Recently, a Daily Maverick women reader asked what diet a post-menopausal female could follow to get rid of persistent belly fat; not long ago, a health-conscious friend complained that despite following a healthy diet and exercising regularly, she had lost her waistline and an expanding middle forced her to adjust her belts. What was once her best asset had now disappeared. Watching a group of men in a coffee shop, I noticed that the majority had signs of a belly. A ‘beer boep’, as it is commonly and sweetly referred to, seems to be common among most South African men over 50. 

Although belly fat has nothing to do with drinking beer say the experts. Despite many tips on google suggesting that to tackle belly fat, one should eat certain food groups, it’s unfortunately not the full picture.

Prof Derick Rall, Head of Endocrinology & Metabolism at The University of the Witwatersrand (Wits), explains that treating belly fat is actually no different from treating fat elsewhere. The problem is that belly fat is often more dangerous because it predisposes one to get type 2 diabetes and other cardiometabolic diseases. 

Two types of fat

We carry two types of fat — subcutaneous fat which is under the top layer of the skin and visceral fat which builds up around internal organs. Both accumulate around one’s waist if one eats more calories than one burns. 

As women age, their oestrogen levels drop; lower levels of it, slow down the metabolism. The body burns calories less efficiently and it becomes harder to build muscle. These hormonal changes, as well as genetic factors, cause subcutaneous fat to be redistributed mainly from around the thighs and bottom to inside one’s internal organs and outside the tummy.  

Men’s ability to build muscle also declines when their testosterone levels drop. Unspent energy is stored as fat around the tummy if muscle isn’t built — why this happens is not quite clear.

Visceral gets stored in the connective tissue around the liver, heart, pancreas and lungs. Even if a lean person has excess fat around the waist, they have an increased risk of developing diseases that are similar to people with obesity. This could cause organ failure, increased inflammation and possibly, cancer; diabetes, high blood pressure and higher cholesterol levels are cardiometabolic disorders that increase the risk of early death.  

Until recently, Body Mass Index (BMI) was used to determine if one was overweight. Now, weight distribution as well as waist circumference is regarded as important. A simple way to check if one is carrying too much fat is to look at both one’s BMI as well as waist circumference. A healthy BMI is regarded as between 18.5 – 24.9 for adults. Waist size should be less than 90cm for females and 100cm for males. A BMI above 30 is regarded as obese and above 40 is considered morbidly obese. 

Obesity and type 2 diabetes have become a worldwide pandemic. Over the past 20 years, obesity has doubled. In 2016, the South African Democratic Health Survey showed that 25% of adults were obese; one in five women was severely obese. The health problems associated with obesity put an enormous strain on the health system. 

The good news is that lifestyle and medical interventions are available that could prevent it from happening or reverse it. 

Lifestyle changes to help prevent belly fat 

Terry Harris, Vitality’s head dietician believes that maintaining a healthy lifestyle is crucial to preventing belly fat. 

Mindful eating and exercising regularly are both equally important. This ensures that the metabolism works efficiently. Any weight loss programme needs to be slow and steady and approached in a smart way. There is no real difference between a weight loss diet and a weight maintenance diet. Harris says that eating three meals a day is no longer essential. She believes one should choose a diet that suits one’s lifestyle and can be maintained: if you don’t like kale, choose an alternative. If your body prefers a banting diet which relies mainly on fat and protein for energy, then go for it. But make sure you eat mostly plant fats. 

Bear in mind that even if you eat a healthy diet, eating more calories than you burn causes weight gain. Key principles are to include all food groups, avoid fizzy or sugary drinks and watch portion size. What one chooses to eat and how much are equally important to ensure a long and healthy life. Small changes result in significant results over time. 

Vitality data shows that purchasing just one more food item a week within each of the healthy categories of dairy, fats and oils, fruit, vegetables, protein-rich foods and legumes, as well as just one less food item a week within each of the unhealthy categories of processed meats, convenience meals, confectionery, sugary drinks, and unhealthy starchy foods, can result in a 3kg weight loss over a year (although this is an average).

It’s also not about when you eat. Whether you eat in the morning, in the evening or follow intermittent fasting it’s mainly about the number of calories you consume. Studies have shown that a high-quality diet and regular exercise help to keep you healthy and reduce mortality by 17%. 

Brett Eloff, a health coach who focuses on longevity, advises clients, who battle with persistent belly fat, to adopt an exercise programme that focuses mainly on muscle building. As one ages, lower hormone levels reduce one’s capacity to build muscle. One doesn’t burn calories as efficiently either. To offset this, one needs to adopt an exercise programme that focuses on strength and resistance training as well as some aerobic exercises. 

Ideally, you should push yourself to fatigue about 2-3 times a week and then allow for recovery and adaptation. The golden rule to remember is that consistency is better than intensity. But he says it should always go hand in hand with a calorie-controlled diet high in unprocessed food. You can’t exercise your way out of belly fat.   

In conclusion, Rall cautions that dieting and exercise will not be sufficient to reverse metabolic problems if one suffers from obesity.  Pharmacological therapy or bariatric surgery, or a combination of both could then be considered, following medical advice. Bariatric surgery is usually chosen when a patient has to lose about 30% of their body weight. Although it can reverse obesity-related co-morbidities, it is not without its complications. As a result, it is usually seen as a last resort. 

As far as pharmaceutical interventions are concerned Harris adds that many studies show that it eventually plateaus. Often lost weight is regained unless one changes one’s lifestyle. Even procedures such as liposuction are temporary solutions. In the end, it is about adopting a routine that includes conscious calorific restriction and regular exercise. DM/ ML

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