Data from 5 participants were excluded because of logical errors or insufficient completion, and we also excluded 30 participants who did not receive a physical examination.

As a result, analyses were conducted on 3, respondents. All respondents gave written informed consent before participation. The study was approved by the Second Military Medical University Ethics Committee in Shanghai, China.

Questionnaires were self-completed in the local residential committee offices, with trained interviewers providing an explanation for any unclear questions. Demographic information was collected, including residential region, sex, age, marital status, education level, current occupation, family income, smoking behaviour, drinking behaviour, and frequency of physical activity.

Respondents were also asked whether they had been diagnosed with chronic diseases, including hypertension, angina pectoris, cerebrovascular disease, chronic bronchitis, rheumatoid arthritis, osteoarthritis, or diabetes. A physical examination was conducted for each respondent to measure weight, height, and waist and hip circumference.

WC and WHR were used to evaluate abdominal obesity. WC was measured during minimal respiration at the mid-point between the lowest rib and the iliac crest to the nearest 0. WHR was calculated as WC divided by hip circumference.

All measurements were taken by trained investigators. As different populations may have different optimal cutoff points for anthropometric measurements in determining obesity, we used cutoff points for WC and WHR that have previously suggested specifically for the Chinese population [ 18 — 20 ].

The questionnaire has proved useful in monitoring population health, estimating the burden of different diseases, monitoring outcomes in clinical practice, and evaluating treatment effects. It comprises 36 questions describing 8 dimensions: physical functioning PF , role limitations due to physical problems RP , bodily pain BP , general health perception GH , vitality VT , social functioning SF , role limitations due to emotional problems RE , and mental health MH.

The SF dimensions can also be divided into 2 categories: a Physical Component Summary PCS and a Mental Component Summary MCS , which represent physical function and wellbeing and emotional wellbeing, respectively.

The responses in the SF were constructed by the Likert method of summated ratings. The raw score of each of the 8 dimensions was derived by summing the item scores and converting it to a value for the dimension from 0 worst possible health state measured by the questionnaire to best possible health state.

The PCS and MCS scores were calculated using standard scoring algorithms [ 23 ]. The data were analysed using Statistical Analysis System SAS 9.

All hypothesis tests used two-sided tests, and p -values of less than 0. As the cut points of anthropometric measures were different between women and men, analyses were conducted separately for women and men.

Differences of WC distribution and WHR distribution among different cities, regions, ages, marital status, education levels, occupations, family income levels, smoking behaviour, drinking behaviour, frequency of physical activity, and the presence of specific chronic diseases were analysed by the Cochran-Mantel-Haenszel test and the Chi-square test, respectively.

Student-Newman-Keuls-q SNK- q test, a statistical method for pairwise comparison between groups, was used to compare the differences of WC and WHR among different age groups.

Differences of HRQOL among different WC categories and WHR categories were analysed using analysis of variance ANOVA , with the SNK- q test used for multiple comparisons.

There was a ceiling effect for HRQOL in this study, meaning that the majority of participants had high SF scores many of them had an SF score of The mean age of participants was Mean WC and WHR were WC and WHR differed by age and gender, as depicted in Figure 1.

In the 60—80 year age group, mean WC and WHR were similar between genders; in the other 4 age groups, mean WC and WHR were significantly higher in men than in women. WC and WHR significantly increased with age. Mean baseline waist circumference and waist-to-hip ratio by gender and age.

waist circumference; b. As evaluated by WC categories, the prevalence of mild abdominal obesity and severe abdominal obesity were The prevalence of abdominal obesity among women and men was As shown in Tables 1 and 2 , according to WC categories, the prevalence of mild and severe abdominal obesity varied significantly by city, region, age, marital status, education level, family income and smoking situation among both women and men.

Abdominal obesity was more frequent in women who engaged in manual work, women who never engaged in physical activity, women who engaged in physical activity at least once per day, and men who drank alcohol. Relative to those with normal WC, women with abdominal obesity tended to have chronic diseases, including hypertension, angina pectoris, cerebrovascular disease, chronic bronchitis, rheumatoid arthritis, osteoarthritis, and diabetes.

Results were similar for men with the exception of rheumatoid arthritis and osteoarthritis. According to the WHR categories, the prevalence of abdominal obesity varied significantly by city, age, marital status, education level and frequency of physical activity among both women and men.

All chronic diseases were more prevalent among participants with abdominal obesity than in those with normal WHR, with the exception of rheumatoid arthritis in men. There was a gender-dependent magnitude between abdominal obesity and HRQOL, as shown in Table 3.

In women, participants with normal WC or normal WHR had significantly higher HRQOL than those with abdominal obesity in the majority of the survey scales.

However, among men, participants with abdominal obesity had a significantly lower HRQOL than those with normal WC or WHR in fewer survey scales. After further consideration of lifestyle variables, socio-demographic variables, and chronic diseases, we found that women with severe abdominal obesity had a lower HRQOL in RP scale based on WC categories, and women with mild abdominal obesity had a higher HRQOL in the VT scale.

In men, only SF had a lower score in those with severe abdominal obesity, and those with mild abdominal obesity had a higher HRQOL in the PF scale Table 4.

Based on WHR categories, similar HRQOL were found in all survey scales in both women and men. In the present study, the prevalence of abdominal obesity differed by some socio-demographic variables.

The prevalence of abdominal obesity in women was higher in Beijing than in other cities; male participants from Shanghai and Beijing showed a higher prevalence of abdominal obesity.

Shanghai and Beijing, as the economic centre and political centre of China, respectively, are more developed than other cities.

The rhythm of life in these 2 cities is much faster, and people suffer from greater life and work stress. It has been proposed that stress reactions are linked with the development of abdominal obesity [ 24 ]. In addition, people with life and work stress are more likely to be smokers and drinkers [ 25 , 26 ].

As found in this and other studies [ 27 , 28 ], abdominal obesity is more frequently among people who smoked and drank alcohol. These could explain why participants in Shanghai and Beijing had higher proportions of abdominal obesity.

For women, the prevalence of abdominal obesity was lower in urban areas than in rural areas, and it was opposite for men, as evaluated by WC categories.

Abdominal obesity was more common among the elderly, particularly among women. This is because older individuals are more likely to accumulate visceral fat than younger individuals [ 29 ].

In addition, a low level of education, a lack of physical activity, and the presence of chronic diseases were associated with abdominal obesity. Similar results were found in a previous study, which investigated abdominal obesity in Iranian adults [ 30 ]. It is therefore imperative that public health officials target community health promotion to individuals with these specific risk factors.

A cross-sectional survey conducted in a nationally representative sample of Chinese adults in — showed that the mean WC and WHR were Compared to the present study, there was an increase in the mean WC among Chinese adults since this time; however, there was no obvious change in the mean WHR.

Men had higher mean WC and mean WHR than women before the age of 60 years, but this trend was not obvious after the age of 60 years. These results were similar to those found in South Korea, another East Asian country.

The mean WC and mean WHR of adults in South Korea were A national survey investigating trends in abdominal obesity among Korean adults found that after the age of 60 years, women had a higher mean WC than men in and , although before the age of 60 years, men consistently had a higher mean WC than women in , , and [ 33 ].

This indicates a similar age and gender pattern of abdominal obesity between the 2 East Asian countries. However, the United States exhibits a different pattern of abdominal obesity, with an obviously higher mean WC in men than in women in all adult age groups, even after the age of 60 years [ 34 ].

As the sample in this study was selected in only five cities of China but not a national one, when we compared the results with those conducted in overall population of China or other countries, the differences in sampling may be responsible for the observed differences in data.

The present study shows that abdominal obesity influences some HRQOL scale scores in both women than in men. However, the influence of abdominal obesity on mental health was not as serious as that on physical health.

In women, all of the 4 physical health scales were affected by abdominal obesity, but only 2 mental health scales were affected. In men, only 1 of the 4 mental health scales SF was affected based on WC; no mental health scale was affected based on WHR.

Men with abdominal obesity had a higher HRQOL with respect to MH than those with normal WC. The summary scores based on both the WC and WHR categories also suggest that abdominal obesity impairs physical health rather than mental health.

This phenomenon is supported by a previous study, which indicated that individuals with a high WC were more likely to have poor physical function that limited many basic activities of daily life; however, there was little evidence to suggest that individuals with a high WC displayed poor mental health or role limitations due to emotional problems [ 16 ].

After further considering lifestyle variables, socio-demographic variables, and the presence of chronic disease, only RP in women and SF in men were impaired by severe abdominal obesity, based on WC.

This also suggests that the physical health of women is associated with abdominal obesity. The strength of this study is that the data were collected from a random sample of adults in the general population rather than in a specific population based on age groups or diseases.

However, there were still some limitations. The cross-sectional nature of the study does not allow us to make causal inferences, and whether the impaired HRQOL was caused by abdominal obesity is difficult to discern. In addition, as there is no clear gold standard for measuring abdominal obesity, we used WC and WHR, resulting in some inconsistencies between the 2 categories.

Further studies are needed to determine the causal relationship between abdominal obesity and HRQOL and to define a proper gold standard for measuring abdominal obesity. In conclusion, we conducted a population-based study in 5 Chinese cities to investigate the prevalence of abdominal obesity among adults in the general population and the relationship between abdominal obesity and HRQOL.

Impairments in physical health, but not mental health, were associated with abdominal obesity, but the specific impairments varied between genders.

Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity in the United States, — NCHS Data Brief , 1—8. The BMI is calculated using body mass and height, and the resulting score is an indirect measure of body fat. This information will be collected for educational purposes, however it will remain anonymous.

Alone, BMI is not enough to determine the risk of developing obesity-related conditions. Excess abdominal fat, regardless of overall body fat, will predispose you to obesity-related disease. This highlights the importance of measuring WHR. BMI remains the best indication of underweight and WHR should not be used for this measure.

Two people with very similar BMIs may vary substantially in the proportion of abdominal fat. A prime example of this is in older individuals. As lean muscle mass declines their BMI may not change, or may even decrease, but fat levels could be increasing with the accompanying redistribution of body fat.

WHR is not the only measure of abdominal obesity. Assessing waist circumference WC is also very useful, and sometimes more reliable. Both the WC and the WHR have their individual strengths and weaknesses and both are usually measured in a clinical evaluation.

For more information, see Body Mass Index and Measuring Central Obesity: Waist Circumference. Measuring the waist to hip ratio WHR is calculated by dividing waist circumference by hip circumference.

Waist measurements should be taken as you breathe out. You should relax and not contract any abdominal muscles. The tape measure should be aligned at the level of the belly button, and circle the whole way around the body and back to the starting point.

Excess abdominal fat distribution is indicated by a WHR greater than 0. Due to the natural variation in body shape and composition between different ethnicities , the cut-off points for determining central obesity are slightly different.

Ethnicities with a smaller build, such as Japanese and Chinese, may be at risk at a lower WHR. It is best to see your doctor to have a thorough examination that takes these factors into account.

If your WHR is greater than the cut-off levels, you should see a doctor. You are at risk for developing the following conditions:. Make sure you are measuring yourself correctly.

A simple measurement error could lead to an incorrect WHR. If you underestimate your WHR, you may incorrectly think that you are not at risk for a number of conditions and diseases. You should see your doctor for an evaluation if you think you carry excess weight in your abdominal region.

The findings suggest that maintaining a healthy weight and metabolic health may be important for preserving cognitive function. The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination.

Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity , [42] is related to the excessive consumption of fructose.

It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar glucose consumption. Intake of trans fat from industrial oils has been associated with increased abdominal obesity in men [47] and increased weight and waist circumference in women.

Numerous large studies have demonstrated that ultra-processed foods have a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women. These findings are consistent among American, [58] Canadian, [59] Latin American, [60] Australian, [61] British, [62] French, [63] Spaniard, [64] Swedish, [65] South Korean, [66] Chinese [67] and Sub-Saharan African [68] populations.

Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high- carbohydrate diets. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein. Visceral fat cells will release their metabolic by-products in the portal circulation , where the blood leads straight to the liver.

Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there.

In the liver, most of it will be stored as fat. This concept is known as ' lipotoxicity '. A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women.

After controlling for energy under-reporting, which have slightly attenuated these associations, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants — but not in the small number of female participants 2.

Further research is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol. The prevalence of abdominal obesity is increasing in Western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.

Other environmental factors, such as maternal smoking , estrogenic compounds in the diet, and endocrine -disrupting chemicals may be important also.

Hypercortisolism , such as in Cushing's syndrome , also leads to central obesity. Many prescription drugs , such as dexamethasone and other steroids , can also have side effects resulting in central obesity, [38] especially in the presence of elevated insulin levels.

In those with a body mass index BMI under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat.

BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements.

Waist measurement e. BMI will illustrate the best estimate of one's total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease.

While central obesity can be obvious just by looking at the naked body see the picture , the severity of central obesity is determined by taking waist and hip measurements.

A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating.

In the cohort of 15, people participating in the National Health and Nutrition Examination Survey NHANES III , waist circumference explained obesity-related health risk better than BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant.

In other words, excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI. a waist circumference at least half of the individual's height is predictive of increased risk.

The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman review.

Index of Central Obesity ICO is the ratio of waist circumference and height first proposed by a Parikh et al. in [85] as a better substitute to the widely used waist circumference in defining metabolic syndrome.

suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm 35 in and 80 cm 31 in for males and females. Parikh et al. looked at the average heights of various races and suggested that by using ICO various race- and gender-specific cutoffs of waist circumference can be discarded.

further tested a modified definition of metabolic syndrome in which waist circumference was replaced with ICO in the National Health and Nutrition Examination Survey NHANES database and found the modified definition to be more specific and sensitive.

This parameter has been used in the study of metabolic syndrome [92] [93] and cardiovascular disease. Central obesity in individuals with normal BMI is referred to as normal weight obesity. Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.

In women, estrogen is believed to cause fat to be stored in the buttocks , thighs , and hips. Central obesity is positively associated with coronary heart disease risk in women and men. It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk.

A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity.

Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine , although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the US , [] the UK , [] the EU , [] Australia , [] Canada , [] Hong Kong , [] and Thailand.

A study published in the International Journal of Sport Nutrition and Exercise Metabolism , [] suggests that combining cardiovascular aerobic exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat.

An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol , a hormone that leads to more belly fat deposits and leptin resistance.

Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics. In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat.

As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer. Specifically it is the deepest layer of belly fat the fat that cannot be seen or grabbed that poses health risks, as these "visceral" fat cells produce hormones that can affect health e.

The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity. For example, fat next to the liver drains into it, causing a fatty liver , which is a risk factor for insulin resistance, setting the stage for type 2 diabetes.

However, visceral fat is more responsive to the circulation of catecholamines. In the presence of type 2 diabetes , the physician might instead prescribe metformin and thiazolidinediones rosiglitazone or pioglitazone as antidiabetic drugs rather than sulfonylurea derivatives.

Thiazolidinediones may cause slight weight gain but decrease "pathologic" abdominal fat visceral fat , and therefore may be prescribed for diabetics with central obesity.

Low-fat diets may not be an effective long-term intervention for obesity: as Bacon and Aphramor wrote, "The majority of individuals regain virtually all of the weight that was lost during treatment. The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.

This difference from baseline between control and intervention groups diminished over time, but a significant difference in weight was maintained through year 9, the end of the study.

There is a common misconception that spot exercise that is, exercising a specific muscle or location of the body most effectively burns fat at the desired location, but this is not the case.

Spot exercise is beneficial for building specific muscles, but it has little effect, if any, on fat in that area of the body, or on the body's distribution of body fat. The same logic applies to sit-ups and belly fat. Sit-ups , crunches and other abdominal exercises are useful in building the abdominal muscles , but they have little effect, if any, on the adipose tissue located there.

A large central adiposity deposit has been assigned many common use names, including "spare tire", "love handle", "paunch", and "potbelly". However, there is little scientific evidence that beer drinkers are more prone to central obesity, despite its being known colloquially as "beer belly", "beer gut", or "beer pot".

One of the few studies conducted on the subject did not find that beer drinkers are more prone to central obesity than nondrinkers or drinkers of wine or spirits.

These symptoms can suggest the appearance of central obesity. Deposits of excess fat at the sides of one's waistline or obliques are commonly referred to as "love handles".

Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31, subjects aged 50—64 years of age with different waist circumferences. Their study showed that an increase in just an additional centimetre above normal waistline caused a 1. To put this in perspective, a woman with a waistline of 95 cm approx Contents move to sidebar hide.

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Download as PDF Printable version. In other projects. Wikimedia Commons. Excess fat around the stomach and abdomen. Medical condition. See also: Diet and obesity.