Excess body fat can increase your risk of heart disease even if you are not obese. As it turns out, where fat settles on your body—is your figure like an apple, pear or hourglass?—affects your health risks.

Many studies have shown that people who store excess fat around their midsection are at much greater risk for a number of health problems, including heart disease, stroke, sudden cardiac death, certain cancers and even dementia._{The Skinny on Belly FatHaving a large waist circumference can be worse for your health than overall obesity.Excess belly fat can come from eating habits and lifestyle factors, your genes, or certain medical conditions.Trimming your midsection can help you feel better and live longer.}

One recent study found people who were apple shaped were two times more likely to die and had nearly a three-fold risk of heart disease compared with people with other body types, despite being in a healthy weight range overall. In another study, people with a normal weight but too much belly fat were found to face a higher risk of dying from heart disease than people who were considered obese.

What Makes Belly Fat Different?

There are two main types of belly fat:

• Subcutaneous fat is found just beneath the skin. It’s the fat you can see and pinch—think of those pesky love handles.
• Visceral fat accumulates deep inside your body. It sticks to and surrounds key organs, including the heart, intestine, kidneys, pancreas and liver.

Visceral fat is more harmful to your health. It is sometimes described as “active” fat because it releases hormones and other substances that can promote inflammation in your tissues. Inflammation is harmful to the body and can damage your heart’s arteries.

Visceral fat also interferes with insulin, a hormone that is critical in helping your body’s cells use sugar, or glucose, for energy. Visceral fat can even disrupt other substances in your body that help to regulate mood, appetite, weight and even thoughts and brain activity.

Losing weight can help lower the risk of heart disease, and also help you feel better overall. But how? According to experts, it’s best to map out a plan. Here are some tips to get you started:

• Make changes slowly. Trying to change your lifestyle overnight or lose weight too quickly can often backfire. Think long term and start slowly.
• Prepare for challenges. Learn the triggers that tend to cause you to eat poorly or not get enough exercise. For example, if you’re stressed, plan ahead so you don’t fall back on high-calorie prepared foods.
• Get help from others. Share your weight loss goals with the people you live with or see often. Enlist their support in helping you keep up with healthy habits.
• Work with your health care team. Frequent, face-to-face visits with your primary care provider or specialists such as weight loss counselors, dietitians and physical therapists are very helpful. If you aim to lose a great deal of weight, medical guidelines recommend visiting a health care professional once a month for the first three months, then every three months for the first year. Many insurance plans and Medicare cover these appointments.

“Again, even a little bit of weight loss goes a long way when it comes to improving heart health and lowering the risk for cardiovascular disease.” —Yasmine Subhi Ali, MD, FACC

Eat Better, Move More

The best way to shed pounds is to eat better and move more. For most people, eating more calories than you burn through exercise and everyday activities is what leads to extra weight. The content of those calories also matters. Research shows, for instance, that eating foods that are high in saturated fats can change body metabolism (the way your body gets energy from food) in such a way that you are more likely to hold on to extra weight.

Here are some ways to get your calories back in balance:

• Find a healthy eating plan that you can stick with. Don’t succumb to fad diets or those that are overly restrictive. It’s not realistic to make too many changes at once. Cut out saturated fats as much as possible, but don’t be afraid of healthy fats such as those found in nuts, avocados and plant-based oils, which have been shown to reduce heart disease risk. Some examples of saturated fats include red meat, high-fat dairy and processed foods that have added unhealthy fats.
• Limit alcohol. Alcoholic beverages tend to be high in sugar and empty calories. Reducing your intake can help shrink your belly.
• Read labels. Be savvy when it comes to choosing prepared and packaged foods such as yogurt, pasta sauces and dressing, which can be loaded with sugar, salt (sodium), fat and calories.
• Get more exercise. Aim for at least 30 minutes of moderate-intensity exercise most days. What does that mean? Examples include brisk walking, water aerobics, playing doubles tennis, dancing, bike riding and gardening. Even shorter bursts of physical activity can help reduce belly fat. Find tips on becoming more physically active.

Other Healthy Habits

Many factors can influence your weight and overall health. These steps can also help you lose weight and reduce your risk of heart disease:

• Get a good night’s sleep. Aim to get 7 to 9 hours of uninterrupted sleep each night. Studies show strong links between lack of sleep and weight gain.
• Quit smoking. Smoking is a major risk factor for heart disease. Quitting will improve your ability to exercise and also cut your chance of developing heart disease.
• Find your stress busters. Reducing stress in your life will support healthy habits and improve your heart health.
• Actively manage your health. Work with your doctor to address other health conditions such as high blood pressure, high cholesterol and diabetes.

“Making lifestyle changes isn’t always easy. Make a plan and surround yourself by people who can support you in your journey to not only be heart healthy, but healthier overall.” —Martha Gulati, MD, FACC

What About Medications and Surgery?

For some people, medications or surgical treatments may be needed to achieve weight loss goals if diet and exercise have been tried without success. Weight-loss medications are usually recommended for people with a BMI greater than 30 AND who have at least one other obesity-related risk factor for heart disease, such as high blood pressure, high cholesterol or diabetes.

However, there is no magic pill when it comes to weight loss. If you are given a prescription for weight-loss medicine, you should be followed closely by a health care professional.

Also, be sure to talk with your health care professional before taking any over-the-counter supplements that promote weight loss. This is especially important for patients with heart disease. In some cases, OTC supplements can be dangerous.

Bariatric surgery—surgical procedures that affect how the body processes food—is another option. Surgery is typically seen as a last resort and recommended only for people who are very obese.

However, these medical options don’t work alone. It is still necessary to establish healthy eating and exercise habits to maintain a healthy weight.

Whether you’re trying to shed a few pounds or have a larger goal in mind, losing weight takes time, energy, and most of all, commitment.

Achieving a healthy weight is well worth the effort. Losing even a few pounds can start to improve your heart health. Find tools and tips to help make your weight loss journey a little bit easier.

Obesity and Heart Disease

Obesity—having too much body fat—is pretty common. Today, obesity affects more than 1 out of 3 adults in the U.S. Being obese raises a person’s risk of many forms of heart disease, as well as other health problems.

But, your risk isn’t just about how much body fat you have. Where you carry the extra weight seems to matter, too. According to research, belly fat is of particular concern. In fact, even people who are not obese but have a large waistline show a higher risk for heart disease.

If you are obese or carry a lot of fat around your middle, take heart. Even small changes can make a big difference for your health. What is Obesity?

Obesity means that you are carrying too much fat on your body. This can hurt your health._{Obesity has been linked to:Heart diseaseHigh blood pressureHigh cholesterolHeart failureHeart attackType 2 diabetesObstructive sleep apneaBreast, colorectal and other cancersDementia and Alzheimer’s diseaseDepressionChronic pain}

Your Body Mass Index (BMI)

You can find out if you are obese by calculating your body mass index (BMI), a measurement based on your height and weight. A BMI of 25-29 means you are overweight and a BMI of 30 or higher means you are obese.

But BMI is not a perfect measurement and it doesn’t give a complete picture of your health. And we know that how your body fat is distributed can also affect your health risks.

BMI is often used in combination with knowing the size of your waistline. This is called your waist circumference.

In general, having a waist size of more than 40 inches in men or 35 inches in women raises a red flag and can be a concern. Learn how to measure your waist.

Recent research has found that having a large middle section can have negative health consequences, including a higher chance of developing diabetes or heart disease—and that’s regardless of your BMI. Our waistlines often expand as we age. Excess belly fat can also come from medical conditions such as thyroid problems. Even people who are not overweight or obese can suffer the negative health effects of belly fat, so it’s important to see your doctor regularly and keep your waist in check.

Small changes make a big difference!

Many people falsely believe that weight loss must be all or nothing. The truth is, every little bit counts.

Research shows losing just 3% of your body weight can lower blood glucose levels, and losing 5%-10% of your body weight can improve your blood pressure and cholesterol. If you weigh 180 pounds, that means dropping just 6 pounds to 18 pounds can make a measurable difference toward reducing your risk of heart disease.

To help protect your heart and overall health, make a plan to shed extra pounds. You’ll be surprised how much baby steps—simple changes like opting for the stairs instead of the elevator, reaching for a healthy snack, walking just a little farther—can add up.

What Causes Excess Body Fat?

Many factors play a part in the accumulation of extra body fat. For many people, a combination of eating habits and lifestyle factors cause a gradual increase in body fat over time. These same unhealthy patterns can also contribute to other obesity-linked problems, like stress and depression that can, in turn, make it more difficult to eat well and exercise.

Key factors related to weight gain include:

• Inactivity. Your body needs regular exercise to maintain a healthy weight. This includes not just occasional bursts of physical activity (such as a trip to the gym), but moving around throughout the day. Sitting for long periods each day is linked to higher rates of death and health problems—a condition known as “sitting disease.”
• Poor eating habits. You need lots of whole grains, fruits and vegetables, and healthy proteins. Foods in which more than 30% of the calories come from saturated fat are much more likely to cause your body to accumulate fat. Drinks with added sugar and alcohol can also be a source of wasted calories.
• Aging. Fat tends to accumulate as we age because of changes in hormones and metabolism, especially after menopause (in women). While you can’t stop aging, you can adjust your portions and eating habits as you expect this natural tendency.
• Genes. Certain genes have been linked with belly fat or obesity. In addition to being more likely to carry excess weight, people with these genes have been shown to face a significant risk of developing heart disease and diabetes.
• Stress, depression and sleep deprivation. These factors not only affect your mood—they also affect your body. Hormonal changes and other factors associated with stress, depression and insufficient sleep can change how your body processes and stores fat, making it more difficult to shed pounds. These factors also make it harder to maintain healthy eating and exercise habits.