Most people dismiss their widening waistlines as a cosmetic or sartorial concern, but this bane of middle age can hurt your health far more than your self-esteem. Several studies, both international and in India, have clearly established a link between a midriff bulge and high blood pressure, heart disease and diabetes.
Worldwide, an apple-shaped body is more common among men, with women usually putting on fat around the hips and thighs to develop a pear-shaped body. In India, however, more women than men have belly fat, which affects one in four people aged 50 and more, showed a six-states survey of more than 7,000 people from across strata in rural and urban Rajasthan, Uttar Pradesh, West Bengal, Assam, Maharashtra, and Karnataka.
The study, which was published in the online journal BMJ Open last week, found 14% of the people surveyed were overweight, defined as a BMI of more than 25 kg/m2, while more than one in three had a midriff bulge, defined as a waist size of more than more than 90 cm (35.4 inches) for men, and more than 80 cm (31.4 inches) for women. Two-thirds (69%) women among the most affluent and almost half (46%) among low to middling incomes had a belly.
More worrying are the findings of a yet-unpublished study of more than 500 people in the 20 to 60 age group, conducted by the All India Institute of Medical Sciences (AIIMS) in New Delhi, which found risks associated with abdominal fat higher among women. “Our study found that risk of the metabolic syndrome, which puts people at risk of high blood pressure, diabetes and heart attacks, was about 12-fold higher in men and more than 20-fold higher in women with large waists,” says lead author Dr Naval Vikram, additional professor of Medicine, AIIMS.
The AIIMS study compared the different measures of obesity as predictors of metabolic syndrome, and found that waist size was better than body weight and waist-to-hip ratio (WHtR ) in predicting metabolic diseases risk. WHtR cutoff of more than 0.5 was, however, a better predictor for hypertension.
The quality of fat that accumulates in the abdomen is to blame. “Visceral fat releases fatty acids and hormones into the blood that push up inflammation, bad cholesterol, triglycerides, blood glucose, and blood pressure, adding to risk of metabolic diseases,” says Dr RR Kasliwal, chairman of clinical & preventive cardiology, Medanta-The Medicity in Gurgaon. It not only raises the risk of heart disease and stroke, but also of some estrogen-sensitive cancers such as post-menopausal breast and endometrial cancer.
An analysis of data from multisite cross-sectional epidemiological studies in north India that included 2,050 men and women showed that the risks for Indians began at waist sizes lower than that recommended for Caucasian populations. “In India, the waist cutoff points for men is 78 cm and for women, it is 72 cm. Anything over these numbers is likely to put them at risk of at least one risk factor for metabolic disease even if they have a healthy weight,” said Dr Anoop Misra, Chairman, Fortis C-DOC, who led the study when he was at AIIMS.
Several large international studies too have linked large waists with heart and diabetes risk. A US study of close to 45,000 women followed for over 16 years showed that women with the highest waist sizes - 35 inches or more - had nearly double the risk of dying from heart disease, compared to women with the lowest waist sizes (less than 28 inches), reported results from the Nurses Health Study in the journal Circulation.
“Where your body ends up storing fat is influenced by several factors, including heredity and hormones, but diet and activity play a key role. Even people with a healthy weight - a BMI less than 23 - are at risk if they have belly fat, so avoiding processed and packaged food and being physically active is essential to stay in shape,” says Dr Vikram.
Controlling stress and getting adequate sleep also plays a role. “Ultimately, it’s about making healthy lifestyle choices. How you live your life affects your health at different levels, so the sooner you start living mindfully, the less stressed your body is likely to be,” says Dr Kasliwal.
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