Reduce Your Risk for Heart Attack, Diabetes and Cancer

Don’t count on the latest diet to shrink an expanding waistline. Belly fat is stubborn. Unlike fat in the thighs, buttocks and hips, which visibly diminishes when you cut calories, belly fat tends to stick around. Even strenuous exercise might not make a dent.

The persistence of a belly bulge isn’t merely cosmetic. Beneath the subcutaneous fat that you can pinch with your fingers, fat deep in the abdomen is metabolically different from “normal” fat. Known as visceral fat, it secretes ­inflammatory substances that increase the risk for heart attack, type 2 diabetes and some cancers. Even if you’re not overweight, a larger-than-average waistline increases health risks.

Surprisingly, even thin people can have a high percentage of visceral fat. It might not be visible, but the risks are the same.

Weight-loss diets can certainly help you drop pounds—and some of that weight will come from the deep abdominal area. But unless you take a broader approach than the standard diet and exercise advice, it’s very difficult to maintain visceral fat reductions over the long haul. Here are better approaches to shrink your belly…

• Don’t stress over losing weight. Everyone knows about “stress eating.” After a fight with your spouse or a hard day at work, food can be a welcome distraction. What people don’t realize is that the struggle to lose weight may itself be highly stressful and that it can cause your belly fat to stick around.

How this happens: Cortisol, one of the main stress-related hormones, increases appetite and makes you less mindful of what you eat. It causes the body to store more fat, particularly visceral fat. People who worry a lot about their weight actually may find themselves eating more.

Take action to reduce stress by practicing yoga, meditation or tai chi for even just a few minutes a day. One study found that there was little or no ­obesity among more than 200 women over age 45 who had practiced yoga for many years. The key is regular practice—it’s better to do 10 minutes of yoga a day than a 90-minute class once a week.

Also helpful: Belly breathing. Sit up straight in a chair or lie down on your back, close your eyes, and tune into your breathing. Breathe in and out through your nose slowly and deeply but without straining. You’ll feel your belly gently moving out as you inhale and then in as you exhale.

This type of breathing is an effective form of stress control. Try it for one to five minutes once or twice a day…or anytime you’re feeling stressed.

• Cultivate mindfulness in your ­everyday life. According to yoga and Ayurvedic medicine (a system of healing that originated in India), an overly busy mind can play as big a role in weight gain as diet or exercise. We all need to step back from the chaos of life and give our nervous system a chance to unwind. Take it one step at a time. Do less multitasking. Try to move a ­little more slowly and deliberately. Spend less time on the Internet and watching television—especially when you’re eating. Although these activities may seem relaxing, they can stimulate the mind and the nervous system and lead to overeating. Bonus: When you eat mindfully, you’ll enjoy your food more and need less to feel satisfied.

• Exercise, but don’t go crazy. Exercise, particularly aerobic exercise, can obviously be good for weight loss. But for many people, the intensity at which they exercise becomes yet another source of stress.

Example: One of my medical colleagues described a “Type A” patient who was an exercise fanatic. Despite her strenuous fitness program, she had a stubborn 10 pounds that she couldn’t get rid of. He suggested that she might have more luck if she’d simply relax a bit. She ignored his advice—until she broke a leg and had to take a break. The 10 pounds melted away.

My advice: Get plenty of exercise, but enjoy it. Don’t let it be stressful—make it a soothing part of your day. Go for a bike ride…swim in a lake…take a hike in nature. Exercise that is relaxing may burn just as many calories as a do-or-die gym workout but without the stress-related rise in cortisol.

Tip: If you’ve practiced belly breathing, try to bring that kind of breath focus to your exercise. It’s even possible to slowly train yourself to breathe through your nose while you exercise, potentially lowering cortisol levels and the rebound hunger that is so common after a workout.

• Eat more fresh, unprocessed food. What really matters for health and healthy weight is the quality of your food. Many diets that have been shown to be effective—such as the low-fat ­vegetarian Ornish program…the Mediterranean diet…and some high-protein plans—disagree with one another, but they all emphasize old-fashioned un­processed food.

My advice: Worry less about micronutrients such as specific vitamins, minerals and types of fat or your protein/carbohydrate balance, and instead focus on eating more fresh vegetables, legumes, whole grains, fruit, nuts and seeds. If you eat animal foods, choose free-range and pasture-raised meat and dairy products, organic if possible.

• Cut back on refined sugar. If you follow the advice above and avoid processed foods, you’ll naturally consume less sugar, refined grains (such as white bread) and other “simple” carbohydrates. This will help prevent insulin surges that can lead to more visceral fat.

As always, balance is important. I don’t advise anyone to give up all ­sources of sugar or all carbohydrates. After all, a plum is loaded with the sugar fructose—and fruits are good for you! It’s the added sugar in junk and fast food that’s the problem. Just be aware that any processed food—including many snacks that are marketed as healthier alternatives—will make it harder to control your weight.