually the fat cells increasing in size and volume.
Conversely, if the person exercises and eats a healthful diet, the fat cells will decrease in size and volume, and the person will lose weight.
All this may be a moot point if the person has diabetes, too. In most cases, and because of possible complications from the surgery, liposuction is usually not recommended for people who have coronary artery disease, a weak immune system, or diabetes.
What is bariatric surgery?
Bariatric surgery is a somewhat generic term that means most surgeries conducted on people who wish to lose weight. It is not for everyone who wants to lose weight, and in most cases, it is suggested only for extremely obese patients, or obese people who have other severe weight-related health problems, such as type 2 diabetes, heart disease, very high blood pressure, and extreme sleep apnea. It is only used as a “last resort” for most obese cases and only after attempts to lose weight, by eating more healthfully and nutritionally, along with exercise, fail.
In most bariatric surgeries, the person has his or her digestive system altered in such a way as to limit the ability to eat, slow down the absorption of nutrients, or a combination of both. The following lists the most common forms of bariatric surgery performed in the United States at this writing:
Adjustable gastric band (AGB) , In this operation, a small band is placed around the top of the stomach to shrink the opening between the esophagus and stomach and reduce a person’s food intake.
Bilopancreatic diversion with duodenal switch (BPD-DS) , This operation (which is usually only conducted on severely obese patients) involves three procedures: removing much of the stomach, making the person feel fuller after eating; changing the effects of bile and other digestive juices to reduce a person’s digestion and absorption of nutrients; and rerouting food around part of the small intestine in order to lessen the absorption of nutrients.
Roux-en-Y gastric bypass (RYGB) , In this operation, a small part of the stomach is stapled, creating a small pouch. This causes the food to go directly from the pouch to the small intestine, bypassing part of the gastrointestinal tract to limit the amount of food it absorbs.
Vertical sleeve gastrectomy (VSG) , Here, most of the stomach is removed, lessening the amount of food eaten and absorbed by the gastrointestinal tract.
What study linked weight-loss surgery and diabetes remission?
A 2013 study reported in the Annals of Surgery noted possible benefits for some people with type 2 diabetes and weight-loss surgery.
The researchers looked at 217 severely obese people with type 2 diabetes, with an average body mass index (BMI; for more about BMI, see this chapter) of 49, an indication of extreme obesity.
The participants had weight-loss surgery between 2004 and 2007, and six years later, the researchers found that 24 percent of them were in complete diabetes remission, meaning they had an A1c of less than 6 percent and were not taking any diabetes medication.
In addition, 26 percent of the participants were in partial remission, or an A1c of 6 to 6.4 percent and not taking diabetes medication.
The researchers also noted that people who had diabetes for less than five years had the most health improvements.
Although this is not an endorsement for weight-loss surgery, it may be a possibility for people who have other severe health problems and diabetes.
The best way to find out is for the patient to ask his or her health care professional if such surgery is an option.
Three types of bariatric surgery are shown above. (Not pictured is BPD-DS surgery.) Such surgeries should only be considered when all other options for weight loss have proven to be ineffective.
How has recent research explained why bariatric surgery is associated with type 2 diabetes remission?
Researchers have known for many years that patients who have bariatric surgery, or stomach surgeries that concentrate on weight loss, often experience type 2 diabetes remission. In 2016, a Cornell University-led study on mice written up in, appropriately, the journal Gut, suggested why the diabetes goes into remission, even days after the surgery and before the weight is lost. The researchers discovered that TGR5, a bile-acid receptor, along with an increase in bile-acid concentrations known to occur after these surgeries, both help to balance glucose levels in the blood.
This does not mean the researchers advocate bariatric surgery to combat type 2 diabetes, as such surgery is not without risks.
Most of these surgeries are conducted on people who have a body mass index (BMI) from 35 to over 40, along with other obesity-related health problems (for more about BMI, see this chapter).
But the researchers do want to concentrate on methods other than weight loss to treat diabetes.
Thus, they are looking at TGR5 as a possible clue to treatment, especially the link between the TGR5 and bile acid.