Beyond the Bathroom Scale

It's about where your weight is carried, not about how much you weigh.
By Lisa Turner

For many of us, the number on our bathroom scale makes or breaks our day: joy, if it moves downward a few pounds, and despair if it creeps upward, as we diet, sweat, and stress our way toward that magical number we believe defines our ideal weight. But that number may not carry as much import as people—and many doctors—have long thought. It turns out that what you weigh isn’t nearly as important as where that weight is.

“Scale weight alone isn’t the best way to assess fitness,” says Philipp Scherer, Ph.D., a professor of cell biology and medicine at Albert Einstein College of Medicine, Bronx, New York, and an expert on fat and metabolism. “It’s more about the quality of fat in the body, which includes where it’s located within our system. We’re learning that this is the critical measure of fitness.”

Unfortunately, ever since the 1950s, everyone’s focused almost exclusively on poundage, which of course lacks context: 130 pounds may qualify as lean for someone who’s 5’8”, but chubby for shorter folks.

To account for variations in height, health researchers in the 1970s popularized the Body Mass Index (BMI). But that doesn’t accurately gauge your health either, because it doesn’t distinguish between body fat and muscle mass. Basketball player Shaquille O’Neal, who’s as sinewy as they come, “has a BMI over 30, which makes him technically obese,” says Mark Hyman, MD, author of Ultrametabolism (Scribner, 2006). On the flip side, “you can also have a low BMI of 19 or 20, but have an unhealthy body fat measure of 50 percent, which is common in the elderly, who lose substantial muscle mass and bone as they get older.”

To address this problem, doctors measure body-fat percentages, often calculated by the skin-fold test. Using set of calipers, the tester pinches different areas of your body, such as the waist and triceps. She then plugs the thickness of each pinch into a formula that calculates body-fat percentage. While this produces more meaningful information, it, too, fails to measure fat distribution, which may be the major factor for predicting disease risk.

Fat, like real estate, is all about location, location, location. Study after study shows that people who carry excess weight around their middle have significantly higher risk for heart disease, diabetes, and other serious illnesses than those who carry it in their hips and thighs,. The INTERHEART study—one of the largest case-controlled studies to examine the causes behind cardiovascular disease—identified abdominal obesity as a leading risk factor for heart attack and found that it predicts cardiovascular disease better than BMI. Additional studies have revealed that belly fat also raises your risk of colon cancer and diabetes. When determining abdominal obesity, it’s the circumference of your waist, rather than your weight, that’s the critical measurement, says Peeke. “Measure around your waist with a tape measure at the level of your belly button,” she says. “If you’re a woman and that measurement is greater than 35 inches, or if you’re a man and it’s greater than 40 inches, there’s a very good chance that you have abdominal obesity.”

Even more important than the size of your waist is the size of your waist relative to your hips. You calculate this by dividing your waist measurement (in inches) at its smallest point by the circumference of the hips at their widest point. In a 2007 study in Circulation, men with the largest waists in relation to their hips had a 55 percent higher risk of developing coronary heart disease; for women, that risk rose to 91 percent. (See "Know Your Scales" for the healthy range of ratios).

Bye, bye belly
The greatest danger of having a big belly is the fat that lies inside the abdomen. When clinicians talk about “abdominal fat,” they usually mean the visceral fat tissue within the abdominal cavity, rather than subcutaneous fat under the surface of the skin. However, an excess of the latter usually indicates an excess of the former.

Visceral fat appears to function differently than fat in other areas of the body, says Hyman. “Fat in the belly isn’t just a storage depot,” he says. “It’s metabolically active, and produces a whole range of molecules that can be very dangerous.” Specifically, it releases compounds called cytokines that increase chronic inflammation “damaging artery walls and increasing the risk of heart disease,” Hyman says.

The heightened metabolic activity of visceral fat may also explain why abdominal obesity increases the risk of developing cancer. “Visceral fat increases inflammation in general which, among other things, compromises immunity,” says Judith S. Stern, Ph.D., professor of nutrition and internal medicine at the University of California, Davis. “So the body’s cancer-killing mechanisms are compromised, and you’re no longer able to fight off cancer.”

Researchers haven’t figured out why we store fat in our bellies, but back in our caveman days, it may have increased survival chances during the lean times. “From an evolutionary point of view, visceral fat is a long-term survival mechanism,” says Hyman. “It’s stored in a protected area, deep within the body. It’s easy to gain—and much harder to access and use up.”

Fat but fit?
Obsessing about the number on the bathroom scale may be misguided for another reason. It fails to take into account either your cardiovascular fitness or the type of food you eat, both key measures of health. Cardiovascular fitness is determined, in part, by measuring the ability of your lungs to deliver oxygen to your body (called the VO2 max). Being aerobically fit actually changes the metabolic activity of your cells. “You metabolize sugars and refined carbohydrates better, and you’re less insulin-resistant—so less belly fat accumulates, and you burn the fat that is there more quickly,” says Hyman.

What’s more, simply changing your diet—by swapping sugary foods for whole grains, veggies, and protein—also dramatically improves cellular metabolism and your health—even if you’re still technically obese. “We see changes in fat cell function very quickly after diet change,” says Hyman.

The bottom line: Cardiovascular fitness and diet, along with abdominal girth, matter more than a simple scale weight. “If I had to look at two things to calculate if someone was healthy,” says Hyman, “I’d look at waist-to-hip ratio to measure abdominal fat and VO2 max to measure cardiovascular fitness.”

Real health
While squeezing back into those size 6 jeans from college may not be a realistic (or even healthy) goal, you can lose that belly fat and increase cardiovascular fitness by focusing on these basics:

1. Keep insulin levels stable. A processed foods diet, especially one high in sugars and refined grains, promotes visceral fat accumulation. “When you eat refined carbs and sugars, you end up throttling the pancreas,” says Peeke. “It constantly has to secrete more and more insulin. Having higher levels of insulin on board makes it easier for your body to store fat.” Even worse, once existing fat cells have reached a critical point of volume, your body creates more. The solution: Go easy on processed foods, especially sugar and refined carbohydrates, and base your diet on fresh vegetables and fruits, nuts, seeds, legumes, and lean protein.

2. Eat to beat inflammation. Visceral fat cells churn out inflammatory cytokine compounds. You can lower the activity of these cells and mitigate their damage by eating anti-inflammatory foods such as: monounsaturated fatty acids (like unrefined olive oil), omega-3 fatty acids (cold water fatty fish, flaxseed, hempseed, and walnuts), orange and yellow bell peppers, dark-colored fruits and vegetables, crucifers (like broccoli and cauliflower), berries, and green tea.

3. Avoid trans fat. A 2006 study at Wake Forest University, North Carolina, found that trans fat not only gets stored in the body more readily than other types of fat, but it actually causes fat to move from other parts of your body into your belly. The FDA now requires that products label their trans fat content, so check the Nutrition Information to make sure it says 0 grams trans fat. Also, read the ingredients, and stay away from any food with hydrogenated or partially hydrogenated oils.

4. Get your dairy. Low-fat dairy foods, rich in calcium, appear to help you burn fat, especially in the tummy. In one 2004 study in Obesity, people who got 1,200 to 1,300 mg a day of calcium from low-fat dairy products lost, on average, more than 10 percent of their body weight—and 66 percent of that weight loss came from abdominal fat. The volunteers also showed a marked increase in insulin sensitivity. Researchers don’t know what triggers the fat loss and speculate that it could be the calcium, some other nutrient in dairy, or a combo of the two. Shoot for 1,200 mg of calcium daily (about three to four servings of low-fat dairy).

5. Jump and jive. Whatever type of exercise you choose—running, dancing, skipping rope—physical activity increases cardiovascular fitness and decreases belly fat, says Hyman. In fact, researchers at Duke University in North Carolina, found that modest exercise—equivalent to a brisk 30-minute walk, six days a week—prevented the accumulation of visceral fat, while exercising more than that burned it away. And in the control group, which didn’t exercise at all, visceral fat increased by more than 8 percent in only 6 months. Hyman recommends getting 45 minutes of aerobic exercise, like bicycling, running, or swimming, at least three to four times a week.

6. Chill out. When we’re under stress, the body releases cortisol and other stress hormones. Some evidence indicates that elevated cortisol increases the accumulation of visceral fat, even in otherwise slender people. It also raises the risk for metabolic syndrome (a precursor to diabetes). So take a deep breath, and do whatever helps you relax: work less, journal, do yoga, meditate, take walks in the park, drive slower, sleep longer, sing, laugh…and push your bathroom scale into the closet for a bit.

Know Your Scales:
Body Mass Index (BMI)
How calculated: Multiply your weight in pounds by 703, divide by your height in inches, and then divide again by your height in inches.
Healthy: 18.5 to 24.9
Overweight: 25 to 29.9
Obese: 30 or higher
Source: American Heart Association, 2007.

Body fat percentage
How calculated: Most commonly, by the skin-fold caliper test, which pinches the skin to measure subcutaneous fat; or by bioelectrical impedance and hydrostatic weighing tanks.
Healthy for women:
Age 20 to 40: 21 to 33 percent
Age 41 to 60: 23 to 35 percent
Age 60 to 79: 24 to 36 percent
Healthy for men:
Age 20 to 40: 8 to 19 percent
Age 41 to 60: 11 to 22 percent
Age 61 to 79: 13 to 25 percent
Overweight for women:
Age 20 to 40: 33 to 39 percent
Age 41 to 60: 35 to 40 percent
Age 60 to 79: over 40 percent
Overweight for men:
Age 20 to 40: 19 to 25 percent
Age 41 to 60: 22 to 27 percent
Age 61 to 79: 25 to 30 percent
Obese for women:
Age 20 to 40: over 39 percent
Age 41 to 60: over 40 percent
Age 60 to 79: over 42 percent
Obese for men:
Age 20 to 40: over 25 percent
Age 41 to 60: over 27 percent
Age 61 to 79: over 30 percent
Source: Gallagher et al. Am J Clin Nut 2000; 72:694-701

Abdominal girth
How calculated: Measure your abdomen at its widest part with a tape measure.
Overweight/obese for women: more than 35 inches
Overweight/obese for men: more than 40 inches
Source: American Heart Association, 2008

Waist-to-hip ratio
How calculated: Divide the circumference of the waist at the navel by the circumference of the hips at their widest point.
Healthy for women: 0.70 to 0.88
Healthy for men: 0.90 to 0.95

Source: American Heart Association, 2008