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Middle March

The journey to middle age doesn't have to begin with mid-section weight gain

If you have a tendency to accumulate fat around your internal organs, age and hormonal changes can worsen the problem. As you get older you tend to pack more weight around the midsection.

For women, the marked reduction in estrogen production after menopause may determine where you have fat build-up. Women become more android in shape and less gynoid, which is a feminine shape. Postmenopausal women are more prone to thickness around the waist.

Unfortunately not only do Americans get rounder as they age, but waistline measurements are increasing at an alarming rate, according to Dr. Osama Hamdy, the Joslin Diabetes Center, Boston.

"The average American has a greater waistline than 10 years ago, and at the same time we're seeing diabetes rates go up," Hamdy says.

You can be a normal weight for your height, petite in fact, and pack your pounds around the middle. Think of a "lemon" shape. That alone can put you at risk for diabetes.

The general rule is that women with a waistline of 35 inches or more and men who measure at least 40 inches should lose weight. But if you're a slight woman you should be concerned with a 30-inch waistline.

You can't lose visceral fat by sweating it out in a sauna or using one of those vibrating gizmos advertised on late-night television.

However, you can trim visceral fat through diet and exercise, although the experts don't agree on whether this fat is the first to go when you cut calories.

No diet will help you lose weight in one particular part of your body. In Hamdy's experience the first weight you lose is visceral fat.

"Going on a diet is very healthy for visceral fat [reduction]. During the first 12 days of weight loss most of the loss is from visceral fat," Hamdy says.

To reduce your waistline and reduce your risk of diabetes at the same time experts recommend eating at least three meals a day, making each one a mini-meal.

"You're going to elicit a smaller insulin response. Choose foods that are high in fiber such as fruits and vegetables. You need about 25 to 35 grams of dietary fiber a day," Hamdy says.

You may never lose all the weight you've gained during adulthood. And maybe that slinky leather belt from your college days will never fit again. But don't let that discourage you, say the experts. You can still eliminate some dangerous visceral fat by dieting.

Exercising at least 30 minutes a day at least as important as losing weight.

"Physical activity is the best modifier of visceral fat," Hamdy says.

The recommendation is to walk or do another moderately vigorous activity for at least 30 minutes a day.

All Fat Is Bad Fat

Don't be complacent if you pack saddlebags instead of love handles, says Dr. Guenher Boden, a diabetes expert at Temple University, Philadelphia.

"There's no question that women gather fat at the waist but it's not certain whether fat at the waist is more important than fat in the hips," Boden says.

"Fat is bad. There are no divided opinions on that. A whole list of things happen when you're overweight - hypertension, high cholesterol, diabetes, blood clots."

While Boden says there are differences between visceral fat cells and subcutaneous fat cells, he doesn't think fat in one part of the body is more or less risky than fat deposited elsewhere.

Boden recommends you go on a diet if you have a body mass index (BMI) of 30 or greater.

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