(CNN)Going to your doctor may soon look more like going to your tailor. Instead of starting with a request to step on a scale, he or she may measure your waist.
That’s because a new study concludes that excess belly fat, even if you are skinny everywhere else, may be even more deadly than being obese or overweight.
In other words, your beer belly may be killing you.
As of now, the guidelines to manage obesity tell your doctor to look at your body mass index, the measure of body fat using a calculation based on your height and weight. It is possible to have a “healthy” BMI and a slim butt, arms and legs. But if your pants are hard to button, and your low-riders make a muffin top, you should still watch your weight.
‘I’m not fat’
“I hear from some of my patients who have a normal BMI. They ask me, ‘Why do I have to exercise if my BMI is normal? I’m not fat. I should be able to eat whatever I want,’” said co-author Dr. Francisco Lopez-Jimenez. Lopez-Jimenez works as a doctor in the division of cardiology at the Mayo Clinic in Minnesota. What this latest study shows is that his patients with paunches should be eating their broccoli and increasing their time on the treadmill.
This study appears in the latest edition of Annals of Internal Medicine. After looking at data from over 15,000 people, researchers estimate that men with pot bellies have twice the mortality risk of people who are just overweight or obese. Women with a similar fat distribution had 1.5 times the risk for death.
“Keep in mind this doesn’t give people license to eat anything they want to even out their fat,” Lopez-Jimenez said. “I’ve gotten a few of those notes that say that is what some people plan to do. I hope they are joking.”
Earlier studies showed that people with a large waist-to-hip ratio face a greater risk of diabetes, stroke, coronary heart disease and other cardiac problems. This is the first study to quantify the risk of death.
Fat that goes deep inside the body
What makes belly fat so deadly? Part of it may be that unlike your love handles — which are pinchable fat right beneath your skin — the kind of fat that likes to hang out in your stomach area goes deep inside your body and wraps around your vital organs. Your liver can act a bit greedy and it borrows this fat to turn it into cholesterol that can slip into your bloodstream and start collecting along your arteries. Too much cholesterol, and the arteries start to harden — and that can lead you down the path to heart attack or stroke.
This deep layer of fat is to blame for your body becoming insulin-resistant. That can turn into Type 2 diabetes and it can also cause inflammation that may be at the root of a number of chronic diseases. This kind of fat can raise your glucose levels and decrease your muscle mass. That last one may be particularly damaging as muscle seems to be a good protector of your heart health.
To fix it: Diet, exercise and calm
If you want to do something to flatten that tummy, you are in luck.
Having a dangerous waist-to-hip ratio is not a permanent condition. Lopez-Jimenez said researchers really don’t have strong evidence yet on what exactly reduces fat in this area, but the advice he gives his patients is solid. A healthy diet, like the Mediterranean diet, is a good way to go. That means you avoid processed food, eat meat sparingly, and above all, eat more plants, whole grains and nuts. On this diet you can even have a daily glass of wine.
Diet alone doesn’t do it, though. If you want to burn off this kind of fat you need regular cardio. Walking for 50 minutes three times a week or 30 minutes six days a week should work, according to earlier studies. What may be even more useful is to add some kind of resistance or weight training to your routine, “anything that will help you improve your muscle mass, and not just for aesthetic reasons,” said Lopez-Jimenez. “We are starting to think muscle mass may have some protective effects to prevent heart attacks and diabetes.”
Stress reduction may also be a big help. Earlier studies showed people who are regularly stressed out tend to have a disproportionate amount of belly fat. You probably can’t quit your job any time soon, so practice deep breathing or try an active form of relaxation such as yoga.
Combine these three — diet, exercise and calm — and your beer belly doesn’t have to hurt you half as much.