Q. I have a normal BMI, I eat right, and I stay quite active for a woman my age. Should I be concerned that I have a belly no matter what I do?

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A. Alice H. Lichtenstein, DSC, director of the Cardiovascular Nutrition Laboratory and executive editor of Tufts Health & Nutrition Letter, answers: “A large waist (over 35 inches for women and 40 inches for men) is one of the components of metabolic syndrome, a cluster of conditions that increases risk for heart attack, stroke, and type 2 diabetes. Here’s why: a large waistline can be an indication that fat has built up around the organs in your abdomen. This type of fat is considered “metabolically active” and can lead to adverse health outcomes. One thing we can’t tell from measuring waist circumference is whether an individual’s belly fat is visceral (around organs) or subcutaneous (under the skin). The latter is of less concern than the former. If your healthcare provider finds blood pressure, blood glucose, and plasma triglyceride and HDL-cholesterol concentrations are normal, you are on the right track.

“Genetics has a major impact on body fat distribution. In addition, distribution can shift with age. We don’t have much control over either of these forces. Regardless of some claims about specific diets and foods or types of activity, recent work has confirmed that little can be done to target weight loss (or gain) to specific regions of the body. The important thing is to achieve and maintain a healthy body weight (a.k.a., BMI), be physically active, avoid tobacco products, get adequate sleep, and identify ways to manage stress. Different things work for different people, so identify strategies that work for you, in the long term.

“Again, if health metrics like your weight, blood pressure, blood sugar control, and blood lipids are normal, I would not be too concerned about your waistline. Stay active, continue your good eating habits, and embrace your healthy, changing body.”

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