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Watch Your Belly – not just to look good!

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Over the past two decades it has been established beyond any doubt that the amount of fat around the waist (aka abdominal fat and visceral fat) is at least as important, if not more important, than the total amount of body fat in predicting and /or causing complications that have been traditionally associated with overweight/obesity.[1]
Abdominal obesity is a strong risk factor for cardiovascular disease independent of BMI (a proxy for obesity) [2, 3] and is thought to affect disease risk through increased insulin resistance.[4, 5]  Actually, the common development of insulin resistance with aging is caused by growing bellies, rather than aging per se.[6] Notably, normal-weight abdominal obesity is associated with higher mortality than generalized obesity (as defined by BMI).[7]
An enlarged belly is an especially strong indicator of metabolic risk in men.[8, 9] People with large a waist circumference – i.e. those having a belly - have an increased risk of cardiovascular disease, diabetes and cancer, compared to those with smaller waist circumferences, regardless of BMI. [10-14] Your waist also impacts your longevity, which I covered in a previous article "Watch Your Waist - it may shorten your life!"
And your belly can interfere with your sex life...

Brain Function and… Erections

Less well known is that your brain shrinks as your waist grows.[15] And for men who want to enjoy sex (anybody doesn’t?) belly watch is critical, not just to look good and attract women, but also to enjoy them! Abdominal obesity and the metabolic syndrome – the hallmark of which is a bulging belly – is an independent risk factor for erectile dysfunction.[16-18] This association between erectile dysfunction and abdominal (visceral) fat accumulation is independent of obesity-associated comorbidities [19], and can occur in non-obese men who tend to store fat around their bellies. An important mechanism linking belly fat with erectile dysfunction is testosterone deficiency (more on this in an upcoming article).[20]

Important for youngsters

Notably, even in non-obese and apparently healthy young men and women - aged 18 to 35 years old - accumulation of abdominal is associated with a worse cardiometabolic profile and subclinical atherosclerosis, whether individuals are normal weight over overweight.[21, 22] This is a great opportunity for primary prevention, as reduction in abdominal obesity in young adults by exercise and diet interventions can prevent progression to irreversible health damage, if left to proceed to middle-age.

Waist Stats

Waist circumference is a simple and reliable measure of abdominal obesity, and is particularly useful as a marker of disease among people who are categorized as normal-weight or overweight.[7] Population surveys show that waist circumference has increased progressively over the past decades; expanding bellies are seen in people among all weight categories (even normal weight and underweight).[23]
Over half of the American population (54.2%) is now strolling around with bulging bellies.[24] Of note, increases in waist circumference have occurred independent of changes in BMI – i.e. increases in waist circumference have occurred in the absence of weight gain - suggesting that abdominal obesity continues its upward trend despite a plateauing in general obesity.[25, 26]

Check yourself with a measuring tape

What is the cutoff for an enlarge belly? According to the American Heart Association (AHA), the cutoff for elevated waist circumference is: [27]
Men:         40 inches (102 cm) or above
Women:    35 inches (88 cm) or above
To measure your waist circumference according to the AHA directions, locate top of your hip bones (the iliac crest). Place a measuring tape in a horizontal plane around abdomen at level of the hip bones. Before reading tape measure, ensure that tape is snug but does not compress the skin and is parallel to floor. Measurement is made at the end of a normal exhalation. 
Alternatively, one can measure waist circumference at the level of the navel or at the level of the narrowest point (if it exists). While there is some scientific debate regarding what waist measurement location is best for indication of health consequences [28-32], for practical purposes, consistent measuring and tracking is key. To gauge your health risk I suggest using the AHA directions, with the cutoffs above for measurements taken at the level of the hip bone. If you prefer to track your fitness progress by measuring at the narrowest waist point – which intuitively makes most sense - you can do that as well.

Bottom line

Keeping an eye on your waist it important not just to look good. A resource worth visiting is, an independent academic multidisciplinary organization by the International Chair on Cardiometabolic Risk, whose mission is to raise awareness of abdominal obesity as a new risk factor.
Your belly – or lack thereof – has a profound impact on every aspect of your health, including brain function and erections! Hence, your waist can be considered to be a vital sign [33] for both health, longevity and sexual attraction AND function. Hey guys, women like tools that work ;)

1.            Tchernof, A. and J.P. Despres, Pathophysiology of human visceral obesity: an update. Physiol Rev, 2013. 93(1): p. 359-404.

2.            Casanueva, F.F., et al., Relationship of abdominal obesity with cardiovascular disease, diabetes and hyperlipidaemia in Spain. Clin Endocrinol (Oxf), 2010. 73(1): p. 35-40.

3.            Lee, S.Y., et al., The impact of obesity on subclinical coronary atherosclerosis according to the risk of cardiovascular disease. Obesity (Silver Spring), 2014. 22(7): p. 1762-8.

4.            Pladevall, M., et al., A single factor underlies the metabolic syndrome: a confirmatory factor analysis. Diabetes Care, 2006. 29(1): p. 113-22.

5.            Reaven, G.M., The metabolic syndrome: is this diagnosis necessary? Am J Clin Nutr, 2006. 83(6): p. 1237-47.

6.            Bryhni, B., et al., Age or waist as determinant of insulin action? Metabolism, 2003. 52(7): p. 850-7.

7.            Sahakyan, K.R., et al., Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality. Ann Intern Med, 2015. 163(11): p. 827-35.

8.            Vega, G.L., et al., Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab, 2006. 91(11): p. 4459-66.

9.            Pischon, T., et al., General and abdominal adiposity and risk of death in Europe. N Engl J Med, 2008. 359(20): p. 2105-20.

10.          Balkau, B., et al., International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Circulation, 2007. 116(17): p. 1942-51.

11.          Ghandehari, H., et al., Abdominal obesity and the spectrum of global cardiometabolic risks in US adults. Int J Obes (Lond), 2009. 33(2): p. 239-48.

12.          Dhaliwal, S.S. and T.A. Welborn, Central obesity and multivariable cardiovascular risk as assessed by the Framingham prediction scores. Am J Cardiol, 2009. 103(10): p. 1403-7.

13.          Britton, K.A., et al., Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol, 2013. 62(10): p. 921-5.

14.          Cerhan, J.R., et al., A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc, 2014. 89(3): p. 335-45.

15.          Willette, A.A. and D. Kapogiannis, Does the brain shrink as the waist expands? Ageing Res Rev, 2015. 20: p. 86-97.

16.          Besiroglu, H., A. Otunctemur, and E. Ozbek, The relationship between metabolic syndrome, its components, and erectile dysfunction: a systematic review and a meta-analysis of observational studies. J Sex Med, 2015. 12(6): p. 1309-18.

17.          Janiszewski, P.M., I. Janssen, and R. Ross, Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. J Sex Med, 2009. 6(7): p. 1990-8.

18.          Sanjay, S., et al., Metabolic syndrome: An independent risk factor for erectile dysfunction. Indian J Endocrinol Metab, 2015. 19(2): p. 277-82.

19.          Corona, G., et al., Erectile dysfunction and central obesity: an Italian perspective. Asian J Androl, 2014. 16(4): p. 581-91.

20.          Kaya, E., S.C. Sikka, and S. Gur, A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med, 2015. 12(4): p. 856-75.

21.          De Larochelliere, E., et al., Visceral/epicardial adiposity in nonobese and apparently healthy young adults: association with the cardiometabolic profile. Atherosclerosis, 2014. 234(1): p. 23-9.

22.          Clemente, G., et al., Visceral adiposity and subclinical atherosclerosis in healthy young men. Int J Food Sci Nutr, 2015. 66(4): p. 466-70.

23.          Okosun, I.S., et al., Abdominal adiposity in U.S. adults: prevalence and trends, 1960-2000. Prev Med, 2004. 39(1): p. 197-206.

24.          Ford, E.S., L.M. Maynard, and C. Li, Trends in mean waist circumference and abdominal obesity among US adults, 1999-2012. JAMA, 2014. 312(11): p. 1151-3.

25.          Freedman, D.S. and E.S. Ford, Are the recent secular increases in the waist circumference of adults independent of changes in BMI? Am J Clin Nutr, 2015. 101(3): p. 425-31.

26.          Stevens, J., E.G. Katz, and R.R. Huxley, Associations between gender, age and waist circumference. Eur J Clin Nutr, 2010. 64(1): p. 6-15.

27.          Grundy, S.M., et al., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 2005. 112(17): p. 2735-52.

28.          Ross, R., et al., Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference? Obes Rev, 2008. 9(4): p. 312-25.

29.          Klein, S., et al., Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr, 2007. 85(5): p. 1197-202.

30.          Mason, C. and P.T. Katzmarzyk, Variability in waist circumference measurements according to anatomic measurement site. Obesity (Silver Spring), 2009. 17(9): p. 1789-95.

31.          Willis, L.H., et al., Minimal versus umbilical waist circumference measures as indicators of cardiovascular disease risk. Obesity (Silver Spring), 2007. 15(3): p. 753-9.

32.          Wang, J., et al., Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr, 2003. 77(2): p. 379-84.

33.          Despres, J.P., Waist circumference as a vital sign in cardiology 20 years after its initial publication in the American Journal of Cardiology. Am J Cardiol, 2014. 114(2): p. 320-3.

Last modified on Sunday, 21 August 2016 00:24

Medical Writer & Nutritionist

MSc Nutrition

University of Stockholm & Karolinska Institute, Sweden 

   Baylor University, TX, USA

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