No one likes belly fat. But it turns out, the soft fat that gives you love handles shouldn't be your biggest concern, especially when it's hard belly fat that can wreak havoc on your health. In other words, when it comes to belly fat, it's all about location.
Here, we'll dig into the difference between soft and hard belly fat, the causes of each, the health risks they bring and how to lose them.
Soft vs. Hard Belly Fat
Soft belly fat: Also known as subcutaneous fat, this is the type you can pinch at your waistline, and according to Harvard Health Publishing, 90 percent of body fat in most people is the soft kind. It's located just underneath your skin, and though many people feel it looks unattractive, it actually acts as insulation and a source of energy for your body.
Subcutaneous fat produces beneficial molecules, such as the hormone leptin, which sends signals to the brain to inhibit hunger and regulate energy balance, per the Hormone Health Network. In other words, leptin helps you maintain your weight.
Adiponectin is another hormone produced mainly by soft fat that improves the body's sensitivity to insulin and protects against type 2 diabetes. It also has an anti-inflammatory effect on the lining of your blood vessels.
Read more: What Is a Good Body Fat Percentage?
Hard belly fat: Also called visceral fat, this is the remaining 10 percent of body fat that's located deep in your abdominal cavity and wrapped around your organs. When your belly protrudes forward and isn't squishy — especially if you measure more than 40 inches around as a man, or 35 inches as a woman — that's visceral fat, and it's cause for concern.
Visceral fat is the more dangerous of the two since it produces a higher number of molecules with possible detrimental health effects. This intra-abdominal fat is strongly linked to insulin resistance, high blood pressure and high cholesterol, as well as heart disease, type 2 diabetes, certain cancers and inevitably, an increased risk of premature death — even for people who have a normal body mass index (BMI).
What Are the Health Risks?
Subcutaneous fat isn't exactly "good" if you're carrying an excess of it. Remember that this fat produces leptin, which helps promote satiety; but when someone is obese, too much of the hormone might be circulating in the blood. This may cause leptin resistance, which can lead to overeating, according to the Hormone Health Network. (Talk about a vicious cycle.)
And in most cases, if you have a lot of soft belly fat and are overweight, then you probably have a lot of visceral fat, too. "Subcutaneous fat has some main functions, including protecting the muscles and bones from any type of impact. However, too much soft fat can increase the risk of heart disease, diabetes, high blood pressure, cancer, fatty liver disease and sleep apnea," says Amanda Mancini, a National Academy of Sports Medicine (NASM)-certified fitness trainer, weight-loss specialist and corrective exercise specialist.
Before researchers realized fat was "active" (and acted like an endocrine gland), they thought high cholesterol was the main health concern when it came to visceral fat. This type of fat releases free fatty acids into the blood and liver, which affects cholesterol production. But now, research has connected this fat to a host of other diseases.
Visceral fat makes proteins called cytokines and other hormones, which can cause low-level inflammation and lead to heart disease, per Harvard Health Publishing. A precursor to the protein angiotensin is also produced, which triggers high blood pressure. Indeed, a study published September 2019 in Nature Medicine confirmed that visceral adipose tissue (VAT) was connected to an increased risk of hypertension, heart attack and angina, as well as other metabolic disorders.
Having a high amount of visceral fat is also linked to insulin resistance, which can cause glucose intolerance and type 2 diabetes. A large study published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy examined the skeletal muscle mass to visceral fat area ratio (SVR) in 798 subjects. The ratio was much higher in subjects without metabolic syndrome and type 2 diabetes, so researchers concluded that SVR is closely connected to an increased risk of type 2 diabetes and metabolic syndrome.
Excess visceral fat also raises the risk of colorectal cancer, and according to the American Cancer Society, some studies have discovered that men who are overweight and have an excess of body fat may actually have a lower risk of prostate cancer overall, but a higher risk of prostate cancers that tend to be fatal. Similarly, a study published in Breast Cancer Research and Treatment concluded — after testing 377 women with breast cancer — that high amounts of upper visceral adipose tissue (VAT) and low-quality VAT were related to poor survival outcomes, increased insulin levels and insulin resistance.
There seems to be a brain connection, too. One study, published November 2019 in Obesity, included over 800,000 older adults and found that a higher waist circumference (which indicates visceral fat) is linked to an elevated risk for obesity-related dementia, regardless of BMI.
Furthermore, studies have found that deep belly fat has been linked to decreased bone strength. Some research speculates this is because visceral fat is correlated with a reduced amount of growth hormone, which is necessary for bone growth and health. More research on this is needed, though.
How Do You Gain It? (And Where Does It Go?)
Your weight and the amount of body fat you have is largely determined by diet and exercise, or lack thereof. If you're consuming more calories than you burn, you'll pack on the pounds and gain some inches everywhere, including your midsection.
"Much of these fats are accumulated in your body from consuming processed carbohydrates, consuming more calories than your body needs, not performing enough exercise and stress," Jim White, RDN, ACSM-certified exercise physiologist and owner of Jim White Fitness and Nutrition Studios, tells LIVESTRONG.com.
But age, genetics, hormones and whether or not you've had children all play a big role in fat gain as well, even when it comes to where you gain it.
As you age, you lose muscle, especially if you're not physically active. And a decrease in muscle means you're not burning as many calories, which makes it harder to maintain a healthy weight and keep the fat off, per the Mayo Clinic.
Older women may notice an increase in belly fat as they age, even if their weight is in check. This is due to a decrease in estrogen production, which influences where fat is distributed. Many women go from a pear shape (curvier hips and thighs) to an apple shape (fat concentrated in the middle of the body). But genetics may have a role in this as well.
Surprisingly, sleep (or lack thereof) may also cause belly fat to accumulate, according to the National Sleep Foundation. People who sleep less than five hours at night tend to gain more belly fat over the years compared to those who sleep more than six hours.
Measure Your Middle
In addition to the pinch test, you can get an idea on whether the fat you carry around your belly is subcutaneous or visceral by measuring your waist circumference with a tape measure. A healthy waist size for women is less than 35 inches, and for men, it's less than 40 inches.
"A way to measure visceral fat can be measuring waist circumference compared to the same individual's body mass index. A waist circumference higher than the BMI can signify unhealthy levels of visceral fat," says White.
On the other hand, "Using a handheld electrical impedance device would accurately measure the amount of subcutaneous fat of the individual. Having a percentage of at or above 25 percent for women and at or above 18 percent for men are where the levels can start showing risk factors for various health conditions," says White.
Tips for Shedding Belly Fat
Change your diet. Pay attention to how much you're eating in a day and what you're eating. Nix refined carbs, sugar and saturated and trans fat, and add in more lean protein, fruits, veggies, whole grains and polyunsaturated fats.
Eating healthy foods is critical, but to really lose both kinds of fat, you need to cut calories, too. One pound of stored fat is equal to about 3,500 calories. Creating a daily 500-calorie deficit helps you lose about 1 pound of fat over a week's time. Use an online calorie calculator like LIVESTRONG.com's MyPlate to determine how many calories you need a day to lose the fat.
Get moving! Visceral fat is easier to lose, so it's the first to go when you start losing weight. Moderate-intensity activity for at least 30 to 60 minutes a day will help combat fat and excess pounds.
You have to work a bit harder to lose soft fat, but increasing exercise will help. Targeted exercises, such as sit-ups, can tighten abdominal muscles, but they won't get at visceral fat. And don't forget about strength-training, which is recommended at least twice a week, according to the Mayo Clinic.
"The best exercise to reduce both subcutaneous and visceral fat would be aerobic activity, including walking, running, biking, the elliptical, etc. I recommend 45 minutes to 1 hour per day of continuous aerobic activity at a moderate effort level most days of the week. Ideally, just find an activity you enjoy and make it part of your daily routine," says Mancini. "In addition, strengthening the core area by doing traditional plank holds are effective as well. I recommend 1 minute plank hold on the elbows, repeated 3 times at the end of each workout."
Rest up. Research suggests that lack of sleep can cause an increase in belly fat, so try getting more shuteye if you're currently lacking. And try to reduces some stress in your life: do yoga, take a stab at meditation or talk to a therapist.
Seek out a professional. If you think you need extra help, make an appointment with an MD who specializes in weight loss or a registered dietician. He or she will get the tape measure out, get you on a healthy eating plan and help you take back control of your health.
- Harvard Health Publishing: "Taking Aim at Belly Fat"
- Hormone Health Network: "What is Leptin?"
- Harvard Health Publishing: "Fight Fat to Help Your Heart"
- Nature Medicine: "Contribution of Genetics to Visceral Adiposity and its Relation to Cardiovascular and Metobolic Disease"
- Diabetes, Metabolic Syndrome and Obesity: "Targets and Therapy: Skeletal Muscle Mass to Visceral Fat Area is an Important Determinant Associated with Type 2 Diabetes and Metabolic Syndrome"
- American Cancer Society: "Diet and Activity Factors That Affect Risks for Certain Cancers"
- Harvard Health Publishing: "Body Fat May Predict Aggressive Prostate Cancer"
- Breast Cancer Research Treatment: "Quality and Quantity of Visceral Fat Tissue Associated with Insulin Resistance and Survival Outcomes After Chemotherapy in Patients with Breast Cancer"
- Columbia University Irving Medical Center: "Study Finds Belly Fat is Associated with Poor Bone Quality"
- Harvard Health Publishing: "Deep Belly Fat May Weaken Your Bones"
- Mayo Clinic: "Belly Fat in Women: Taking — and Keeping — It Off."
- National Sleep Foundation: "Sleep Linked to Gains in Abdominal Fat"
- Mayo Clinic: "Counting Calories: Get Back to Weight-Loss Basics"
- Harvard Health Publishing: "Abdominal Fat and What to Do About It"
- Obesity: "Association Between Waist Circumference and Dementia in Older Persons: A Nationwide Population‐Based Study"
- Baylor College of Medicine: Adult Energy Needs and BMI Calculator