# Abdominal obesity - any successful treatment? **URL:** \ **Category:** Factual Questions\ **Created:** [August 5, 2012, 7:06am UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496 "2012-08-05T07:06:01Z")\ **Posts on this page:** 12\ **Page:** 3
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 12, 2012, 4:39pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/41 "2012-08-12T16:39:59Z")
**aux203** , Waiting until someone who is obese (not just overweight), and in particular has the central obesity pattern most strongly associated with a wide variety of adverse health outcomes, _has_ those adverse health outcomes, to begin lifestyle interventions that substantially lower those risks is foolish. Advising someone at great risk of developing (if not already having) those health problems to not bother with exercise is worse than woo. As far as whether or not the op’s mother has central obesity or a tumor or ascites or some other relatively rare condition … well all have agreed she should see a doctor, for a variety of reasons, but in medicine there is an oft-repeated aphorism: “When you hear hoofbeats think horses not zebras.” Uh, yes, ascites and ovarian tumors are pretty uncommon compared to central obesity. At the risk of being accused of regurgitating a google search allow me to share some actual studies regarding the importance of exercise for treating central obesity and the increased health risks associated with it in particular. Moderate exercise with no dietary intervention causes a [preferential loss of visceral fat](http://www.springerlink.com/content/j362588t8422x624/)even in non-obese women. The balance of studies confirm this preferential loss of visceral fat with exercise in the obese and even the few that have [found otherwise](http://www.eje-online.org/content/160/5/759.full) note improved metabolic parameters by adding exercise (that study with a controlled very low calorie liquid diet, adding extra calories to the diet plus diet exercise group to make up for the calories expended by exercise and with a higher drop out rate among those in the diet only group.) If a post-menopausal woman has central obesity and already has developed Type 2 diabetes then it seems to be nearly impossible to lose significant amounts of visceral adipose tissue (VAT), the portion of abdominal fat that is considered the most harmful, [without exercise](http://jcem.endojournals.org/content/90/3/1511.full). > [@](#): > > The accumulation of fat mass results in the development of impaired fat and glucose metabolism involving both hepatic and peripheral tissues (1, 2). More specifically, intraabdominal visceral adipose tissue (VAT) is positively associated with insulin resistance in obese individuals and individuals with type 2 diabetes (3, 4, 5). VAT accumulation results in elevations in plasma free fatty acid (FFA) release into the portal vein, resulting in disturbances in glycemic control (6). Chronic exposure to elevated FFA levels causes resistance to the effects of both insulin and glucose on adipose tissue lipolysis and triglyceride storage (7); in individuals with type 2 diabetes, this response is more deranged, thus potentially causing more deleterious metabolic consequences. Weight loss, whether with diet and/or exercise, results in reductions in abdominal fat, particularly in the visceral depot in healthy obese individuals, and these changes in abdominal fat have also been associated with improvements in insulin sensitivity (8, 9, 10, 11, 12, 13). Exercise without weight loss is also effective in reducing visceral adipose tissue (14, 15). However, these earlier studies did not include individuals with type 2 diabetes … > > … During exercise, a marked increase in lipolysis in abdominal sc adipose tissue (SAT) compared with femoral adipose tissue has been observed (16), and this difference is more pronounced in women than in men (16). Also, greater lipid and lower carbohydrate oxidation is found in women compared with men during moderate intensity exercise (17, 18). Only a few studies examining abdominal fat loss have included women (9, 15), yet a different response to diet and exercise interventions may occur in women than has been observed in men. Because women with type 2 diabetes have altered fat metabolism, they may not have a similar abdominal fat loss as that previously reported in obese men. Because visceral fat is an important predictor of metabolic complications of obesity and insulin resistance (6, 19), we believed it was necessary to understand how abdominal fat is lost in this population. > > The purpose of this study was to determine the independent effects of a weight-reducing diet or diet plus exercise on abdominal fat loss and glycemic control in obese, postmenopausal women with type 2 diabetes. We also examined the effects of exercise alone, without weight loss, on total abdominal fat and abdominal fat distribution. … > > … Because there is a strong association between abdominal fat, especially VAT, and type 2 diabetes, the goal of most weight loss programs is to try to reduce this fat depot. The addition of aerobic exercise to the diet intervention augmented the abdominal fat loss, causing a 13% reduction in VAT, compared with a 7.5% reduction with the diet alone intervention. … Exercise was necessary to reduce VAT in the present study, suggesting that exercise alters adipose tissue metabolism in individuals, possibly by mobilizing FFA from VAT. The greater visceral fat loss observed with the exercise intervention could be attributed to the higher sensitivity of the omental and mesenteric adipocytes to lipolytic stimulation in response to catecholamines (34). The dramatic increase in catecholamines during exercise could stimulate β-adrenoreceptors in the VAT depot, resulting in greater FFA release and oxidation. The disordered fat storage and mobilization with type 2 diabetes may require increased lipolytic stimulation for the VAT to respond. Thus, exercise may be necessary to use this adipose tissue depot effectively. … In this study we demonstrated that exercise alone, without weight loss, is sufficient to produce a reduction in waist circumference and improvements in VAT, SAT, and total abdominal fat in women with type 2 diabetes. Exercise also protected the fat-free mass in this group, unlike both the D and D+E groups where approximately 2 kg was lost. … > > … Our data add to the current literature by demonstrating that moderate weight loss (∼4.5 kg) results in abdominal fat loss in women with type 2 diabetes; however, exercise is essential for a decrease in the VAT depot in this population. Exercise alone, without weight loss, is sufficient to result in abdominal fat loss and improved insulin sensitivity. Because changes in insulin levels are associated with the changes in abdominal fat loss, particularly in the VAT depot, this finding emphasizes the need for exercise … The exercise required to gain those benefits, that loss of visceral adipose tissue and significantly improved metabolic markers? Merely “a supervised walking program three times per week for 50 min” The conclusion that moderate exercise has substantial benefits on abdominal fat (and more importantly the health risks that the abdominal fat represents) is not highly optimistic: it is highly well documented. Sure, [more exercise will delivery more dramatic effects](http://jap.physiology.org/content/99/4/1613.full) but some is a huge amount better than none. > [@](#): > > The data support several key findings. First, in sedentary, overweight adults assigned to the control group, a relatively short period of continued physical inactivity resulted in a sizeable and significant increase in visceral abdominal fat. This finding emphasizes the high cost of continuing to choose a sedentary lifestyle for overweight, middle-aged adults. A second key finding was that in both low-amount groups, no significant increase in visceral fat was observed, suggesting that this amount of exercise was adequate for preventing the deterioration seen in the inactive controls … Third, the observation that the high amount of exercise (approximately equivalent to 17 miles/wk of vigorous exercise) not only prevented increases in visceral fat but actually resulted in sizable and significant decreases in visceral fat, as well as in subcutaneous and total abdominal fat, suggests an exercise prescription for reversing metabolic disease. That this amount of exercise can reverse metabolic disease is supported by the present data and by previously published findings from this cohort that showed improvements in lipids and lipoproteins (15), insulin sensitivity (10), and body mass and fat mass loss (31). … In conclusion, continued physical inactivity in a sedentary middle-aged overweight population led to significant gains in visceral abdominal fat over a relatively short period of time (6 mo). This finding emphasizes the high cost of continued physical inactivity for sedentary, overweight adults. Even a relatively modest exercise program, consistent with the activity recommendations from Centers for Disease Control and American College of Sports Medicine prevented significant increases in visceral abdominal fat. In view of the high rate of recidivism with weight-loss programs, the importance of prevention cannot be overemphasized. However, a modest increase in weekly caloric expenditure over Centers for Disease Control and American College of Sports Medicine recommendations resulted in significant decreases in visceral, subcutaneous, and total abdominal fat without significant changes in caloric intake. You can stand by your assertion all you like but the op did not ask about “weight loss”; the op asked about treatment of abdominal obesity. The answer to that question, whether or not it applies to the op’s mother (and as middle-aged woman in Saudi Arabia it fairly likely does), is straightforward: diet and exercise along with screening and treatment of the problems that run with the condition. What diet? Room for debate. That study with the diabetic obese women used a high monunsaturated fat diet. The DASH diets are excellent. For some low-carbing works well. Some do well with what is marketed as “Paleo” (it’s actual resemblence to the macronutrient balance of ancestral humans being another debate.) Some do well with vegan diets. Lots of options and room to discuss what can work for her in her context. Clearly a diet almost exclusively consisting of yogurt and bread is not it. And exercise is critical, whether one loses weight by doing it or not. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 12, 2012, 4:47pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/42 "2012-08-12T16:47:49Z")
> [@The\_Flying\_Dutchman](#): > > The only thing that can explain the obesity epidemic that we face today is the huge increase in the simple carbs that we consume today… Witness away. Happy it works for you. But no that is not the only thing that can explain the obesity epidemic. The fact that we, on average, eat many more calories than we used to and move around a lot less just might also have something to do with it. The fact that we are surrounded by hyper-rewarding food stimuli, designed to be highly rewarding but not very satiating (and thus to sell more of it) also just might be a factor. The fact that the industrial trans-fats that we are exposed to cause inflammation and dysfunction in the brain’s food related reward centers possibly even with prenatal exposure onset (the prenatal bit being demonstrated so far in animal studies) may also play a role. I have no problem with low carb; those who witness for it like born-agains, unwilling to accept that what works for them might not be the best choice for everyone else on the planet, do however annoy the hell out of me. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 12, 2012, 5:04pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/43 "2012-08-12T17:04:25Z")
Sorry for the multi-post but a resource [This article](http://www.ajcn.org/content/86/2/285.full) summarizes various diet plans advised for treating metabolic syndrome (with specific attention to the issue of non-alcoholic fatty liver disease - NAFLD) \*Lots \*of detail there but there bottom-line remains: > [@](#): > > It is likely that there will be no one correct approach for all NAFLD patients, and diets will therefore need to be tailored to individual needs. The inclusion of n−3 fatty acids, high-MUFA foods, fruit, vegetables, and low-GI, high-fiber foods and reduced intakes of saturated fats, simple carbohydrates, and sweetened drinks may be universally recommended to NAFLD patients. ---
**Author:** ![The\_Flying\_Dutchman](https://avatars.discourse-cdn.com/v4/letter/t/9fc348/32.png) [@The\_Flying\_Dutchman](https://boards.straightdope.com/u/The_Flying_Dutchman)\ **Post date:** [August 12, 2012, 9:03pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/44 "2012-08-12T21:03:37Z")
> [@DSeid](#): > > I have no problem with low carb; those who witness for it like born-agains, unwilling to accept that what works for them might not be the best choice for everyone else on the planet, do however annoy the hell out of me. Well if that is the way you feel, why did you quote this “bottom line” as you’ve described it. > [@](#): > > It is likely that there will be no one correct approach for all NAFLD patients, and diets will therefore need to be tailored to individual needs. The inclusion of n−3 fatty acids, high-MUFA foods, fruit, vegetables, and low-GI, high-fiber foods and reduced intakes of saturated fats, simple carbohydrates, and sweetened drinks may be universally recommended to NAFLD patients. “Universally recommended” . It seems to support what I’m saying. I can recommend that to EVERYONE. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 12, 2012, 9:37pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/45 "2012-08-12T21:37:32Z")
If you actually bother to read the article, and its review of a wide variety of approaches, you will understand the context is that a wide variety of approaches all seem to have specific pluses and minuses that may be more salient to any particular individual and the individual circumstance. There is not enough quality information to state that one is superior to another. For metabolic syndrome, and especially in the context of already having NAFLD but also in the context of someone at high statistical risk of developing NAFLD and/or diabetes and hypertension, as demonstrated by already having central obesity, any of the various nutrition plans that includes those features (and many choices do, including many versions of low carb and “paleo” and including some vegan diet plans along with many point in-between too) are highly likely to be effective in improving their health. Which one is the right one for any particular person? Not necessarily the choice that works best for me or for you. By the way, ever see a skinny walrus? Eats a diet almost completely animal-based and universally FAT. Yes it is a silly point as is your bit about lions. ---
**Author:** ![The\_Flying\_Dutchman](https://avatars.discourse-cdn.com/v4/letter/t/9fc348/32.png) [@The\_Flying\_Dutchman](https://boards.straightdope.com/u/The_Flying_Dutchman)\ **Post date:** [August 12, 2012, 9:46pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/46 "2012-08-12T21:46:43Z")
Surprise surprise. I would have thought that with all that swimming they do they would look as fit as Phelps. So much for exercise or eating fish. :rolleyes: ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [August 15, 2012, 3:12am UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/47 "2012-08-15T03:12:23Z")
> [@DSeid](#): > > I have no problem with low carb; those who witness for it like born-agains, unwilling to accept that what works for them might not be the best choice for everyone else on the planet, do however annoy the hell out of me. Likewise those (like doctors that Mrs Cad has gone to) that refuse to believe the empirical evidence that maybe, possibly, perhaps there is someone outside the box and maybe weight loss for them isn’t as simple as “Take the fucking fork out of your mouth!” and insist that the person doesn’t know how to measure food with a scale, count calories and exercise aerobically. Incidently, I’ve been reading some research that seems to imply that those that have high insulin levels may benefit more from strength training than aerobic training. Aerobic training apparently lowers the amount of insulin your body puts out in response to glucose (the whole insulin resistance/sensitivity). Strength training does that and also lowers your fasting insulin. If general insulin levels are positivly related to weight gain as some researchers think it is, then already this research would imply that there is more than calories-in vs. calories-out in regards to weight control. … but try to convince a doctor to check fasting insulin levels. The solution is “Take the fucking fork out of your mouth!” ---
**Author:** ![allotrope](https://avatars.discourse-cdn.com/v4/letter/a/edb3f5/32.png) [@allotrope](https://boards.straightdope.com/u/allotrope)\ **Post date:** [August 15, 2012, 4:54am UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/48 "2012-08-15T04:54:59Z")
I would like to point out that obesity is much more complex than simple caloric intake. [For example, it is becoming clear that the microbiome plays a significant role.](http://www.jci.org/articles/view/58109) That should be no surprise since gut organisms are instrumental in extracting nutrients from food. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 16, 2012, 1:53am UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/49 "2012-08-16T01:53:45Z")
These boards of course keep having those “debates” … and of course it both is extremely complex and very simple. Simple in that sure if one takes in less than one expends one loses weight. Complex in that both are dynamic processes under active and often not conscious control (bodies react to caloric restriction by changing drives and metabolism and activity) - that many factors play roles that we barely are beginning to understand (including the microbiome and brain center inflammation and a host of other factors) - that losing weight is not the same as losing fat and that not all fat is even the same (the issue of this thread) … But then again simple in that at the end of the day commonsense prevails: any of a wide variety of nutrition plans coupled with regular exercise will result in better health almost always and usually at least some modest weight loss in the bargain. **Saint Cad** honestly there are plenty enough of reasons to include strength training for most people that I cannot see how checking an insulin level is required. The biggest factor though in what exercise to do is determining what exercise a person _will_ do and will keep up with. If that is exclusively slow runs, fine. If that is exclusively weight training, that also works. HIIT only? Also great. Maybe some specific combination of different sorts is most ideal, maybe some specific combination _is_ somewhat more effective for some with certain features than others. Some good arguments are made for various different approaches … but the differences between the sorts and combinations of them are minor compared to the difference between _inactivity_ and any of the sorts/combination of activity. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [August 17, 2012, 4:15pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/50 "2012-08-17T16:15:13Z")
> [@DSeid](#): > > **Saint Cad** honestly there are plenty enough of reasons to include strength training for most people that I cannot see how checking an insulin level is required. My point on the insulin was that if you think your insulin level is high which is why you are having trouble losing weight it doesn’t matter because for doctors it’s all about taking in fewer calories with no thought that there may be a hormonal interplay at work. Mrs. Cad has now been prescribed 4 different drugs for obesity. Guess what they all have been - appetite suppressents. She cancelled her last appointment because for $200 she gets weighed, told by the doctor that the medication is not working and gets a new suppressent prescribed. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 17, 2012, 8:48pm UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/51 "2012-08-17T20:48:23Z")
Of course there is hormonal interplay at work. Fat tissue is an endocrine organ and obesity therefore induces all sorts of hormonal reactions. The issue is if the test will lead to different actions. Assume the test is performed and her baseline insulin level is high, perhaps she even has poor glucose tolerance. And? It is impossible to say whether that is cause or effect or both in some interplay effecting each other. More importantly what is it going to suggest she, with the help of her healthcare providers, do differently? Of course if she is out and out diabetic that needs to be treated but she is still left with: 1. Finding a healthy nutrition plan that works for her. That is more than “Take the fucking fork out of your mouth.” And it is more than accepting that there is only one approach that can work for all people. Sure, there is some suggestion that a [low-glycemic load diet](http://care.diabetesjournals.org/content/28/12/2939.full) (40% carbohydrate, 30% protein, 30% fat, 15 g fiber/1,000 kcal, mean estimated daily glycemic index of 53, and glycemic load of 45 g/1,000 kcals at 30% calorie restriction compared with baseline individual energy needs) may be more effective in the context of high insulin secretion than when insulin secretion is not high. But there is no reason not to discuss trying that diet without knowing insulin levels. 2. Exercise. Preferably including some periods of higher intensity and including some resistance exercise. Sure such makes even more sense in the context of knowing, rather than presuming, high insulin levels, for many reasons, but it is something that she should be doing in any case. 3. Support. That is more than you can provide alone. Serious support systems with groups. 4. Realistic expectations. Those three will likely result in modest fat loss and significantly lowered risk of health problems. Many set them up for failure by expecting more than that and then go back to old habits. 5. And if obese enough and/or also with comorbidities, and not making any progress with those options, considering bariatric surgery. Until we have enough information to be able to advise with confidence one nutrition/exercise plan over another based on the lab result, or some other intervention based on the lab result, doing the test seems at best an intellectual exercise. ---
**Author:** ![allotrope](https://avatars.discourse-cdn.com/v4/letter/a/edb3f5/32.png) [@allotrope](https://boards.straightdope.com/u/allotrope)\ **Post date:** [August 18, 2012, 2:38am UTC](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496/52 "2012-08-18T02:38:39Z")
> [@Saint\_Cad](#): > > My point on the insulin was that if you think your insulin level is high which is why you are having trouble losing weight it doesn’t matter because for doctors it’s all about taking in fewer calories with no thought that there may be a hormonal interplay at work. Mrs. Cad has now been prescribed 4 different drugs for obesity. Guess what they all have been - appetite suppressents. She cancelled her last appointment because for $200 she gets weighed, told by the doctor that the medication is not working and gets a new suppressent prescribed. Amphetamines, which is what I assume you mean by ‘appetite suppressant’, don’t work for everyone. However there are other medications and especially combination meds that may be more effective. For example, the combination of phentermine (a mild amphetamine) and topiramate (an anti-epileptic) has been approved as the drug [Qsymia](http://www.cnn.com/2012/07/17/health/fda-diet-drug/index.html) (formerly Qnexa). [Previous page](https://boards.straightdope.com/t/abdominal-obesity-any-successful-treatment/630496.md?page=2)