Shedding Central Fat: Strategies for a Healthier Waist-to-Hip Ratio

An article by Dr Edward Leatham, Consultant Cardiologist

Obesity, particularly central obesity, poses significant health risks, including an increased likelihood of developing cardiovascular diseases. As a cardiologist, I am deeply aware of the impact that targeted lifestyle changes can have on reducing central fat and improving one’s waist-to-hip ratio. In this guide, we will explore a multifaceted approach involving increased physical activity, dietary modifications, and consistent monitoring to effectively lose fat and enhance overall health.

Let’s start by dispelling a few myths

1. Your weight is only partially affected by how much saturated and unsaturated fat you eat. In fact many of the healthiest diets promote an increase in unsaturated fats such as olive oil and avocado, in exchange for a reduced carbohydrate intake.  This is important if you consume processed foods where ‘low fat’ products may well be high in fructose or carbohydrates – the exact opposite of what you need!
2. Coronary heart disease is not caused by fats that you eat directly depositing in your arteries.  Although it is true that foods that are high in saturated fats can influence your serum LDL, most people find that even after an extreme change in diet (such as become a vegetarian), serum LDL Cholesterol reduces by a meagre 10-20%.  This is because 80% of our body’s cholesterol is synthesized in the liver, where it is tightly regulated by various genetically determined processes. If you eat less dietary fat (eg lower meat and diary saturated fats), depending on which of the various ‘loss and gain of function’ mutations you have inherited, your liver will synthesise more cholesterol to compensate, and vice versa.
3. In most people, the only achievable way to reduce serum lDL to the low levels required to shrink or slow coronary plaque growth in order to lower long term cardiovascular risk, is ‘pharmacological’ ie by taking medication (such as Statins) which increases LDL receptor density on hepatocytes, thereby removing more LDL from the circulation.

Increasing Physical Activity

The first step in addressing central obesity is increasing physical activity. Sedentary lifestyles contribute significantly to the accumulation of visceral fat. By incorporating both aerobic and strength-training exercises, individuals can significantly improve their body composition.

1. Increase Step Counts and Brisk Walking: Aim for a gradual increase in daily steps, remember anything is better than nothing however why not aim high – at least 10,000 steps per day for as many days of the week as you can manage. Brisk walking, in particular, is more effective than an amble. A daily 30-minute brisk walk can enhance cardiovascular health and stimulate fat burning.
2. Engage in Regular Muscle-Strengthening Activities: Incorporating upper and lower body exercises helps build muscle mass via increased mitochondrial density, which in turn boosts metabolism. Strength training exercises such as squats, lunges, push-ups, and weight lifting will have a useful impact, ideally performed at least twice a week.
3. Move More: Simple lifestyle changes like using stairs instead of elevators, walking or cycling to nearby destinations, and standing more often during the day can increase calorie expenditure.

Dietary Adjustments

Modifying dietary habits is important  in managing and reducing central fat. Here are key dietary strategies to consider:

1. Reduce Carbohydrate Intake, Especially High-Glycaemic Index Carbs: Reducing intake of refined sugars and starches is essential. Opt for whole grains instead of white bread, pasta, and rice. Consider replacing breakfast carbohydrates with fibre, protein and good fats: eggs have become a popular healthy choice again!
2. Increase Fiber Intake: Fiber-rich foods such as fruits, vegetables, legumes, and whole grains help improve satiety and reduce overall calorie intake.
3. Implement Longer Fasting Periods: Intermittent fasting, such as the 16/8 method (fasting for 16 hours and eating within an 8-hour window), has been shown to aid in weight loss and fat reduction.
4. Stay Hydrated and Limit Alcohol Consumption: Drinking plenty of water throughout the day aids metabolism and helps control hunger. Limit alcohol, which is high in calories and can lead to fat accumulation, particularly around the waist.
5. Switch Carbohydrates to Fibre: Replace high-carb snacks with high-fiber alternatives. This not only reduces caloric intake but also helps in managing blood sugar levels.
6. Reduce Consumption of High-Fructose Foods: Foods high in fructose, such as certain fruits, candies, and soft drinks, can contribute to fat accumulation around the abdomen.
7. Aim for a balance of food types on your plate:  with an emphasis on the largest component being fibre (‘fist sized’) and protein and carbohydrates being smaller, creating a healthier  balance of protein, fibre and carbohydrates.
8. Limit Snacking and Avoid Large Evening Meals: Frequent snacking can lead to an increased calorie intake. Moreover, consuming large meals in the evening, especially those high in starch, can contribute to weight gain. Adopting a meal schedule where breakfast is substantial and dinner is lighter can be more conducive to losing weight.
9. Consider using a CGM to guide:  Everyone digests their food in a unique way- dependant on food types, the order in which it is taken, the gut microbiome and genetic factors that affect insulin and fat absorption and handling. Early experience with CGMs indicate that by being able to see your own tissue glucose response in real time, you can steer away from foods and snacks that cause unhealthy glucose spikes which may both contribute to an unhealthy weight as well as help fuel a pro inflammatory response.

Lifestyle and Behavioral Changes

1. Adopt Slow and Sustainable Dietary Changes: The most successful diets are those that can be maintained over the long term rather than quick fixes. Gradual weight loss through sustainable changes is more likely to yield permanent results.
2. Use Tools for Consistent Monitoring: Employing body fat instruments or skin calipers can provide quantitative feedback and motivation. Tracking progress helps in making necessary adjustments to diet and exercise plans.
3. Get help: If there is an important medical reason to lose weight, or you struggle to lose it following your own plans, I would strongly recommend having some professional help. Depending on your preference this may be from a life coach, nutritional therapist, registered dietician or personal trainer: each providing a slightly different mix of what may be needed to achieve to help you achieve your goals.

Specialist medical advice and services

For patients who find themselves unable to shift the extra weight that threatens their health, additional medical assistance is available,. This includes access to more specialist services including psychologists and drug therapies such as Metformin and GLP-1 agonists such as Liraglutide and Semaglutide, which work by increasing insulin secretion, suppress glucagon secretion, and slow gastric emptying. Where necessary, serious obesity issues can lead to referral for surgical procedures (bariatric surgery) that, alongside all the other measures, can be highly effective in reducing long term weight.

Conclusion

Losing central fat and improving the waist-to-hip ratio requires a committed and holistic approach. By combining increased physical activity with strategic dietary changes and consistent monitoring, individuals can make significant strides toward better health and a reduced risk of cardiovascular diseases. Remember, the journey to weight loss should be gradual, focusing on long-term results and overall well-being.