To gauge whether they are a healthy size, many people rely on a scale, height-and weight chart or mathematical formula that calculates body mass index (BMD. Yet new research reveals that a tape measure more accurately predicts a person's risk for many major health problems. That's because waist measurement indicates the amount of belly fat—the fat that accumulates deep in the abdomen, around the intestines, liver and other internal organs. Belly fat is linked to a strongly elevated risk for diabetes, heart disease, stroke, high blood pressure and abnormal cholesterol levels...some types of cancer, including breast and colorectal cancers...and dementia.

Surprising: Having a big belly is more dangerous than simply being overweight or even obese. In a 16-year study of 45,000 female nurses, women whose waists measured 35 inches or more were much more likely to die prematurely than women with waists of less than 28 inches-even when their weight was within the normal range for their height. Women in the middle range had a small-to-moderate increase in risk. Reasons…

  • Belly fat may be more metabolically active than other fat, releasing free fatty acids (fat cell products that circulate in the bloodstream) directly to the liver. This can lead to insulin resistance (inability of the body's cells to use insulin properly) and widespread inflammation, both of which significantly increase diabetes and heart disease risk.
  • Belly fat may be a sign of fat deposits in the liver and around the heart, which can impair organ function.
  • After menopause, the tendency to accumulate belly fat increases as women produce less estrogen relative to androgens (male hormones). Androgens promote abdominal fat.

To measure: Wrap a tape measure around your torso at the level of your navel-usually slightly below the narrowest part of the abdomen. The tape should be snug but not cut into your flesh. For women of any height, a waist size of less than 30 inches is optimal...30 inches to 35 inches indicates moderately elevated health risk...and more than 35 inches indicates high risk. To reduce belly fat...

  • Lose weight. Often the first fat to go is abdominal fat. Even a modest loss of 10% of your starting weight confers great health benefits.
  • Reduce stress. Stress causes adrenal glands to release the hormone cortisol, which promotes belly fat.
  • Get the right kinds of exercise. You cannot melt away belly fat with targeted abdominal exercises, such as sit-ups. Instead, engage in aerobic activity, such as brisk walking and racket sports. Doing three hours of aerobic exercise weekly can eliminate about 50% of the excess risk for heart disease associated with belly fat and up to 25% of the excess risk for diabetes.

Also healthful: Resistance exercises (such as using arm and leg weights).

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