Muffin top. Spare tire. Beer belly. Whatever you call it, research shows that extra fat around your belly poses a unique health threat.

The study in the March 6, 2018 issue of the Journal of the American Heart Association involved about 500,000 people, ages 40 to 69, in the United Kingdom. The researchers took body measurements of the participants and then kept track of who had heart attacks over the next seven years. During that period, the women who carried more weight around their middles (measured by waist circumference, waist-to-hip ratio, or waist-to-height ratio) had a 10% to 20% greater risk of heart attack than women who were just heavier over all (measured by body mass index, or BMI, a calculation of weight in relation to height). A larger waist-to-hip ratio, in particular, appeared to be a bigger heart attack risk factor for women than for men. The analysis showed that compared with BMI, waist-to-hip ratio was 18% stronger as a heart attack predictor in women — versus 6% stronger in men.

But the message that you should take from this study should be less about the gender differences and more about the overall risks presented by central adiposity, says Dr. Barbara Kahn, the George Richards Minot Professor of Medicine at Harvard Medical School.

Widening waistline, growing risks

Regardless of whether women are more vulnerable than men to heart problems related to abdominal weight gain, it’s pretty clear that central adiposity presents important health risks, Dr. Kahn says. Researchers have shown that weight gain around the middle represents an increase in the amount of visceral fat, the type of fat that encases your internal organs. “There are many studies showing that an unfavorable waist-to-hip ratio is highly associated with diabetes and cardiovascular risk,” says Dr. Kahn.

So, if your waistband has been feeling a little tighter these days, it may be time to take some action.

Strategies to whittle your waist and lower your risk

Keep weight gain in check. “The focus should be on limiting weight gain over all,” says Dr. Kahn. Women tend to put on pounds as they get older and after menopause. This occurs for many reasons, among them hormonal changes, a decline in muscle mass (because fat burns less calories than muscle), and in some cases lifestyle changes. Keeping tabs on your weight — and your waist — and making changes to your daily routine can help prevent the pounds from creeping up as you go through this transition. “I don’t talk with patients as much about going on a diet as I do about creating a long-term lifestyle program that includes physical activity and sustainable dietary changes,” says Dr. Kahn. Weight that comes off slowly tends to stay off. By contrast, very rapid weight loss can trigger your body to slow its metabolism, setting the stage for the weight to be regained quickly.

Get moving. It’s probably no surprise that increasing the amount of exercise you do should be a goal if you’re looking to keep your waistline in check. “I’m a big proponent of regular exercise,” says Dr. Kahn. If you’re squeezed for time, fit it in where you can — for instance, a half-hour walk outside the office at noon or before you drive home for the day. “It doesn’t have to be excessively vigorous. You don’t need to go to the gym and change your clothes,” she says. Just being physically active can help improve your metabolic health. Even getting up to walk around periodically during work can be beneficial. Regular physical activity may not always help you lose weight, but again, it can help you maintain a healthy weight, and also improve blood sugar for people with diabetes. Having a higher proportion of muscle mass can help you burn more calories, so adding strength training at least twice a week, focusing on all the major muscle groups, may also help you maintain your weight.

Unfortunately, avoiding weight gain around the middle may be easier for some women than others, as some people are simply more prone to adding extra pounds in the belly. Research may one day help to uncover new ways to head off this dangerous type of fat and, in turn, reduce the risk for diabetes and cardiovascular disease. Certain newer medications used to treat people with diabetes — known as sodium-linked glucose transport inhibitors — have the interesting side effect of inducing weight loss and reducing visceral fat, says Dr. Kahn. “This does point to the possibility that there may be some physiological mechanisms that target visceral adiposity,” says Dr. Kahn. In the meantime, focus on lifestyle changes and exercise, and keep an eye on your belt buckle to gauge your progress.

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