Spare tire. Beer belly. Muffin top.
We have a lot of unkind terms for excess abdominal fat, and we see a lot of images (often fake) of perfectly flat tummies. As a result, the belly is a part of the body that many people are sensitive about and want to change. You may wish for visible abdominal muscles; you may just want your jeans to reliably fit.
Beyond aesthetics, though, there are important health reasons to pay attention to your belly. Excess fat in the midsection puts you at increased risk for disease. That’s why there’s a movement among some doctors toward measuring patients’ waistlines, which may be more useful than the current standard of body mass index. BMI, a measure of weight and height that determines whether someone is overweight or obese, has been criticized for not considering ethnicity or distribution of fat and muscle.
“BMI is not a perfect measure and not accurate for certain groups,” says Andrea Coviello, MD, medical director of the UNC Health Medical Weight Program. “It gives an approximation of health, but it doesn’t tell us where fat masses are located. Measuring the waist circumference and adjusting for height—a measure of body roundness—provides a more nuanced and precise measurement for disease risk.”
Dr. Coviello answers some common questions about belly fat.
What are the health risks associated with belly fat?
There are actually two types of fat in your middle: subcutaneous fat, or the fat you can see and touch, and visceral or intra-abdominal fat, which you can’t, because it’s located behind your wall of abdominal muscles. It’s actually the fat that you can’t see that poses the greatest health risk.
“Excess visceral or intra-abdominal fat is associated with metabolic dysfunction, metabolic syndrome (high blood pressure, high blood sugar and high cholesterol), insulin resistance, diabetes and cardiovascular disease,” Dr. Coviello says.
Too much visceral fat also has been linked to certain cancers.
How do you measure belly fat?
Because you can’t see visceral fat, the only way to truly measure how much you have would be an MRI or a CT scan, which would be impractical. However, how much visceral fat we have is related to how much subcutaneous belly fat we have—the more subcutaneous fat you see, the more visceral fat there likely is. As you lose subcutaneous fat, you’re losing visceral fat.
That’s why a simple tape measure can help you and your doctor understand your health risk. Measuring body roundness involves taking a measurement of your waist circumference and adjusting for age, sex and height; your provider can help you understand if your measurement is within a healthy range.
How do you get rid of belly fat?
Forget what you’ve seen about tricks for quickly losing your gut in two weeks; reducing belly fat is about sustainable lifestyle changes.
“You can reduce fat in the middle with a healthy diet and physical activity,” Dr. Coviello says. “Cardio exercise works best, and walking is effective and safe if you’re starting out. Starting slow and building up slowly is the key.”
Dr. Coviello says that many people try to do too much too soon and end up hurting themselves or developing an aversion to exercise. If you build an exercise routine that is enjoyable and manageable for you, you’ll eventually notice improvements in endurance and strength.
You can work to minimize ultraprocessed foods, saturated fats, sweets and sodium in your diet, but be wary of any food plan that promises quick belly fat loss by restricting any one type of food or eating a magic ingredient. The goal is a balanced, healthy diet, which includes protein, fat and carbohydrates. A dietitian can help you make the changes you need to lose weight while getting the nutrients you need.
Prescribed weight loss medications, such as semaglutide (brand name Ozempic and Wegovy) and tirzepatide (brand name Mounjaro and Zepbound), or bariatric surgery in combination with lifestyle changes can help; talk to your doctor about whether these options are right for you.
Can you spot-reduce belly fat by working on your core muscles?
Maybe you’ve started walking and making changes to your diet but you haven’t seen any changes in your middle yet. Could adding crunches, planks and other core-strengthening moves help? Your abdominal muscles and obliques are part of your core, which also includes the spine and pelvis.
“Strengthening the core reduces back pain and improves posture, but toning up the abdominal wall by itself may not reduce intra-abdominal fat,” Dr. Coviello says. “It has to be incorporated into a broader program of exercise for fat mass to be decreased.”
That said, if you’re stronger and standing up straighter, it’s likely you’ll feel (and look) better in your body.
Does stress increase belly fat?
Persistent stress has been shown to affect our overall health—could it be responsible for your belly?
“There’s a school of thought that chronic stress causes the release of too many hormones, like cortisol and adrenaline, causing adverse health outcomes,” Dr. Coviello says. “People focus a lot on high cortisol, and it’s getting a bad name.”
Increased stress does make it more difficult to make healthy food choices or feel like you have time to exercise, making weight gain likely, but you probably don’t have a “cortisol belly,” as the ads on social media call it. While there is a condition where you can make too much cortisol (Cushing’s syndrome), Dr. Coviello says it’s rare.
“It’s more likely that you’re not sleeping well,” Dr. Coviello says, noting that cortisol is normal in the body, especially in the morning as you wake, and decreases as you prepare for bed.
The good news? Exercise is a natural way to balance cortisol levels and reduce stress, and it also helps you get quality sleep.
Why is my belly bigger than it was when I was young?
Your belly will naturally change over your life.
“Weight changes as we get older, so we can’t have the same criteria for all ages,” Dr. Coviello says. “You gain weight to go through puberty. You gain weight during pregnancy. Between the ages of 40 and 60, data shows that you might gain a pound a year.”
Notably, as women go through the transition to menopause, their body composition changes, and fat that had been stored in the butt, hips and thighs is redistributed to the middle. It is important for women to be aware of this change, as it does increase risk for cardiovascular disease.
In general, though, you can’t compare your middle-age belly to your teenage belly.
“Exercise and attend to the quality of your diet so you can lose weight in your middle, but be gentle with yourself,” Dr. Coviello says. “You probably won’t get to the physique you had in high school or your early 20s with typical aging.”
Can I lose belly fat with supplements, powders, teas, cleanses, devices, gummies or anything else I see sold?
Someone on social media is promising they’ve found the magic ingredient for losing your belly fat. What’s the harm in trying it?
“These products are in an unregulated space,” Dr. Coviello says. “They don’t have to substantiate their claims with data because they’re not FDA-approved. If you expect a supplement to have a medical effect, then it might also have an adverse effect, like any other medication. These products don’t come without risk.”
For example, some of these products contain stimulants, which could affect cardiovascular function.
It can be frustrating when you want a quick fix, but the answer really is diet and exercise.
“On social media, someone is usually selling you something, so be aware of that,” Dr. Coviello says. “They’re preying on your insecurities about your weight and how you look. If it sounds too good to be true, it probably is.”
Is it possible to have a totally flat belly?
Your health care provider can help you determine whether your belly fat puts you at increased risk for health concerns, but bear in mind that the goal is not to have zero fat. We need some visceral fat because it cushions our organs and provides fuel for our body’s activities.
“Fat has a lot of negative bias and stigma, but having too much and too little is bad,” Dr. Coviello says. “Both have health risks. You need a healthy target and reasonable goals.”
Instead of focusing on the number on your waistband, focus on how your diet, exercise and sleep are helping to prevent chronic health conditions and improving your quality of life.
“You can assess your health without a number,” Dr. Coviello says. “It’s important to be healthy without too much focus on a specific number or seeing fat as the problem. Look at your lifestyle, and manage your expectations, because there’s not just one ideal. You have to reframe expectations at every age and be kinder to yourself.”
Concerns about your body’s shape and size? Talk to your doctor. If you need a doctor, find one near you.