Getting Rid Of Your Belly

By Dr.Harold Gunatillake FRCS

When you visit Bali, you invariably acquire a ‘Bali Belly’ purely by eating sea food and other treats from the little not-so-clean food outlets close to the beaches.
There would be a temporary noisy fullness of the tummy due to food poisoning, which clears within days after returning from your holiday.
This article is all about the belly that keeps coming insidiously without your knowledge with age, and the difficulties you face to reverse it.
Awareness and prevention would be the key and the way to go, but changing lifestyles may hinder the process.
When people are self-conscious of getting a belly, most people take a deep breath in front of the mirror to conceal it. During your youth the problem would not be visible, and workouts at the gym with emphasis on stomach exercises avert these bulges. One would like to show off, as most body builders do, the cross demarcations that reveal their muscles!
As you grow older, with changes in your lifestyles, affluence and diminished physical activities, you are likely to experience the belly protruding more prominently and becoming flabby seems like an inevitable occurrence, whether you indulge in extreme consumption of food, or otherwise.

Genetics?

Short people seem to be getting the bulge earlier and the body shape could be the replica of the old bloke. Taller people do get it, but would be less apparent during the early stages. There is a reason to it and shall explain later in the discussion.
We are talking of belly fat, and there is more to it than what you see. Fat here is found under the skin, thin or very thick layered (subcutaneous), not visibly present within the muscles, and the rest is found hidden within the abdominal cavity, referred to as visceral fat.
Most ladies find their fat distributed in the tummy more under the skin, hanging like aprons that can be eradicated surgically.
Ladies store fat in the thighs, calves, arms and buttocks, mainly under the skin which can also be reduced through suction.
Not all fat is the same. Geographically, it is the fat located in the tummy areas that would be the concern of the cardiologists. Again, it is not the fat that is revealed by the “pinch test” that would be the concern, it is the fat within (intra-abdominal) or visceral fat that is the concern and linked with health of heart. A man should measure round his waist line (circumference), less than 40 inches, and a woman should measure less than 35 inches round the waist-line. Studies have revealed that measurements more than these limits may have some link with heart disease.
As you gain weight mainly due to over-eating and a lethargic existence, there is a tendency to gain both subcutaneous and visceral fat. Women under 50 years seem to accumulate fat under the skin (pear shape), and after menopause store more visceral fat. Men tend to store more visceral fat when less than 50 years (apple shape).

Visceral fat and exercise

It is difficult or impossible to reduce this visceral fat with exercises unless you also reduce your diet to a minimum. Likewise, dieting to maintain a healthy weight occasionally, sometimes may not be sufficient to reduce visceral fat, unless dieting and exercise are combined, as genetic factors also influences the status of the visceral fat associated with a prominent belly. Most of the deeper visceral fat is around organs, like the kidneys (acts as a cushion), within the liver (fatty liver), mesentery that hold the total seventeen feet of bowel, under the peritoneum (inner lining of the abdominal cavity called para-peritoneal fat and the highest collections found in the omentum, a membrane that falls from the greater curvature of the stomach. The latter membrane is nicknamed the ‘policeman of the tummy”.
Though many people are self-conscious about the fat they can see under the skin, research shows that hidden fat poses the bigger threats. According to Kristen Hairston, MD, assistant professor of endocrinology and metabolism at Wake Forest School of Medicine; “Fat doesn’t just sit idle. It acts like an organ that secretes substances.”
While visceral fat provides necessary cushioning around organs, Hairston says, it secretes “lots of nasty substances” that can be absorbed by the neighboring organs.
These chemicals released from visceral fat may release inflammatory compounds that can lead to insulin resistance and some cancers.
Excess visceral fat is linked to greater risk of high blood pressure, type two diabetes, heart disease, dementia, and cancers of the breast, colon, and endometrium.

Belly development without excess visceral or subcutaneous fat

In this situation, as one grows older, due to the natural shortening of the spinal column, especially in the lumbar region, one should expect the abdominal wall muscles to bulge.
In this scenario there may be no increased subcutaneous or visceral fat, and the subject may invariably be even a short or tall, slim individual. The situation would be most frustrating, when especially you are at a healthy weight.
So, it is ironic that whether you have excess infiltration of visceral fat or have minimum visceral fat with a healthy weight, both conditions can make you prone to bulging bellies.
These people would complain that they find impossible to reduce the belly with all the determined efforts such as doing regular stomach exercises. With exercises, the belly muscles may get firmer but the bulging profile never changes due to the shortened spine occurring with age.
On the other hand, the belly of an overweight person with much visceral fat may be able to reduce his or her belly with much exercises and extreme restricted dieting for long periods

How can you reduce visceral fat?

Vigorous aerobic exercise and to the burning of calories may trim subcutaneous and visceral fat. In addition, resistance training may help to reduce the subcutaneous fat, and may reduce the belly prominence. Vigorous exercise includes jogging, for fit people and brisk walking for an hour on a daily basis  for less active people. Workouts at the gym also will help.
Most people at the gym commonly complain that the belly does not get flattened even after years of gym workouts.
It is observed that those who have had open heart surgery recently seem to come home with a flattened belly and gross weight loss. The lesson you learn is to restrict your diet akin to diets given in the hospitals. There aren’t any specific diets recommended to reduce visceral and subcutaneous fat.

Core exercise

Any exercise that uses the trunk of your body without support counts as a core exercise. Abdominal crunches are a classic core exercise. Try lying on your back and placing your feet on a wall so that your knees and hips are bent at 90-degree angles. Tighten your abdominal muscles, and then raise your head and shoulders off the floor. Classic push-ups count, too. You can also do push-ups on your knees or standing up against a wall.
Want more defined abdominal muscles? Core exercises are important. Although it takes aerobic activity to burn abdominal fat, core exercises can strengthen and tone the underlying muscles.

Link between belly fat and diabetes

Researchers in U.S. have concluded that belly fat is largely to be blamed for the higher diabetes incidence in the U.S., especially among women.
Sri Lankans seem to accept the belly profile with no complaints or shame. It is also an observation that those people who wear sarongs are pushing the belly muscles forward unconsciously to hold the sarong in place. This would add to the problem.
Sri Lankan ladies too don’t seem to worry about bellies, as hiding behind the saree gives them adequate confidence. Only those sun lovers, rare in the Island, would be concerned about their body shape to fit into slim bikini clothing.

Toddy belly

It is quite a common incidence to see beer and toddy drinkers having “pot bellies”
It is presumed, that the calories in the alcohol add more visceral fat. Those who wish to have a flat belly should not indulge in drinking alcoholic beverages, after all that would be adding calories, in addition to the calories from your diet. Prevention should be the aim in order to avoid the problem.