The shocking risks of central adiposity: how body fat distribution affects your health
By Dr. Sarika Arora, MD
Why do some people store fat in the belly instead of the hips? My patients often ask me this, because their top goal is to lose belly fat — but they don’t know how.
It turns out the difference isn’t just cosmetic — it’s because fat cells aren’t all the same. The kind of fat that creates “central adiposity” (the apple shape, with fat around the abdomen) is very different than the fat that builds up on the hips and thighs (the pear shape).
And the adipose tissue behind belly fat is especially dangerous to your health. In fact, as I explain to my patients, that fat itself is sick. Understanding the difference between the different types of fat will motivate you to get rid of it.
Some fat cells are “sick”
Women who are “apple-shaped” and carry their body fat around the belly are at risk of many health concerns. By contrast, women who are “pear-shaped,” or who have a more evenly distributed fat layer, don’t have the same level or type of health risks, even if they’re overweight.
Here’s why: Abdominal fat does more than just ruin the fit of your clothes. It’s also an active endocrine organ that adversely affects your metabolism.
Because the systemic effects of central adiposity are so varied and comprehensive, many clinicians view central adiposity as an endocrine disease, and refer abdominal fat as “sick fat.”
By taking a moment to review these various effects, we’ll help you better understand the health risks of belly fat.
Top risks of central adiposity
These are some of the most serious health risks where central adiposity is part of the contributing factors:
- Insulin resistance, diabetes and metabolic syndrome. Central adiposity is part of the foundation of insulin resistance, diabetes and metabolic syndrome. Those conditions in turn increase the risk of heart disease and other diabetes complications, such as kidney disease.
- Cardiovascular disease. Women with central adiposity have an increased risk of death due to cardiovascular disease, independent of whether they have hypertension or diabetes.
- Cancer. Belly fat corresponds to an increased risk of pre- and post-menopausal breast cancer, and is associated with a higher risk of other cancers as well.
- Gastrointestinal and liver issues. Obesity, and particularly central adiposity, is linked to a host of gastrointestinal and liver ailments, including gastroesophageal reflux disease, erosive esophagitis and gastritis, Barrett’s esophagus, esophageal and gastric cancer, diarrhea, colonic diverticular disease, polyps and colon cancer, nonalcoholic fatty liver disease, cirrhosis and liver cancer, gallstones, acute pancreatitis and pancreatic cancer.
- Sleep issues. Central adiposity is also linked to sleep disturbances, in that excess weight contributes to obstructive sleep apnea. Loss of sleep also contributes to ongoing weight gain, forming a vicious cycle.
Other long-term health damage includes hearing loss, joint and muscle dysfunction, loss of mobility, and imbalance in neurochemicals (leading to mood swings or depression) and other hormonal imbalances that can produce cravings, perimenopause symptoms, and fatigue. All of these are likely to reduce the quality of your life.
What can you do about central adiposity?
While there’s no “magic bullet” when it comes to losing stubborn abdominal weight, the top thing I urge women to do is improve their nutrition. The diet high in simple carbohydrates and saturated fats is what most often contributes most to visceral fat stores, and changing how you eat can be the first, best step toward reversing your health risks.
If you crave sugar, for example, you have an opportunity to break the cycle of excess carbohydrate intake that contributes to both the abdominal fat deposits and hormonal imbalances such as insulin resistance. Reducing the amount of sugar you eat will actually help you crave it less. But there are also nutrients that help curb sugar cravings too, such as B vitamins and chromium picolinate.
- Bays HE, González-Compoy JM, Henry RR, et al. Is adiposopathy (sick fat) an endocrine disease? International Journal of Clinical Practice 2008;62(10):1474-1483.
- Camilleri M, Malhi H, Acosta A. Gastrointestinal complications of obesity. Gastroenterology 2017; 152(7):1656–1670.
- Farb MG, Gokce N. Visceral adiposopathy: a vascular perspective. Hormone Molecular Biology and Clinical Investigation. 2015;21(2):125-136.
- Garg SK, Maurer H, Reed K, Selagamsetty R. Diabetes and cancer: two diseases with obesity as a common risk factor. Diabetes, Obesity & Metabolism 2014;16(2):97-110.
- Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength? World Journal of Diabetes 2014;5(4):444-470.
- Prineas RJ, Folsom AR, Kaye SA. Central adiposity and increased risk of coronary artery disease mortality in older women. Annals of Epidemiology 1993;3(1):35–41.
- White AJ, Nichols HB, Bradshaw PT, Sandler DP. Overall and central adiposity and breast cancer risk in the Sister Study. Cancer 2015;121:3700–3708.
- Wohlfahrt P, Redfield MM, Lopez-Jimenez F, et al. Impact of general and central adiposity on ventricular-arterial aging in women and men. JACC Heart Failure 2014;2(5):509-511.