View source for Abdominal obesity

{{short description|Excess fat around the stomach and abdomen}}
{{use dmy dates|date=July 2024}}
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{{Infobox medical condition (new)
| name          = Abdominal obesity
| image         = Obesity6.JPG
| caption       = An abdominous obese male{{Break}}Weight: 182 kg/400 lbs{{Break}}Height: 185 cm/6 ft 1 in{{Break}}[[Body mass index]]: 53
| pronounce     = 
| field         = [[Endocrinology]]
| synonyms      = Central obesity, truncal obesity; see also {{section link||Colloquialisms}}
| symptoms      = 
| complications = [[Heart disease]], [[asthma]], [[stroke]], [[diabetes]]
| onset         = 
| duration      = 
| types         = 
| causes        = [[Sedentary lifestyle]], [[overeating]], [[Cushing's syndrome]], [[alcoholism]], [[Polycystic ovarian syndrome]], [[Prader-Willi syndrome]]
| risks         = 
| diagnosis     = 
| differential  = 
| prevention    = 
| treatment     = 
| medication    = 
| prognosis     = 
| frequency     = 
| deaths        = 
| alt           = 
}}

'''Abdominal obesity''', also known as '''central obesity''' and '''truncal obesity''', is the human condition of an excessive concentration of [[visceral fat]] around the [[stomach]] and [[abdomen]] to such an extent that it is likely to harm its bearer's health. Abdominal [[obesity]] has been strongly linked to [[cardiovascular disease]],<ref name="Yusuf2004"/> [[Alzheimer's disease]], and other [[Metabolic Diseases|metabolic]] and [[vascular disease]]s.<ref name="Razay2006" />

[[Visceral]] fat, central abdominal fat, and [[waist circumference]] show a strong association with [[type 2 diabetes]].<ref>{{cite journal | vauthors = Anjana M, Sandeep S, Deepa R, Vimaleswaran KS, Farooq S, Mohan V | title = Visceral and central abdominal fat and anthropometry in relation to diabetes in Asian Indians | journal = Diabetes Care | volume = 27 | issue = 12 | pages = 2948–53 | date = December 2004 | pmid = 15562212 | doi = 10.2337/diacare.27.12.2948 | doi-access = free }}</ref>

Visceral fat, also known as organ fat or ''intra-abdominal fat'', is located inside the [[peritoneal cavity]], packed in between [[internal organ]]s and [[torso]], as opposed to [[subcutaneous fat]], which is found underneath the [[skin]], and [[intramuscular fat]], which is found interspersed in [[skeletal muscle]]. Visceral fat is composed of several [[adipose depot]]s including [[mesenteric]], [[epididymis|epididymal]] white [[adipose tissue]] (EWAT), and [[perirenal fat]]. An excess of [[Adipose tissue#Visceral fat|adipose visceral fat]] is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped" in which fat is deposited on the hips and buttocks.

Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease, [[diabetes]], and [[dyslipidemia]]. Abdominal obesity was more closely related with [[metabolic dysfunction]]s connected with cardiovascular disease than was general obesity. In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as [[computed tomography]] and [[magnetic resonance imaging]] made it possible to categorize mass of [[adipose tissue]] located at the abdominal level into intra-abdominal fat and subcutaneous fat.<ref name="Poehlman1998">{{cite journal | vauthors = Poehlman ET | title = Abdominal Obesity: The Metabolic Multi-risk Factor |journal=Coronary Heart Disease |volume=9 |issue=8 |pages=469–471 |year=1998 |doi=10.1097/00019501-199809080-00001|s2cid=57778374 }}</ref>

Abdominal obesity is linked with higher cardiovascular events among [[Ethnic groups in South Asia|South Asian ethnic]] populations.<ref>{{Cite journal |last1=Misra |first1=A. |last2=Soares |first2=Mario J. |last3=Mohan |first3=Viswanathan |last4=Anoop |first4=Shajith |last5=Abhishek |first5=Vishnu |last6=Vaidya |first6=Ruchi |last7=Pradeepa |first7=Rajendra |date=2018 |title=Body fat, metabolic syndrome and hyperglycemia in South Asians |url=https://linkinghub.elsevier.com/retrieve/pii/S1056872718303465 |journal=Journal of Diabetes and Its Complications |language=en |volume=32 |issue=11 |pages=1068–1075 |doi=10.1016/j.jdiacomp.2018.08.001 |pmid=30115487 |s2cid=52020830 |via=PubMed|url-access=subscription }}</ref>

== Health risks ==
===Heart disease===
Abdominal obesity is typically associated with a statistically higher risk of [[heart disease]], [[hypertension]], [[insulin resistance]], and [[Diabetes Mellitus Type 2|type 2 diabetes]] (see below).<ref>{{cite journal | vauthors = Westphal SA | title = Obesity, abdominal obesity, and insulin resistance | journal = Clinical Cornerstone | volume = 9 | issue = 1 | pages = 23–29; discussion 30–1 | year = 2008 | pmid = 19046737 | doi = 10.1016/S1098-3597(08)60025-3 }}</ref> With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well.<ref>{{cite journal | vauthors = Cameron AJ, Zimmet PZ | title = Expanding evidence for the multiple dangers of epidemic abdominal obesity | journal = Circulation | volume = 117 | issue = 13 | pages = 1624–6 | date = April 2008 | pmid = 18378623 | doi = 10.1161/CIRCULATIONAHA.108.775080 | doi-access = free }}</ref> [[Metabolic syndrome]] is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, type 2 diabetes, and an increased risk of developing cardiovascular disease.<ref name="Després">{{cite journal | vauthors = Després JP, Lemieux I | title = Abdominal obesity and metabolic syndrome | journal = Nature | volume = 444 | issue = 7121 | pages = 881–7 | date = December 2006 | pmid = 17167477 | doi = 10.1038/nature05488 | s2cid = 11944065 | bibcode = 2006Natur.444..881D }}</ref><ref>{{cite journal | title = Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) | journal = JAMA | volume = 285 | issue = 19 | pages = 2486–97 | date = May 2001 | pmid = 11368702 | doi = 10.1001/jama.285.19.2486 | last1 = Expert Panel On Detection | first1 = Evaluation }}</ref><ref name="Grundy">[http://circ.ahajournals.org/cgi/reprint/109/3/433.pdf Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant D, for the Conference Participants. Definition of metabolic syndrome: report of the National, Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition.] Circulation. 2004;109:433-438.</ref><ref>{{cite web|url=http://www.americanheart.org/presenter.jhtml?identifier=4756 |title=American Heart Association's description of Syndrome X |publisher=Americanheart.org |access-date=2013-01-05}}</ref> It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.<ref name="Poehlman1998" /><ref>{{cite journal | vauthors = Mørkedal B, Romundstad PR, Vatten LJ | title = Informativeness of indices of blood pressure, obesity and serum lipids in relation to ischaemic heart disease mortality: the HUNT-II study | journal = European Journal of Epidemiology | volume = 26 | issue = 6 | pages = 457–61 | date = June 2011 | pmid = 21461943 | pmc = 3115050 | doi = 10.1007/s10654-011-9572-7 }}</ref>

Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and that [[Body Volume Index|BVI]] calculations correlate significantly with all biomarkers of cardiovascular risk.<ref>Romero-Corral, A. Somers, V. Lopez-Jimenez, F. Korenfeld, Y. Palin, S. Boelaert, K. Boarin, S. Sierra-Johnson, J. Rahim, A. (2008) 3-D Body Scanner, Body Volume Index: A Novel, Reproducible and Automated Anthropometric Tool Associated with Cardiometabolic Biomarkers ''Obesity A Research Journal'' 16 (1) 266-P</ref>

=== Diabetes ===
There are numerous theories as to the exact cause and mechanism in [[Diabetes Mellitus Type 2|type 2 diabetes]]. Central obesity is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called [[adipokine]]s that may possibly [[Impaired glucose tolerance|impair glucose tolerance]]. But [[adiponectin]], an anti-inflammatory adipokine, which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus (T2DM).<ref>{{cite journal | vauthors = Ghoshal K, Bhattacharyya M | title = Adiponectin: Probe of the molecular paradigm associating diabetes and obesity | journal = World Journal of Diabetes | volume = 6 | issue = 1 | pages = 151–66 | date = February 2015 | pmid = 25685286 | pmc = 4317307 | doi = 10.4239/wjd.v6.i1.151 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Darabi H, Raeisi A, Kalantarhormozi MR, Ostovar A, Assadi M, Asadipooya K, Vahdat K, Dobaradaran S, Nabipour I | display-authors = 6 | title = Adiponectin as a Protective Factor Against the Progression Toward Type 2 Diabetes Mellitus in Postmenopausal Women | journal = Medicine | volume = 94 | issue = 33 | article-number = e1347 | date = August 2015 | pmid = 26287420 | pmc = 4616451 | doi = 10.1097/md.0000000000001347 }}</ref>

[[Insulin resistance]] is a major feature of diabetes mellitus type 2, and central obesity is correlated with both insulin resistance and T2DM itself.<ref>{{cite journal |vauthors=Duman BS, Turkoglu C, Gunay D, Cagatay P, Demiroglu C, Buyukdevrim AS | year = 2003 | title = The interrelationship between insulin secretion and action in type 2 diabetes mellitus with different degrees of obesity: evidence supporting central obesity | journal = Diabetes Butr Metab | volume = 16 | issue = 4| pages = 243–250 }}</ref><ref>{{cite journal | vauthors = Gabriely I, Ma XH, Yang XM, Atzmon G, Rajala MW, Berg AH, Scherer P, Rossetti L, Barzilai N | display-authors = 6 | title = Removal of visceral fat prevents insulin resistance and glucose intolerance of aging: an adipokine-mediated process? | journal = Diabetes | volume = 51 | issue = 10 | pages = 2951–8 | date = October 2002 | pmid = 12351432 | doi = 10.2337/diabetes.51.10.2951 | doi-access = free }}</ref> Increased [[adiposity]] (obesity) raises serum [[resistin]] levels,<ref name=Asensio2004>{{cite journal | vauthors = Asensio C, Cettour-Rose P, Theander-Carrillo C, Rohner-Jeanrenaud F, Muzzin P | title = Changes in glycemia by leptin administration or high- fat feeding in rodent models of obesity/type 2 diabetes suggest a link between resistin expression and control of glucose homeostasis | journal = Endocrinology | volume = 145 | issue = 5 | pages = 2206–13 | date = May 2004 | pmid = 14962997 | doi = 10.1210/en.2003-1679 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Degawa-Yamauchi M, Bovenkerk JE, Juliar BE, Watson W, Kerr K, Jones R, Zhu Q, Considine RV | display-authors = 6 | title = Serum resistin (FIZZ3) protein is increased in obese humans | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 88 | issue = 11 | pages = 5452–5 | date = November 2003 | pmid = 14602788 | doi = 10.1210/jc.2002-021808 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Lee JH, Bullen JW, Stoyneva VL, Mantzoros CS | title = Circulating resistin in lean, obese, and insulin-resistant mouse models: lack of association with insulinemia and glycemia | journal = American Journal of Physiology. Endocrinology and Metabolism | volume = 288 | issue = 3 | pages = E625-32 | date = March 2005 | pmid = 15522996 | doi = 10.1152/ajpendo.00184.2004 | s2cid = 20609673 }}</ref><ref>{{cite journal | vauthors = Vendrell J, Broch M, Vilarrasa N, Molina A, Gómez JM, Gutiérrez C, Simón I, Soler J, Richart C | display-authors = 6 | title = Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity | journal = Obesity Research | volume = 12 | issue = 6 | pages = 962–71 | date = June 2004 | pmid = 15229336 | doi = 10.1038/oby.2004.118 | doi-access = free }}</ref> which in turn directly correlate to insulin resistance.<ref>{{cite journal | vauthors = Hirosumi J, Tuncman G, Chang L, Görgün CZ, Uysal KT, Maeda K, Karin M, Hotamisligil GS | display-authors = 6 | title = A central role for JNK in obesity and insulin resistance | journal = Nature | volume = 420 | issue = 6913 | pages = 333–6 | date = November 2002 | pmid = 12447443 | doi = 10.1038/nature01137 | url = http://www.hsph.harvard.edu/GSH-LAB/tnf-ins.html | s2cid = 1659156 | bibcode = 2002Natur.420..333H | url-access = subscription }}</ref><ref>{{cite journal | vauthors = Rajala MW, Qi Y, Patel HR, Takahashi N, Banerjee R, Pajvani UB, Sinha MK, Gingerich RL, Scherer PE, Ahima RS | display-authors = 6 | title = Regulation of resistin expression and circulating levels in obesity, diabetes, and fasting | journal = Diabetes | volume = 53 | issue = 7 | pages = 1671–9 | date = July 2004 | pmid = 15220189 | doi = 10.2337/diabetes.53.7.1671 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Silha JV, Krsek M, Skrha JV, Sucharda P, Nyomba BL, Murphy LJ | title = Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance | journal = European Journal of Endocrinology | volume = 149 | issue = 4 | pages = 331–5 | date = October 2003 | pmid = 14514348 | doi = 10.1530/eje.0.1490331 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Smith SR, Bai F, Charbonneau C, Janderová L, Argyropoulos G | title = A promoter genotype and oxidative stress potentially link resistin to human insulin resistance | journal = Diabetes | volume = 52 | issue = 7 | pages = 1611–8 | date = July 2003 | pmid = 12829623 | doi = 10.2337/diabetes.52.7.1611 | doi-access = free }}</ref> Studies have also confirmed a direct correlation between resistin levels and T2DM.<ref name=Asensio2004/><ref>{{cite journal | vauthors = Fujinami A, Obayashi H, Ohta K, Ichimura T, Nishimura M, Matsui H, Kawahara Y, Yamazaki M, Ogata M, Hasegawa G, Nakamura N, Yoshikawa T, Nakano K, Ohta M | display-authors = 6 | title = Enzyme-linked immunosorbent assay for circulating human resistin: resistin concentrations in normal subjects and patients with type 2 diabetes | journal = Clinica Chimica Acta; International Journal of Clinical Chemistry | volume = 339 | issue = 1–2 | pages = 57–63 | date = January 2004 | pmid = 14687894 | doi = 10.1016/j.cccn.2003.09.009 }}</ref><ref>{{cite journal | vauthors = McTernan PG, Fisher FM, Valsamakis G, Chetty R, Harte A, McTernan CL, Clark PM, Smith SA, Barnett AH, Kumar S | display-authors = 6 | title = Resistin and type 2 diabetes: regulation of resistin expression by insulin and rosiglitazone and the effects of recombinant resistin on lipid and glucose metabolism in human differentiated adipocytes | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 88 | issue = 12 | pages = 6098–106 | date = December 2003 | pmid = 14671216 | doi = 10.1210/jc.2003-030898 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS, Lazar MA | display-authors = 6 | title = The hormone resistin links obesity to diabetes | journal = Nature | volume = 409 | issue = 6818 | pages = 307–12 | date = January 2001 | pmid = 11201732 | doi = 10.1038/35053000 | s2cid = 4358808 | bibcode = 2001Natur.409..307S }}</ref> And it is waistline adipose tissue (central obesity) which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin.<ref>{{cite journal | vauthors = LiPuma JJ, Spilker T, Coenye T, Gonzalez CF | title = An epidemic Burkholderia cepacia complex strain identified in soil | journal = Lancet | volume = 359 | issue = 9322 | pages = 2002–3 | date = June 2002 | pmid = 12076559 | doi = 10.1016/S0140-6736(02)08836-0 | bibcode = 2002Lanc..359.2002L | s2cid = 8649208 | url = https://biblio.ugent.be/publication/162874/file/8172364 | url-access = subscription }}</ref><ref>{{cite journal | vauthors = McTernan PG, McTernan CL, Chetty R, Jenner K, Fisher FM, Lauer MN, Crocker J, Barnett AH, Kumar S | display-authors = 6 | title = Increased resistin gene and protein expression in human abdominal adipose tissue | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 87 | issue = 5 | page = 2407 | date = May 2002 | pmid = 11994397 | doi = 10.1210/jc.87.5.2407 | doi-access = free }}</ref> Conversely, serum resistin levels have been found to ''decline'' with decreased adiposity following medical treatment.<ref>{{cite journal | vauthors = Valsamakis G, McTernan PG, Chetty R, Al Daghri N, Field A, Hanif W, Barnett AH, Kumar S | display-authors = 6 | title = Modest weight loss and reduction in waist circumference after medical treatment are associated with favorable changes in serum adipocytokines | journal = Metabolism | volume = 53 | issue = 4 | pages = 430–4 | date = April 2004 | pmid = 15045687 | doi = 10.1016/j.metabol.2003.11.022 }}</ref>

=== Asthma ===

Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. Obesity causes decreased [[tidal volume]]s due to a reduction in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragm.<ref>{{cite journal | vauthors = Mohanan S, Tapp H, McWilliams A, Dulin M | title = Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care | journal = Experimental Biology and Medicine | volume = 239 | issue = 11 | pages = 1531–40 | date = November 2014 | pmid = 24719380 | pmc = 4230977 | doi = 10.1177/1535370214525302 }}</ref> It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air.<ref>{{cite journal | vauthors = Shore SA, Johnston RA | title = Obesity and asthma | journal = Pharmacology & Therapeutics | volume = 110 | issue = 1 | pages = 83–102 | date = April 2006 | pmid = 16297979 | doi = 10.1016/j.pharmthera.2005.10.002 }}</ref> People with obesity are also more likely to be hospitalized for asthma. A study has stated that 75% of patients treated for asthma in the emergency room were either overweight or obese.<ref>{{cite journal | vauthors = Thomson CC, Clark S, Camargo CA | title = Body mass index and asthma severity among adults presenting to the emergency department | journal = Chest | volume = 124 | issue = 3 | pages = 795–802 | date = September 2003 | pmid = 12970000 | doi = 10.1378/chest.124.3.795 | s2cid = 13138899 }}</ref>

=== Alzheimer's disease ===
Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear.<ref name="Razay2006">{{cite journal | vauthors = Razay G, Vreugdenhil A, Wilcock G | title = Obesity, abdominal obesity and Alzheimer disease | journal = Dementia and Geriatric Cognitive Disorders | volume = 22 | issue = 2 | pages = 173–6 | year = 2006 | pmid = 16847377 | doi = 10.1159/000094586 | s2cid = 24351283 }}</ref> A study by Debette et al. (2010) examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of [[dementia]].<ref>{{cite journal | vauthors = Debette S, [[Alexa Beiser|Beiser A]], Hoffmann U, Decarli C, O'Donnell CJ, Massaro JM, Au R, Himali JJ, Wolf PA, Fox CS, Seshadri S | display-authors = 6 | title = Visceral fat is associated with lower brain volume in healthy middle-aged adults | journal = Annals of Neurology | volume = 68 | issue = 2 | pages = 136–44 | date = August 2010 | pmid = 20695006 | pmc = 2933649 | doi = 10.1002/ana.22062 }}</ref><ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/8693947.stm |publisher=BBC News |title='Beer belly' link to Alzheimer's |date=2010-05-20 }}</ref><ref>{{cite web | vauthors = Mitchell S |url=http://www.nbcnews.com/id/23800703 |archive-url=https://web.archive.org/web/20150318143512/http://www.nbcnews.com/id/23800703/ |archive-date=18 March 2015 |title=Bulging belly now could mean dementia later |publisher=NBC News |date=2008-03-26 |access-date=2013-01-05}}</ref> Alzheimer's disease and abdominal obesity has a strong correlation and with metabolic factors added in, the risk of developing Alzheimer's disease was even higher. Based on logistic regression analyses, it was found that obesity was associated with an almost 10-fold increase risk of Alzheimer's disease.<ref name="Razay2006" />

=== Cancer ===
Abdominal obesity has been associated with an increased risk of several cancers, particularly malignancies of the digestive system.<ref name=":0">{{Cite journal |last1=Deng |first1=Hai |last2=Duan |first2=Xueru |last3=Huang |first3=Jun |last4=Zheng |first4=Murui |last5=Lao |first5=Miaochan |last6=Weng |first6=Fan |last7=Su |first7=Qi-ying |last8=Zheng |first8=Zhen-feng |last9=Mei |first9=Yunting |last10=Huang |first10=Li |last11=Yang |first11=Wen-han |last12=Xing |first12=Xiaohui |last13=Ma |first13=Xiaofeng |last14=Zhao |first14=Wenjing |last15=Liu |first15=Xudong |date=2023-09-21 |title=Association of adiposity with risk of obstructive sleep apnea: a population-based study |journal=BMC Public Health |language=en |volume=23 |issue=1 |pages=1835 |doi=10.1186/s12889-023-16695-4 |doi-access=free |issn=1471-2458 |pmc=10512644 |pmid=37735660}}</ref> These include colorectal, pancreatic, and esophageal cancers. These associations often remain even after adjustment for overall body mass index, which suggests that abdominal fat distribution is an independent risk factor. In women, abdominal obesity has also been linked to higher rates of breast cancer in both the pre- and post-menopausal periods, beyond the effects of general obesity.<ref name=":0" />

=== Obstructive sleep apnea ===
Abdominal obesity is an important risk factor for obstructive sleep apnea, as increased abdominal fat can place pressure on the airway and narrow it.<ref name=":1">{{Cite journal |last1=Li |first1=Xue |last2=Lian |first2=Yajun |last3=Ping |first3=Weiwei |last4=Wang |first4=Kunbo |last5=Jiang |first5=Lingyan |last6=Li |first6=Shaoxia |date=2023-11-27 |title=Abdominal obesity and digestive system cancer: a systematic review and meta-analysis of prospective studies |journal=BMC Public Health |language=en |volume=23 |issue=1 |pages=2343 |doi=10.1186/s12889-023-17275-2 |doi-access=free |issn=1471-2458 |pmc=10680266 |pmid=38012596}}</ref> This can lead to reduced lung volumes during sleep. Higher waist circumference and waist-to-hip ratio are associated with obstructive sleep apnea, even in individuals whose body mass index is only in the overweight range.<ref name=":1" />

===Other health risks===

Central obesity can be a feature of [[lipodystrophy|lipodystrophies]], a group of diseases that is either [[genetic disorder|inherited]], or due to secondary causes (often [[protease inhibitor (pharmacology)|protease inhibitor]]s, a group of [[medication]]s against [[AIDS]]). Central obesity is a symptom of [[Cushing's syndrome]]<ref name="Does central obesity reflect Cushi">{{cite journal | vauthors = Bujalska IJ, Kumar S, Stewart PM | title = Does central obesity reflect "Cushing's disease of the omentum"? | journal = Lancet | volume = 349 | issue = 9060 | pages = 1210–3 | date = April 1997 | pmid = 9130942 | doi = 10.1016/S0140-6736(96)11222-8 | s2cid = 24643796 }}</ref> and is also common in patients with [[polycystic ovary syndrome]] (PCOS). Central obesity is associated with [[glucose intolerance]] and [[dyslipidemia]]. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.<ref>{{Cite journal |last1=Lukács |first1=Anita |last2=Horváth |first2=Edina |last3=Máté |first3=Zsuzsanna |last4=Szabó |first4=Andrea |last5=Virág |first5=Katalin |last6=Papp |first6=Magor |last7=Sándor |first7=János |last8=Ádány |first8=Róza |last9=Paulik |first9=Edit |date=2019-11-15 |title=Abdominal obesity increases metabolic risk factors in non-obese adults: a Hungarian cross-sectional study |journal=BMC Public Health |volume=19 |issue=1 |page=1533 |doi=10.1186/s12889-019-7839-1 |issn=1471-2458 |pmc=6858760 |pmid=31730482 |doi-access=free }}</ref>

Ghroubi et al. (2007) examined whether abdominal circumference is a more reliable indicator than [[Body mass index|BMI]] or the presence of [[knee osteoarthritis]] in obese patients.<ref name="Ghroubi2007">{{cite journal | vauthors = Ghroubi S, Elleuch H, Guermazi M, Kaffel N, Feki H, Abid M, Baklouti S, Elleuch MH | display-authors = 6 | title = [Abdominal obesity and knee ostheoarthritis] | journal = Annales de Réadaptation et de Médecine Physique | volume = 50 | issue = 8 | pages = 661–6 | date = November 2007 | pmid = 17445932 | doi = 10.1016/j.annrmp.2007.03.005 }}</ref> They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. (2007) concluded that a high abdominal circumference is associated with great functional repercussion.<ref name="Ghroubi2007"/>

Research published in [[The Lancet]] (2023) found that high levels of visceral fat were related to poorer cognitive performance. The findings suggest that maintaining a healthy weight and metabolic health may be important for preserving cognitive function.<ref>{{cite journal | author7=Low DYW | author8=Lam BCC | title=Adiposity impacts cognitive function in Asian populations: An epidemiological and Mendelian Randomization study | journal=The Lancet Regional Health. Western Pacific | date=2023 | volume=33 | article-number=100710 | doi=10.1016/j.lanwpc.2023.100710 | pmid=36851942 | pmc=9957736 | vauthors = Mina T, Yew YW, Ng HK, Sadhu N, Wansaicheong G, Dalan R }}</ref>

== Causes ==

===Diet===

{{see also|Diet and obesity}}
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 [[Metabolic waste|elimination]]. Some studies indicate that visceral adiposity, together with [[lipid]] dysregulation and [[Insulin resistance|decreased insulin sensitivity]],<ref>{{cite journal | vauthors = Stanhope KL, Havel PJ | title = Fructose consumption: recent results and their potential implications | journal = Annals of the New York Academy of Sciences | volume = 1190 | issue = 1 | pages = 15–24 | date = March 2010 | pmid = 20388133 | pmc = 3075927 | doi = 10.1111/j.1749-6632.2009.05266.x | bibcode = 2010NYASA1190...15S }}</ref> is related to the excessive consumption of [[fructose]].<ref>{{cite journal | vauthors = Elliott SS, Keim NL, Stern JS, Teff K, Havel PJ | title = Fructose, weight gain, and the insulin resistance syndrome | journal = The American Journal of Clinical Nutrition | volume = 76 | issue = 5 | pages = 911–22 | date = November 2002 | pmid = 12399260 | doi = 10.1093/ajcn/76.5.911 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Perez-Pozo SE, Schold J, Nakagawa T, Sánchez-Lozada LG, Johnson RJ, Lillo JL | title = Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response | journal = International Journal of Obesity | volume = 34 | issue = 3 | pages = 454–61 | date = March 2010 | pmid = 20029377 | doi = 10.1038/ijo.2009.259 | s2cid = 4344197 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Choi ME | title = The not-so-sweet side of fructose | journal = Journal of the American Society of Nephrology | volume = 20 | issue = 3 | pages = 457–9 | date = March 2009 | pmid = 19244571 | doi = 10.1681/asn.2009010104 | url = http://jasn.asnjournals.org/content/20/3/457.full | series = 3 | doi-access = free | url-access = subscription }}</ref> Some evidence shows that in regards to juveniles, when [[Free sugars|free fructose]] is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. 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.<ref>{{Cite web|title=Fructose sugar makes maturing human fat cells fatter, less insulin-sensitive, study finds|url=https://www.sciencedaily.com/releases/2010/06/100621091203.htm|access-date=2021-03-08|website=ScienceDaily|language=en}}</ref>

Intake of [[Trans fatty acids|trans fat]] from industrial oils has been associated with increased abdominal obesity in men<ref>{{cite journal | vauthors = Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W, Rimm E | title = Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men | journal = The American Journal of Clinical Nutrition | volume = 78 | issue = 4 | pages = 719–27 | date = October 2003 | pmid = 14522729 | doi = 10.1093/ajcn/78.4.719 | doi-access = free }}</ref> and increased weight and waist circumference in women.<ref>{{cite journal | vauthors = Bendsen NT, Chabanova E, Thomsen HS, Larsen TM, Newman JW, Stender S, Dyerberg J, Haugaard SB, Astrup A | display-authors = 6 | title = Effect of trans fatty acid intake on abdominal and liver fat deposition and blood lipids: a randomized trial in overweight postmenopausal women | journal = Nutrition & Diabetes | volume = 1 | issue = 1 | article-number = e4 | date = January 2011 | pmid = 23154296 | pmc = 3302130 | doi = 10.1038/nutd.2010.4 }}</ref> These associations were not attenuated when fat intake and calorie intake was accounted for.<ref>{{cite journal | vauthors = Micha R, Mozaffarian D | title = Trans fatty acids: effects on cardiometabolic health and implications for policy | journal = Prostaglandins, Leukotrienes, and Essential Fatty Acids | volume = 79 | issue = 3–5 | pages = 147–52 | date = 1 September 2008 | pmid = 18996687 | doi = 10.1016/j.plefa.2008.09.008 | url= | pmc = 2639783 }}</ref><ref>{{cite journal | vauthors = Kavanagh K, Jones KL, Sawyer J, Kelley K, Carr JJ, Wagner JD, Rudel LL | title = Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys | journal = Obesity | volume = 15 | issue = 7 | pages = 1675–84 | date = July 2007 | pmid = 17636085 | doi = 10.1038/oby.2007.200 | s2cid = 4835948 | doi-access = free }}</ref> Greater [[meat]] ([[processed meat]], [[red meat]], and [[poultry]]) consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories.<ref>{{cite journal | vauthors = Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Travier N, Luan J, Wareham N, Slimani N, Rinaldi S, Couto E, Clavel-Chapelon F, Boutron-Ruault MC, Cottet V, Palli D, Agnoli C, Panico S, Tumino R, Vineis P, Agudo A, Rodriguez L, Sanchez MJ, Amiano P, Barricarte A, Huerta JM, Key TJ, Spencer EA, Bueno-de-Mesquita B, Büchner FL, Orfanos P, Naska A, Trichopoulou A, Rohrmann S, Hermann S, Boeing H, Buijsse B, Johansson I, Hellstrom V, Manjer J, Wirfält E, Jakobsen MU, Overvad K, Tjonneland A, Halkjaer J, Lund E, Braaten T, Engeset D, Odysseos A, Riboli E, Peeters PH | display-authors = 6 | title = Meat consumption and prospective weight change in participants of the EPIC-PANACEA study | journal = The American Journal of Clinical Nutrition | volume = 92 | issue = 2 | pages = 398–407 | date = August 2010 | pmid = 20592131 | doi = 10.3945/ajcn.2009.28713 | doi-access = free }}</ref><ref>{{cite journal |title=Reply to A Astrup et al |journal=The American Journal of Clinical Nutrition |date=2010-11-01 |issn=0002-9165 |pages=1275–1276 |volume=92 |issue=5 |doi=10.3945/ajcn.110.000786 | vauthors = Vergnaud AC, Norat T, Romaguera D, Peeters PH |doi-access=free }}</ref> Conversely, studies suggest that oily [[Fish as food|fish]] consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant.<ref>{{cite journal | vauthors = Hosseini-Esfahani F, Mirmiran P, Koochakpoor G, Daneshpour MS, Guity K, Azizi F | title = Some dietary factors can modulate the effect of the zinc transporters 8 polymorphism on the risk of metabolic syndrome | journal = Scientific Reports | volume = 7 | issue = 1 | article-number = 1649 | date = May 2017 | pmid = 28490771 | pmc = 5431973 | doi = 10.1038/s41598-017-01762-9 | bibcode = 2017NatSR...7.1649H | url = }}</ref><ref>{{cite journal | vauthors = Noreen EE, Sass MJ, Crowe ML, Pabon VA, Brandauer J, Averill LK | title = Effects of supplemental fish oil on resting metabolic rate, body composition, and salivary cortisol in healthy adults | journal = Journal of the International Society of Sports Nutrition | volume = 7 | article-number = 31 | date = October 2010 | pmid = 20932294 | pmc = 2958879 | doi = 10.1186/1550-2783-7-31 | doi-access = free }}</ref> Similarly, increased [[soy protein]] consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.<ref>{{cite journal | vauthors = Sites CK, Cooper BC, Toth MJ, Gastaldelli A, Arabshahi A, Barnes S | title = Effect of a daily supplement of soy protein on body composition and insulin secretion in postmenopausal women | journal = Fertility and Sterility | volume = 88 | issue = 6 | pages = 1609–17 | date = December 2007 | pmid = 17412329 | pmc = 2200634 | doi = 10.1016/j.fertnstert.2007.01.061 }}</ref><ref>{{cite journal | vauthors = Bakhtiari A, Yassin Z, Hanachi P, Rahmat A, Ahmad Z, Sajadi P, Shojaei S | title = Effects of Soy on Body Composition: A 12-Week Randomized Controlled Trial among Iranian Elderly Women with Metabolic Syndrome | journal = Iranian Journal of Public Health | volume = 41 | issue = 4 | pages = 9–18 | date = 2012-04-30 | pmid = 23113160 | pmc = 3481610 }}</ref>

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.<ref>{{cite journal|last1=Monteiro|first1=Carlos Augusto|last2=Cannon|first2=Geoffrey|last3=Moubarac|first3=Jean-Claude|last4=Levy|first4=Renata Bertazzi|last5=Louzada|first5=Maria Laura C.|last6=Jaime|first6=Patrícia Constante|date=January 2018|title=The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing|journal=Public Health Nutrition|language=en|volume=21|issue=1|pages=5–17|doi=10.1017/S1368980017000234|issn=1368-9800|pmid=28322183|pmc=10261019 |doi-access=free}}</ref> Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among American,<ref>{{Cite web|title=Processed foods highly correlated with obesity epidemic in the US|url=https://www.sciencedaily.com/releases/2020/01/200106122009.htm|access-date=2021-03-08|website=ScienceDaily|language=en}}</ref> Canadian,<ref>{{cite journal |last1=Nardocci |first1=Milena |last2=Leclerc |first2=Bernard-Simon |last3=Louzada |first3=Maria-Laura |last4=Monteiro |first4=Carlos Augusto |last5=Batal |first5=Malek |last6=Moubarac |first6=Jean-Claude |title=Consumption of ultra-processed foods and obesity in Canada |journal=Canadian Journal of Public Health |date=20 September 2018 |volume=110 |issue=1 |pages=4–14 |doi=10.17269/s41997-018-0130-x |pmid=30238324 |issn=0008-4263|pmc=6964616 }}</ref> Latin American,<ref>{{cite book |last1=Organization |first1=Pan American Health |title=Ultra-processed food and drink products in Latin America: Sales, sources, nutrient profiles, and policy implications |date=17 June 2019 |url=https://iris.paho.org/handle/10665.2/51094 |access-date=15 March 2021 |language=en |isbn=978-92-75-12032-3}}</ref> Australian,<ref>{{cite journal | vauthors = Machado PP, Steele EM, Levy RB, da Costa Louzada ML, Rangan A, Woods J, Gill T, Scrinis G, Monteiro CA | display-authors = 6 | title = Ultra-processed food consumption and obesity in the Australian adult population | journal = Nutrition & Diabetes | volume = 10 | issue = 1 | article-number = 39 | date = December 2020 | pmid = 33279939 | doi = 10.1038/s41387-020-00141-0 | pmc = 7719194 | doi-access = free }}</ref> British,<ref>{{cite journal | vauthors = Rauber F, Steele EM, Louzada ML, Millett C, Monteiro CA, Levy RB | title = Ultra-processed food consumption and indicators of obesity in the United Kingdom population (2008-2016) | journal = PLOS ONE | volume = 15 | issue = 5 | article-number = e0232676 | date = 2020-05-01 | pmid = 32357191 | pmc = 7194406 | doi = 10.1371/journal.pone.0232676 | bibcode = 2020PLoSO..1532676R | doi-access = free }}</ref> French,<ref>{{cite journal | vauthors = Beslay M, Srour B, Méjean C, Allès B, Fiolet T, Debras C, Chazelas E, Deschasaux M, Wendeu-Foyet MG, Hercberg S, Galan P, Monteiro CA, Deschamps V, Calixto Andrade G, Kesse-Guyot E, Julia C, Touvier M | display-authors = 6 | title = Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort | journal = PLOS Medicine | volume = 17 | issue = 8 | article-number = e1003256 | date = August 2020 | pmid = 32853224 | pmc = 7451582 | doi = 10.1371/journal.pmed.1003256 | doi-access = free }}</ref> Spaniard,<ref>{{cite journal | vauthors = Sandoval-Insausti H, Jiménez-Onsurbe M, Donat-Vargas C, Rey-García J, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P | title = Ultra-Processed Food Consumption Is Associated with Abdominal Obesity: A Prospective Cohort Study in Older Adults | journal = Nutrients | volume = 12 | issue = 8 | date = August 2020 | page = 2368 | pmid = 32784758 | pmc = 7468731 | doi = 10.3390/nu12082368 | doi-access = free }}</ref> Swedish,<ref>{{Cite journal |last1=Juul |first1=Filippa |last2=Hemmingsson |first2=Erik |date=December 2015 |title=Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010 |journal=Public Health Nutrition |volume=18 |issue=17 |pages=3096–3107 |doi=10.1017/S1368980015000506 |issn=1475-2727 |pmid=25804833|pmc=10277202 |s2cid=22016427 }}</ref> South Korean,<ref>{{Cite journal|last1=Sung|first1=Hyuni|last2=Park|first2=Ji Min|last3=Oh|first3=Se Uk|last4=Ha|first4=Kyungho|last5=Joung|first5=Hyojee|date=February 2021|title=Consumption of Ultra-Processed Foods Increases the Likelihood of Having Obesity in Korean Women|journal=Nutrients|language=en|volume=13|issue=2|page=698|doi=10.3390/nu13020698|pmid=33671557| pmc=7926298|doi-access=free}}</ref> Chinese<ref>{{Cite journal|last1=Li|first1=Ming|last2=Shi|first2=Zumin|date=August 2021|title=Ultra-Processed Food Consumption Associated with Overweight/Obesity among Chinese Adults—Results from China Health and Nutrition Survey 1997–2011|journal=Nutrients|language=en|volume=13|issue=8|page=2796| pmid=34444957|  doi=10.3390/nu13082796 | pmc=8399660 |doi-access=free}}</ref> and Sub-Saharan African<ref>{{Cite journal|last1=Reardon|first1=Thomas|last2=Tschirley|first2=David|last3=Liverpool-Tasie|first3=Lenis Saweda O.|last4=Awokuse|first4=Titus|last5=Fanzo|first5=Jessica|last6=Minten|first6=Bart|last7=Vos|first7=Rob|last8=Dolislager|first8=Michael|last9=Sauer|first9=Christine|last10=Dhar|first10=Rahul|last11=Vargas|first11=Carolina|date=2021-03-01|title=The processed food revolution in African food systems and the double burden of malnutrition|journal=Global Food Security|language=en|volume=28|article-number=100466|doi=10.1016/j.gfs.2020.100466|pmid=33868911| pmc=8049356|bibcode=2021GlFS...2800466R |issn=2211-9124}}</ref> populations.

Obesity plays an important role in the impairment of [[Lipid metabolism|lipid]] and [[carbohydrate metabolism]] shown in high-[[carbohydrate]] diets.<ref>{{cite journal | vauthors = Ibrahim IA, Abd El-Aziz MF, Ahmed AF, Mohamed MA |title=Is the effect of high fat diet on lipid and carbohydrate metabolism related to inflammation? |volume=4 |issue=3 |pages=203–209 |doi=10.1007/s12349-011-0056-9 |journal=Mediterranean Journal of Nutrition and Metabolism |year=2011|s2cid=83758966 }}</ref>{{Unreliable source? |date=February 2012 |reason=Source claims high-fat diet causes obesity, which is a vast oversimplification.}} It has also been shown that quality [[protein]] intake during a 24-hour period and the number of times the [[essential amino acid]] threshold of approximately 10&nbsp;g<ref>{{cite journal | vauthors = Cuthbertson D, Smith K, Babraj J, Leese G, Waddell T, Atherton P, Wackerhage H, Taylor PM, Rennie MJ | display-authors = 6 | title = Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle | journal = FASEB Journal | volume = 19 | issue = 3 | pages = 422–4 | date = March 2005 | pmid = 15596483 | doi = 10.1096/fj.04-2640fje | doi-access = free | s2cid = 22609751 }}</ref> has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.<ref>{{cite journal | vauthors = Loenneke JP, Wilson JM, Manninen AH, Wray ME, Barnes JT, Pujol TJ | title = Quality protein intake is inversely related with abdominal fat | journal = Nutrition & Metabolism | volume = 9 | issue = 1 | page = 5 | date = January 2012 | pmid = 22284338 | pmc = 3284412 | doi = 10.1186/1743-7075-9-5 | doi-access = free }}</ref>

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 [[triglyceride]]s and [[fatty acid]]s 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]]'.<ref>President and fellows of Harvard College. (2006). Abnormal obesity and your health. Retrieved from http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml {{Webarchive|url=https://web.archive.org/web/20130315182221/http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml |date=2013-03-15 }}</ref>

=== Alcohol consumption ===
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 (2.13%) with elevated alcohol consumption, even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol. [[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.<ref>{{cite journal | vauthors = Schröder H, Morales-Molina JA, Bermejo S, Barral D, Mándoli ES, Grau M, Guxens M, de Jaime Gil E, Alvarez MD, Marrugat J | display-authors = 6 | title = Relationship of abdominal obesity with alcohol consumption at population scale | journal = European Journal of Nutrition | volume = 46 | issue = 7 | pages = 369–76 | date = October 2007 | pmid = 17885722 | doi = 10.1007/s00394-007-0674-7 | url = http://redheracles.net/media/upload/research/pdf/17885722.pdf | s2cid = 7185367 }}</ref>

A systemic review and meta-analysis failed to find data pointing towards a dose-dependent relationship between [[beer]] intake and general obesity or abdominal obesity at low or moderate intake levels (under ~500&nbsp;mL/day). However, high beer intake (above ~4&nbsp;L/wk) appeared to be associated with a higher degree of abdominal obesity specifically, particularly among men.<ref>{{cite journal | vauthors = Bendsen NT, Christensen R, Bartels EM, Kok FJ, Sierksma A, Raben A, Astrup A | title = Is beer consumption related to measures of abdominal and general obesity? A systematic review and meta-analysis | journal = Nutrition Reviews | volume = 71 | issue = 2 | pages = 67–87 | date = February 2013 | pmid = 23356635 | doi = 10.1111/j.1753-4887.2012.00548.x | doi-access = free }}</ref>

===Other factors===
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.<ref name="Carey1998">{{cite journal |last=Carey |first=D. G. P. |year=1998 |title=Abdominal Obesity |journal=Current Opinion in Lipidology |pages=35–40 |volume=9 |issue=1|doi=10.1097/00041433-199802000-00008 |pmid=9502333 }}</ref><ref>{{cite journal |vauthors=Després J |year=2006 |title=Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk |journal=European Heart Journal |volume=8 |issue=Supplements |pages=B4–B12 |doi=10.1093/eurheartj/sul002 |doi-access=free}}</ref>

Other environmental factors, such as [[Smoking and pregnancy|maternal smoking]], [[estrogenic]] [[Chemical compound|compound]]s in the diet, and [[endocrine]]-disrupting chemicals may be important also.<ref>{{cite book | vauthors = Heindel J |title=Obesity Before Birth |chapter=The Obesogen Hypothesis of Obesity: Overview and Human Evidence |series=Endocrine Updates |year=2011 |volume=4 |pages=355–365 |doi=10.1007/978-1-4419-7034-3_17 |isbn=978-1-4419-7033-6|publisher=Springer }}</ref>

[[Hypercortisolism]], such as in [[Cushing's syndrome]], also leads to central obesity. Many [[prescription drug]]s, such as [[dexamethasone]] and other [[steroid]]s, can also have [[side effect]]s resulting in central obesity,<ref name="Does central obesity reflect Cushi"/> especially in the presence of elevated insulin levels.

== Diagnosis ==
[[File:Obesity-waist circumference.svg|thumb|190px|Silhouettes and waist circumferences representing normal, overweight, and obese]]
There are various ways of measuring abdominal obesity including:
*Absolute waist circumference (>{{convert|102|cm|in|abbr=on}} in men and >{{convert|88|cm|in|abbr=on}} in women)<ref name="ATP3pii17" />
*[[Waist–hip ratio]] (the circumference of the waist divided by that of the hips of >0.9 for men and >0.85 for women)<ref name=Yusuf2004/>
*[[Waist-to-stature ratio|Waist-stature ratio]] (waist circumference divided by their height, >0.5 for adults under 40 and >0.6 for adults over 50)
*[[Sagittal Abdominal Diameter]]<ref name=pmid17041127>{{cite journal | vauthors = Iribarren C, Darbinian JA, Lo JC, Fireman BH, Go AS | title = Value of the sagittal abdominal diameter in coronary heart disease risk assessment: cohort study in a large, multiethnic population | journal = American Journal of Epidemiology | volume = 164 | issue = 12 | pages = 1150–9 | date = December 2006 | pmid = 17041127 | doi = 10.1093/aje/kwj341 | doi-access = free }}</ref>

[[File:Excess abdominal fat.jpg|alt=|thumb|Overweight teenage boy holding his excess abdominal fat]]
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.<ref name=HSTAT>{{cite book|author=U.S. Preventive Services Task Force Evidence Syntheses|title=HSTAT: Guide to Clinical Preventive Services, 3rd Edition: Recommendations and Systematic Evidence Reviews, Guide to Community Preventive Services|year=2000|url=https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.section.36199|access-date=2017-08-29|archive-date=2009-07-04|archive-url=https://web.archive.org/web/20090704131837/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.section.36199}}</ref> Intra-abdominal or [[Adipose tissue#Visceral fat|visceral fat]] has a particularly strong correlation with [[cardiovascular disease]].<ref name=Yusuf2004>{{cite journal | vauthors = Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L | display-authors = 6 | title = Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study | journal = Lancet | volume = 364 | issue = 9438 | pages = 937–52 | year = 2004 | pmid = 15364185 | doi = 10.1016/S0140-6736(04)17018-9 | hdl-access = free | s2cid = 30811593 | hdl = 10983/21615 }}</ref>

BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. Waist measurement (''e.g.'', for [[Body fat percentage|BFP]] standard) is more prone to errors than measuring height and weight (''e.g.'', for [[Body mass index|BMI]] standard). 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.<ref>Abdominal obesity and your health. (2006). Retrieved from http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml {{Webarchive|url=https://web.archive.org/web/20130315182221/http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml|date=2013-03-15}}</ref> It is recommended to use both methods of measurements.<ref>{{cite web |title=Abdominal obesity and your health |work=Harvard Health |url=http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml |archive-url=https://web.archive.org/web/20130315182221/http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml |archive-date=2013-03-15 |access-date=2013-01-05 |publisher=Health.harvard.edu}}</ref>
[[File:Centrally Obese Man.jpg|thumb|A man with abdominal obesity]]
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. The absolute waist circumference {{convert|102|cm|in}} in men and {{convert|88|cm|in}} in women and the [[waist–hip ratio]] (>0.9 for men and >0.85 for women)<ref name=Yusuf2004/> are both used as measures of central obesity. A [[differential diagnosis]] includes distinguishing central obesity from [[ascites]] and intestinal [[bloating]]. In the [[cohort (statistics)|cohort]] of 15,000 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 [[Clinical endpoint|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 [[body mass index|BMI]].<ref>{{cite journal | vauthors = Smith SC, Haslam D | title = Abdominal obesity, waist circumference and cardio-metabolic risk: awareness among primary care physicians, the general population and patients at risk--the Shape of the Nations survey | journal = Current Medical Research and Opinion | volume = 23 | issue = 1 | pages = 29–47 | date = January 2007 | pmid = 17261236 | doi = 10.1185/030079906X159489 | s2cid = 11796524 }}</ref> Another measure of central obesity which has shown superiority to BMI in predicting cardiovascular disease risk is the [[Index of Central Obesity]] (waist-to-height ratio, WHtR), where a ratio of >=0.5 (i.e. a waist circumference at least half of the individual's height) is predictive of increased risk.<ref>{{cite journal | vauthors = Knowles KM, Paiva LL, Sanchez SE, Revilla L, Lopez T, Yasuda MB, Yanez ND, Gelaye B, Williams MA | display-authors = 6 | title = Waist Circumference, Body Mass Index, and Other Measures of Adiposity in Predicting Cardiovascular Disease Risk Factors among Peruvian Adults | journal = International Journal of Hypertension | volume = 2011 | article-number = 931402 | date = January 2011 | pmid = 21331161 | pmc = 3034939 | doi = 10.4061/2011/931402 | doi-access = free }}</ref>
Another diagnosis of obesity is the analysis of intra-abdominal fat having the most risk to one's personal health. 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]] (1998) review.<ref name="Poehlman1998" />
An increasing acceptance of the importance of central obesity within the medical profession as an indicator of health risk has led to new developments in obesity diagnosis such as the [[Body Volume Index]], which measures central obesity by measuring a person's body shape and their weight distribution. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.

=== Index of central obesity ===
Index of Central Obesity (ICO) is the ratio of waist circumference and height first proposed by a Parikh ''et al.'' in 2007<ref name=pmid20450297>{{cite journal | vauthors = Méthot J, Houle J, Poirier P | title = Obesity: how to define central adiposity? | journal = Expert Review of Cardiovascular Therapy | volume = 8 | issue = 5 | pages = 639–44 | date = May 2010 | pmid = 20450297 | doi = 10.1586/erc.10.38 | s2cid = 31913449 }}</ref> as a better substitute to the widely used waist circumference in defining [[metabolic syndrome]].<ref name=pmid19558273>{{cite journal | vauthors = Parikh RM, Joshi SR, Pandia K | title = Index of central obesity is better than waist circumference in defining metabolic syndrome | journal = Metabolic Syndrome and Related Disorders | volume = 7 | issue = 6 | pages = 525–7 | date = December 2009 | pmid = 19558273 | doi = 10.1089/met.2008.0102 }}</ref> The [[National Cholesterol Education Program]] Adult Treatment Panel III suggested cutoff of {{convert|102|cm|in|abbr=on}} and {{convert|88|cm|in|abbr=on}} for males and females as a marker of central obesity.<ref name=ATP3pii17>{{cite book |title=Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report) |publisher=[[National Institutes of Health]] |year=2002 |url=http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm |author=National Cholesterol Education Program |page=II–17 |author-link=National Cholesterol Education Program |access-date=2011-05-14 |archive-url=https://web.archive.org/web/20050524010904/http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm |archive-date=2005-05-24 }}</ref> The same was used in defining [[metabolic syndrome]].<ref name=ATP3pii27>{{cite book |title=Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report) |publisher=[[National Institutes of Health]] |year=2002 |url=http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm |author=National Cholesterol Education Program |page=II–27 |author-link=National Cholesterol Education Program |access-date=2011-05-14 |archive-url=https://web.archive.org/web/20050524010904/http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm |archive-date=2005-05-24 }}</ref> Misra et al. suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to {{convert|90|cm|in|abbr=on}} and {{convert|80|cm|in|abbr=on}} for males and females.<ref name=pmid20156066>{{cite journal | vauthors = Misra A, Wasir JS, Vikram NK, Pandey RM, Kumar P | title = Cutoffs of abdominal adipose tissue compartments as measured by magnetic resonance imaging for detection of cardiovascular risk factors in apparently healthy adult Asian Indians in North India | journal = Metabolic Syndrome and Related Disorders | volume = 8 | issue = 3 | pages = 243–7 | date = June 2010 | pmid = 20156066 | doi = 10.1089/met.2009.0046 }}</ref> Various race specific cutoffs were suggested by different groups.<ref>{{Cite web|website=hsph.harvard.edu|date=2012-10-21|title=Abdominal Obesity Measurement Guidelines for Different Ethnic Groups|url=https://www.hsph.harvard.edu/obesity-prevention-source/waist-circumference-guidelines-for-different-ethnic-groups/|access-date=2021-03-31|department=Obesity Prevention Source|language=en-us}}</ref> The [[International Diabetes Federation]] defined central obesity based on these various race and gender specific cutoffs.<ref name=Alberti2005>{{cite journal | vauthors = Alberti KG, Zimmet P, Shaw J | title = The metabolic syndrome--a new worldwide definition | journal = Lancet | volume = 366 | issue = 9491 | pages = 1059–62 | year = 2005 | pmid = 16182882 | doi = 10.1016/S0140-6736(05)67402-8 | s2cid = 30586927 }}</ref> The other limitation of waist circumference is that it the measurement procedure has not been standardized and in children there are no, or few, comparison standards or reference data.<ref>{{Cite web|website=hsph.harvard.edu|date=2012-10-21|title=Measuring Obesity|url=https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/|access-date=2021-03-31|department=Obesity Prevention Source|language=en-us}}</ref>

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.<ref name=pmid19558273/> An ICO cutoff of 0.53 was suggested as a criterion to define central obesity. Parikh ''et al.'' 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.<ref name=pmid19558273/>

This parameter has been used in the study of [[metabolic syndrome]]<ref name=pmid18700281>{{cite journal | vauthors = Joshi PP | title = Is waist to height ratio a better and more practical measure of obesity to assess cardiovascular or diabetes risk in indians? | journal = The Journal of the Association of Physicians of India | volume = 56 | pages = 202–3; author reply 203–4 | date = March 2008 | pmid = 18700281 | url = http://www.japi.org/march2008/Corr2.htm | access-date = 2011-06-04 | archive-date = 2017-10-11 | archive-url = https://web.archive.org/web/20171011175412/http://www.japi.org/march2008/Corr2.htm }}</ref><ref name=veigas2011>{{cite journal | vauthors = Veigas NM, Dharmalingam, Marcus SR |year=2011 |title=Oxidative Stress in Obesity and Metabolic Syndrome in Asian Indians |journal=Journal of Medical Biochemistry |volume=30 |issue=2 |pages=115–20 |doi=10.2478/v10011-011-0006-6|doi-access=free }}</ref> and [[cardiovascular disease]].<ref name=pmid18051732>{{cite journal | vauthors = Gupta R, Rastogi P, Sarna M, Gupta VP, Sharma SK, Kothari K | title = Body-mass index, waist-size, waist–hip ratio and cardiovascular risk factors in urban {{sic|nolink=y|reason=error in source|subejcts}} | journal = The Journal of the Association of Physicians of India | volume = 55 | pages = 621–7 | date = September 2007 | pmid = 18051732 | url = http://www.japi.org/september2007/O-621.htm | access-date = 2011-06-04 | archive-date = 2017-10-12 | archive-url = https://web.archive.org/web/20171012204029/http://www.japi.org/september2007/O-621.htm }}</ref>

Central obesity in individuals with normal BMI is referred to as [[normal weight obesity]].

=== Sex differences ===
There are sex-dependent differences in regional fat distribution.

Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.<ref>{{cite journal |vauthors=Elbers JM, Asscheman H, Seidell JC, Gooren LJ |date=February 1999 |title=Effects of sex steroid hormones on regional fat depots as assessed by magnetic resonance imaging in transsexuals |journal=The American Journal of Physiology |volume=276 |issue=2 |pages=E317-25 |doi=10.1152/ajpendo.1999.276.2.E317 |pmid=9950792}}</ref> When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women.<ref>{{cite journal |vauthors=Lemieux S, Prud'homme D, Bouchard C, Tremblay A, Després JP |date=October 1993 |title=Sex differences in the relation of visceral adipose tissue accumulation to total body fatness |journal=The American Journal of Clinical Nutrition |volume=58 |issue=4 |pages=463–7 |doi=10.1093/ajcn/58.4.463 |pmid=8379501|doi-access=free }}</ref><ref>{{cite journal |vauthors=Carey DG, Campbell LV, Chisholm DJ |year=1996 |title=Is visceral fat (intra-abdominal and hepatic) a major determinant of gender differences in insulin resistance and dyslipidaemia? |journal=Diabetes |volume=45 |page=110A}}</ref>

In women, [[estrogen]] is believed to cause fat to be stored in the [[buttocks]], [[thighs]], and [[hips]].<ref>{{cite journal | vauthors = Andersen BL, Legrand J | title = Body Image for Women: Conceptualization, Assessment, and a Test of its Importance to Sexual Dysfunction and Medical Illness | journal = Journal of Sex Research | volume = 28 | issue = 3 | pages = 457–477 | year = 1991 | pmid = 21451731 | pmc = 3065017 | doi = 10.1080/00224499109551619 }}</ref> When women reach [[menopause]] and the estrogen produced by [[ovaries]] declines, fat at their buttocks, hips, and thighs decreases while fat at their belly increases.<ref>{{cite web |url=http://health.yahoo.com/topic/nutrition/overview/article/womens-health/26287 |archive-url=https://web.archive.org/web/20071024193506/http://health.yahoo.com/topic/nutrition/overview/article/womens-health/26287|archive-date=October 24, 2007 |work=Yahoo! Health |title=A Matter of Fat |first=Michelle |last=Andrews |date=2006-12-01}}</ref><ref>{{cite web |url=http://www.health.harvard.edu/newsweek/Abdominal-fat-and-what-to-do-about-it.htm |title=Abdominal fat and what to do about it. Visceral fat more of a health concern than subcutaneous fat |publisher=Harvard Health Publications |access-date=2013-01-05 |archive-url=https://web.archive.org/web/20110928081252/http://www.health.harvard.edu/newsweek/Abdominal-fat-and-what-to-do-about-it.htm |archive-date=2011-09-28 }}</ref>

50% of men and 70% of women in the [[United States]] between the ages of 50 and 79 years now{{when|date=July 2024}} exceed the waist circumference threshold for central obesity.<ref>{{cite journal |vauthors=Li C, Ford ES, McGuire LC, Mokdad AH |title=Increasing trends in waist circumference and abdominal obesity among US adults |journal=Obesity |year=2007 |volume=15 |issue=1 |pages=216–224|doi=10.1038/oby.2007.505 |pmid=17228050 }}</ref>

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.<ref>{{cite journal |vauthors=Wingard DL |date=May 1990 |title=Sex differences and coronary heart disease. A case of comparing apples and pears? |journal=Circulation |volume=81 |issue=5 |pages=1710–2 |doi=10.1161/01.cir.81.5.1710 |pmid=2331775 |doi-access=free}}</ref> Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women.<ref>{{cite journal | vauthors = Barrett-Connor E | title = Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys Lecture | journal = Circulation | volume = 95 | issue = 1 | pages = 252–64 | date = January 1997 | pmid = 8994444 | doi = 10.1161/01.cir.95.1.252 }}</ref>

==Management==
{{expand section|date=January 2019}}
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.<ref>{{cite web|url=http://www.webmd.com/fitness-exercise/news/20091106/even-a-little-exercise-fights-obesity |title=Even a Little Exercise Fights Obesity |publisher=Webmd.com |date=2009-11-06 |access-date=2013-01-05}}</ref> A single pound of fat yields approximately 3500 calories of energy (32 000 kJ energy per kilogram of fat), and weight loss is achieved by reducing energy intake,<ref>{{cite web|url=http://www.washington.edu/admin/hr/benefits/wellness/weight.html |title=Weight Management |publisher=Washington.edu |date=2012-11-26 |access-date=2013-01-05 |archive-url=https://web.archive.org/web/20130209125420/http://www.washington.edu/admin/hr/benefits/wellness/weight.html |archive-date=February 9, 2013 }}</ref> or increasing energy expenditure, thus achieving a negative balance. 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]],<ref name="wsj">{{cite news| vauthors = Rockoff JD, Dooren JC |title=Abbott Pulls Diet Drug Meridia Off US Shelves |url=https://www.wsj.com/article/BT-CO-20101008-710904.html |access-date=8 October 2010|newspaper=The Wall Street Journal|date=October 8, 2010| archive-url= https://web.archive.org/web/20101011004015/http://online.wsj.com/article/BT-CO-20101008-710904.html| archive-date= 11 October 2010 | url-status= live}}</ref> the [[UK]],<ref>{{cite news | url=http://news.bbc.co.uk/1/hi/health/8473555.stm |title=Top obesity drug sibutramine being suspended |access-date=2010-01-22 |publisher=BBC News |date=2010-01-22| archive-url= https://web.archive.org/web/20100125005254/http://news.bbc.co.uk/1/hi/health/8473555.stm| archive-date= 25 January 2010 | url-status= live}}</ref> the [[European Union|EU]],<ref>{{in lang|de}} Sibutramin-Vertrieb in der Europäischen Union ausgesetzt [http://www.abbott.de/content/e17/e127/e15940/index_de.html] {{Webarchive|url=https://archive.today/20120719155409/http://www.abbott.de/content/e17/e127/e15940/index_de.html|date=2012-07-19}}. [[Abbott Laboratories]] in Germany. [[Press release]] 2010-01-21. Retrieved 2010-01-27</ref> [[Australia]],<ref>{{cite web|url=http://sibutramine.com/australia/en-au/ |title=Sibutramine (brand name Reductil) Information - Australia |year=2010 |access-date=2010-10-08 |publisher=Abbott Laboratories |archive-url=https://web.archive.org/web/20101014014348/http://sibutramine.com/australia/en-au/ |archive-date=14 October 2010 }}</ref> [[Canada]],<ref>{{cite web|url=http://hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/_2010/meridia_hpc-cps-eng.php |title=Health Canada Endorsed Important Safety Information on MERIDIA (Sibutramine Hydrochloride Monohydrate): Subject: Voluntary withdrawal of Meridia (sibutramine) capsules from the Canadian market |publisher=Hc-sc.gc.ca |date=2010-10-14 |access-date=2013-01-05}}</ref> [[Hong Kong]],<ref>{{cite press release |url=http://www.info.gov.hk/gia/general/201011/02/P201011020204.htm |title=De-registration of pharmaceutical products containing sibutramine |publisher=info.gov in Hong Kong |date=November 2, 2010 |access-date=2010-11-08}}</ref> and [[Thailand]].<ref>{{cite press release|url=http://elib.fda.moph.go.th/fulltext2/word/41633/41633.pdf |title=Thai FDA reveals voluntary withdrawal of sibutramine from the Thai market |publisher=Food and Drug Administration of Thailand |date=October 20, 2010 |access-date=2010-12-22 |archive-url=https://web.archive.org/web/20110511225841/http://elib.fda.moph.go.th/fulltext2/word/41633/41633.pdf |archive-date=May 11, 2011 }}</ref>

A 2006 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.<ref>{{cite journal | vauthors = Arciero PJ, Gentile CL, Martin-Pressman R, Ormsbee MJ, Everett M, Zwicky L, Steele CA | title = Increased dietary protein and combined high intensity aerobic and resistance exercise improves body fat distribution and cardiovascular risk factors | journal = International Journal of Sport Nutrition and Exercise Metabolism | volume = 16 | issue = 4 | pages = 373–92 | date = August 2006 | pmid = 17136940 | doi = 10.1123/ijsnem.16.4.373 | title-link = Endurance training | citeseerx = 10.1.1.517.3533 }}</ref> 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.<ref>{{cite journal | vauthors = Kelley GA, Kelley KS, Roberts S, Haskell W | title = Combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults: a meta-analysis | journal = Journal of Obesity | volume = 2012 | article-number = 985902 | date = 2012 | pmid = 22523670 | pmc = 3317197 | doi = 10.1155/2012/985902 | doi-access = free }}</ref>

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.g. increased insulin resistance and/or breast cancer risk). 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 [[diabetes mellitus|type 2 diabetes]], the physician might instead prescribe [[metformin]] and [[thiazolidinedione]]s ([[rosiglitazone]] or [[pioglitazone]]) as [[antidiabetic drug]]s rather than [[sulfonylurea]] derivatives. [[Thiazolidinediones]] may cause slight weight gain but decrease [[Abdominal fat|"pathologic" abdominal fat (visceral fat)]], and therefore may be prescribed for diabetics with central obesity.<ref>{{cite journal | vauthors = Fonseca V | title = Effect of thiazolidinediones on body weight in patients with diabetes mellitus | journal = The American Journal of Medicine | volume = 115 Suppl 8A | issue = 8 | pages = 42S–48S | date = December 2003 | pmid = 14678865 | doi = 10.1016/j.amjmed.2003.09.005 }}</ref>
Thiazolidinedione has been associated with heart failure and increased cardiovascular risk; so it has been withdrawn from the market in Europe by EMA in 2010.<ref>23/09/2010 European Medicines Agency recommends suspension of Avandia, Avandamet and Avaglim http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/09/news_detail_001119.jsp&mid=WC0b01ac058004d5c1 {{Webarchive|url=https://web.archive.org/web/20180621070054/http://www.ema.europa.eu/ema//index.jsp?curl=pages/news_and_events/news/2010/09/news_detail_001119.jsp&mid=WC0b01ac058004d5c1 |date=21 June 2018 }}</ref>

New clinical guidelines support the use of glucagon-like-peptide-1 receptor agonists, such as semaglutide, for adults with abdominal obesity who have not been able to achieve adequate weight reduction with lifestyle modifications.<ref name=":2">{{Cite journal |last1=Wang |first1=Jing-Yue |last2=Wang |first2=Quan-Wei |last3=Yang |first3=Xin-Yu |last4=Yang |first4=Wei |last5=Li |first5=Dong-Rui |last6=Jin |first6=Jing-Yu |last7=Zhang |first7=Hui-Cong |last8=Zhang |first8=Xian-Feng |date=2023-02-01 |title=GLP−1 receptor agonists for the treatment of obesity: Role as a promising approach |journal=Frontiers in Endocrinology |language=English |volume=14 |article-number=1085799 |doi=10.3389/fendo.2023.1085799 |doi-access=free |issn=1664-2392 |pmc=9945324 |pmid=36843578}}</ref> These medications have largely replaced the use of other anti-diabetic drugs for weight loss. GLP-1 agonists have shown clinically meaningful reductions in body weight and abdominal obesity, and demonstrated improvements in cardiovascular health in randomized trials.<ref name=":2" />

For patients unresponsive to lifestyle and medication management of abdominal obesity, metabolic and bariatric surgical options exist. These include sleeve gastrectomy and Roux-en-Y gastric bypass surgery.<ref name=":3">{{Cite journal |last1=American Diabetes Association Professional Practice Committee |last2=ElSayed |first2=Nuha A. |last3=McCoy |first3=Rozalina G. |last4=Aleppo |first4=Grazia |last5=Balapattabi |first5=Kirthikaa |last6=Beverly |first6=Elizabeth A. |last7=Briggs Early |first7=Kathaleen |last8=Bruemmer |first8=Dennis |last9=Echouffo-Tcheugui |first9=Justin B. |last10=Ekhlaspour |first10=Laya |last11=Garg |first11=Rajesh |last12=Khunti |first12=Kamlesh |last13=Kushner |first13=Robert F. |last14=Lal |first14=Rayhan |last15=Lingvay |first15=Ildiko |date=2025-01-01 |title=8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes–2025 |url=https://diabetesjournals.org/care/article/48/Supplement_1/S167/157555/8-Obesity-and-Weight-Management-for-the-Prevention |journal=Diabetes Care |language=en |volume=48 |issue=Supplement_1 |pages=S167–S180 |doi=10.2337/dc25-S008 |pmid=39651976 |pmc=11635032 |pmc-embargo-date=January 1, 2026 |issn=0149-5992}}</ref> These surgical options are effective in patients with severe abdominal obesity without significant comorbidities. Surgery leads to substantial reductions in abdominal obesity, waist circumference, and is associated with improvements in type 2 diabetes mellitus, hypertension, and other complications associated with abdominal obesity.<ref name=":3" />

[[Low-fat diet]]s 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."<ref name="bacon">{{cite journal | vauthors = Bacon L, Aphramor L | title = Weight science: evaluating the evidence for a paradigm shift | journal = Nutrition Journal | volume = 10 | issue = 9 | article-number = 9 | date = January 2011 | pmid = 21261939 | pmc = 3041737 | doi = 10.1186/1475-2891-10-9 | doi-access = free }}</ref> The Women's Health Initiative ("the largest and longest randomized, controlled dietary intervention clinical trial"<ref name="bacon"/>) found that long-term dietary intervention increased the waist circumference of both the intervention group and the control group, though the increase was smaller for the intervention group. The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.2&nbsp;kg (P<.001) and was 2.2&nbsp;kg less than the control group change from baseline at year 1. 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.<ref>{{cite journal | vauthors = Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, Rodabough RJ, Snetselaar L, Thomson C, Tinker L, Vitolins M, Prentice R | display-authors = 6 | title = Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial | journal = JAMA | volume = 295 | issue = 1 | pages = 39–49 | date = January 2006 | pmid = 16391215 | doi = 10.1001/jama.295.1.39 | doi-access = free }}</ref>

==Society and culture==

=== Myths ===
There is a common misconception that [[spot reduction|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-up (exercise)|Sit-ups]], [[Crunch (exercise)|crunches]] and other [[abdominal exercises]] are useful in building the [[abdomen#Muscles|abdominal muscles]], but they have little effect, if any, on the [[adipose tissue]] located there.<ref>{{cite web|url= http://www.mayoclinic.com/health/belly-fat/MC00054|title= Belly fat in men: What you need to know|access-date= 2008-04-07| vauthors = Jensen M |date= 2007-01-19|publisher= Mayoclinic.com|quote= Sit-ups will make your abdominal muscles stronger, sure. And, you may look thinner by building your abdominal muscles because you can hold in your belly fat better. But strengthening your stomach muscles alone will not specifically reduce belly fat.| archive-url= https://web.archive.org/web/20080323120054/http://www.mayoclinic.com/health/belly-fat/MC00054| archive-date= 23 March 2008 | url-status= live}}</ref>

=== Colloquialisms ===
A large central adiposity deposit has been assigned many common use names, including "spare tire", "love handle", "paunch", "boiler", and "potbelly".<ref>
*{{cite web |title=spare tire |url=https://www.merriam-webster.com/dictionary/spare%20tire |website=Merriam-Webster |access-date=August 2, 2021}}
*{{cite web |title=paunch |url=https://www.merriam-webster.com/dictionary/paunch |website=Merriam-Webster |access-date=August 2, 2021}}
*{{cite web |title=potbelly |url=https://www.merriam-webster.com/dictionary/potbelly |website=Merriam-Webster |access-date=August 2, 2021}}</ref> Several colloquial terms used to refer to central obesity, and to people who have it, refer to [[beer]] drinking. 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.<ref>{{cite journal | vauthors = Bobak M, Skodova Z, Marmot M | title = Beer and obesity: a cross-sectional study | journal = European Journal of Clinical Nutrition | volume = 57 | issue = 10 | pages = 1250–3 | date = October 2003 | pmid = 14506485 | doi = 10.1038/sj.ejcn.1601678 | doi-access = free }}</ref><ref>{{cite news|author=Staff writer|title=Why the beer belly may be a myth|date=2003-10-12|publisher=BBC News|url=http://news.bbc.co.uk/2/hi/health/3175488.stm}}</ref> Chronic alcoholism can lead to [[cirrhosis]], symptoms of which include [[gynecomastia]] (enlarged breasts) and [[ascites]] (abdominal fluid). These symptoms can suggest the appearance of central obesity.

=== Economics ===
Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31,840 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 1.25% and 2.08% rise in health care costs in women and men respectively. To put this in perspective, a woman with a waistline of 95&nbsp;cm (approx 37.4 in) and without underlying health problems or co-morbidities can incur economic costs that are 22%, or US$397, higher per year than a woman with a normal waist circumference.<ref>"Economic costs of abdominal obesity"; Højgaard, Betina and Olsen, Kim Rose and Søgaard, Jes and Sørensen, Thorkild I A and Gyrd-Hansen, Dorte; ''Obesity facts'', {{ISSN|1662-4025}}, 2008, Volume 1, Issue 3, pp. 146–154.</ref>

== See also ==
* [[Bariatrics]], the branch of medicine that deals with the causes, prevention, and treatment of obesity
* [[Lipoatrophy]], the term describing the localized loss of fat tissue
* [[Muffin top]]
* [[Normal weight obesity]], normal BMI with excessive fat, usually centrally localized
* [[Panniculus]], hanging belly fat
* [[Steatosis]], also called ''fatty change'', ''fatty degeneration'' or ''adipose degeneration''

== References ==
{{Reflist}}

== Further reading ==
* {{cite thesis |vauthors=Griesemer RL |date=July 25, 2008 |title=Index of Central Obesity as a Parameter to Evaluate Metabolic Syndrome for White, Black, and Hispanic Adults in the United States |url=http://digitalarchive.gsu.edu/iph_theses/42 |publisher=Public Health Theses, [[Georgia State University]] |doi=10.57709/1062268 |type=Master's thesis |archive-date=22 July 2012 |access-date=4 June 2011 |archive-url=https://web.archive.org/web/20120722140918/http://digitalarchive.gsu.edu/iph_theses/42/ }}
* {{cite journal | vauthors = Lee K, Song YM, Sung J | title = Which obesity indicators are better predictors of metabolic risk?: healthy twin study | journal = Obesity | volume = 16 | issue = 4 | pages = 834–40 | date = April 2008 | pmid = 18239595 | doi = 10.1038/oby.2007.109 | s2cid = 1633972 | doi-access = free }}
* {{cite journal | vauthors = Shao J, Yu L, Shen X, Li D, Wang K | title = Waist-to-height ratio, an optimal predictor for obesity and metabolic syndrome in Chinese adults | journal = The Journal of Nutrition, Health & Aging | volume = 14 | issue = 9 | pages = 782–5 | date = November 2010 | pmid = 21085910 | doi = 10.1007/s12603-010-0106-x | s2cid = 11187741 | doi-access = free }}
* {{Cite journal |last=Pant |first=Shravya |date=31 October 2025 |title=Normal BMI With Abdominal Obesity Associated With Cardiometabolic Risks |journal=[[JAMA]] |type=Medical News in Brief |publication-date=31 October 2025<!--published online--> |volume=334 |issue=16 |page=1875 |doi=10.1001/jama.2025.17532 |pmid=41171291 }}

== External links ==
* {{Commons category-inline}}

{{Medical resources
|   ICD10       = E66
|   ICD9        = {{ICD9|278}}
}}
{{Obesity}}

{{DEFAULTSORT:Abdominal Obesity}}
[[Category:Abdomen]]
[[Category:Medical conditions related to obesity]]
[[Category:Medical signs]]
[[Category:Classification of obesity]]
[[Category:Tissues (biology)]]