A BREAKTHROUGH PLAN FROM THE EDITORS OF A FLAT BELLY IS ABOUT FOOD & ATTITUDE. PERIOD. (NOT A SINGLE CRUNCH REQUIRED) BY LIZ VACCARIELLO, Editor-in-Chief, with Cynthia Sass, MPH, RD RUE A EER LEAThis book is intended as a reference volume only, not as.a medical manual. The information given here is designed to help you make informed decisions about your health. It isnot intended as a substitute for any treatment that may have been prescribed by your doctor: If you suspect thal you havea medical problem, we urge you to seek competent medical help Mention of specific brand-name pracucts, companies, organizations, or authorities in this book, does uot imply endorsement by the author or publisher, nor does mention of specific brand-srame products, companies, organizations, or authorities imply that they cudorse this boak, its author, or the publisher. The bra aime products mentioned in this book are trademarks or registered traderiasks of their respective companies Internet addresses given in this book were accurate at the time it went to press, Direct and trade editions are both bei ©2008 by Rodale Ine. 1s published in 2008. hts reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any other information storage and retrieval systens, without the ssxittens permission of the publisher: Rodale books nay be purehased for business or promotional use or for special sales. or information, please write to: Special Markets Department, Rodale Ine., 733 Third Avenue, New York, NY 10017 Prevention is a registered trademark of Rodale Ine Plat Belly Diet is a registered trademark of Rodale Ine, Printed in Une United States of Rodale Ine. makes every effort to use acid-free @, reeyeled paper ®. erica, Direct edition photo credits: Back cover photographs {bottor by Marcus Nilssou, food styling by AU and Associat left) by Kristine Larsen; (top right) ne Distude, prop styling by Deborah Williams for Pat Bates ape measure photo) by Ted Morrison Trade edition photo credits: Tape measure photo by Ted Morrison Cover and interior design by Jill Armas Interior exercise phatos © ‘Tam MacDonald/Rodale Images Before/alter/now photos by Kristine Larsen Publica rary of Congress Cataloging: Data Flat belly diet? : a Mat belly is about food & attitude, period, Guota single ‘Vacearicllo, editor-in-ehief ; with Cynthia Sass, — Rev. ed, nch required) / by Liz pe em Toclucles bibliographical references and index ISBN-15: 978-1-60) ect hardcover) ISBN-10: “6 (direct hardcover) ISBN-15: ¢ 1S-851-1 (trade hardcover) ISBN-IO: 1-59486-851-4 (trade hardcover) 1.Reducingdiets. 2. Abdomen, 1. Vaccariello, jn, TL. Sass, Cynthia. RM222.2.F585 20088 613.2%5—den9 2008010908 Distributed to the trade by Macmillan 2465 0 5 3 1 direct hardeover 24 6 8 WO 5 9 1 trade hardeaver iE We inspire and enable people to improve their lives and the world around them For more of our products visit rodalestore.com or call 800-848-4735ACKNOWLEDGMENTS, PAGE VI Cha) Ghepter1 1 faramy PAGEI Chapter 2 THE SWIMM Gn BELLY EAT PAGE 13 Chapter 3 THE MAGIC OE MUEAS PAGE 27, Chapter 4 THE MIND-BELLY CONNECTION PAGE 45. Chapter 5 THEEOUB-DAY ANT-RLOAT JUMPSTART PAGE 65 Chapter 6 THE FLAT BELLY DIET RULES: PAGE 95 1 3 ol 10 Tl Chapter 7 THEPOURAWEEK PLAN: QUICK-ANO- EASY MEALS PAGE 115 Chapter 8 THEEQUBAWEEK BLAM BECIPES PAGE 143 Chapter 9 THEFOUB-WEEK PLAN OUPNaL | PAGE 237 Chapter 10 HEEL AT BELLY wORKOUT PAGE 271 Chapter 11 YOUR GUIDE TO DAY 33 AND BEYOND PAGE 315, ENDNOTES PAGE 327 INDEX PAGE 333acknowle Vio onecey pierdgments We dedicate the Flat Belly Diet to the readers of Prevention—all 11 million of you—who have told us in no uncertain terms that belly fat is your biggest physical challenge. Our gratitude to the Rodale family. For generations, through their magazines, books, and online properties, they have been committed toa special mission, that of giving people the tools and inspiration to live their whole lives. Our most heartfelt thanks to Rodale CEO Steve Mur- phy, whose leadership means Rodale is the kind of company where cre= ativity is nurtured and the highest standards are set—and met—daily. It all starts with the edit, Steve! Like magazines, books are a collaborative effort, and this one is no exception, Very special thanks to Gregg Michaelson (“Let's make it hap- pent"), Janine Slaughter, Liz Perl Erichsen, and Jim Berra (the unsung hero behind all things Prevention). ‘To Robin Shallow, who never met.an idea she d ’t improve, and Karen Mazzotta, who is tireless in her enthusiasm, support, and belief in this plan, And to Fotoulla Euripidou, for her understanding of the Prevention audience and for helping us determine whether Prevention readers would be interested in this kind of diet book—by asking them!We'd also like to extend our gratitude to the original members ofour tial test panel, which was conducted in summer of 2007. They first opened our eyes to how special the Hat Belly Dict really was. Thank you Mary Aquilar, Syndi Becker, Kath ne Brechner, Donna Chr Evelyn Gomer, Diane Kaspareck, Patti Lloyd, Kevin Martin, Nichole Mich1, Colleen O'Neill-Groves, Julie Plavsie, and Mary Anne Speshok for devoting your summer to this project and providing us with the ess atial insights that helped us develop this book beyond daily meal plans, Thank you also Gina Allchin, President-Health Trek P-T-T,, who measured cach and every one of our panelists with precision and com- passion—a tough combination! You literally would not be holding this book in your hands without executive editor Nancy Hancock (“good to great!”), All thanks to her luding Chris Krogermeier, Mari it Padakis, Anthony Serge, JoAm Brader, Keith Biery, Hope Clarke, Wendy Gable, and Ana Palmiero. And of course, to Ina Yalof—one of the fastest, most creative writers we've ever known—we offer a round of applause. Big hugs to Prevention's brilliant ereative director, Jill Armus, whose ability to commumicate elegance, authority, and strength through color and design have infused the entire Prevention brand of products (most recently this book cover and interior) with new vitality. And to Prevention fitness direetor Michele Stanten, whose contribution to and extensive review of Chapter 10 have helped make it one of the most authorit tive sourees of information on banishing belly fat with exercise, WLEDOMENThanks also to Miriam Back s, Merritt Watts, Amy Gorin, Katie Kackenmeister, and Kristen Watson, who assisted with eoordin ting the test panel and editing and fact-checking the manuscript, even during precious nights and weekends. To Lori Conte, Courtenay Smith, and Polly Cheval for keeping the trains running on time. And to the smartest photo and art team in the business, including Prevention’s Helen Cannavale, Kim Latza, Faith Encmark, Jessiea Sokol, and Donna Agajanian. And of course to Rosalie Rung, who helped capture the enor- mous success of our test panelists on film and video. Our decpest gratitude we save for brand editor Leah McLaughlin, a longtime colleague and friend to both of us. From helping develop the initial idea to making sure the most engaging, authoritative manuseript shipped to the printer and every moment in between, Leah was critical to the launch of this book—not to mention the companion online sub- scription service, flatbellydict.com. Finally, wed like to thank our husbands, Steve Vaceariello and Jack Bremen, and families (especially Olivia and Sophia Vaccariello and Diane Salvagno!) for putting up with all the late—late!—nights an never-ending conversations about Fat Belly Diet this and Flat Belly Diet that. (Yes, now we can take a weekend off, guys!) RDOMPNT. ixGET READY FOR A FLAT BELLY |T DOESN'T MATTER what your personal stumbling blocks are: baby weight, killer cravings, or (say it with me) “getting older.” Belly fat is no# your destiny. I am delighted to tell you thal you can, and. will, get rid of it. Prevention has found away to target belly fat that is healthy, real, long-lasting, and works for everyone. Before we get started, I think it’s important to do a “gut cheek.” Chances are, if you've plunked down cold, hard cash for a book called Flat Belly Diet, you may wish you had someone else’s belly or wish you had your own belly—from 20 years ago. If that’s you, [ask you to change your thinking. Be kind to your belly. No matter how flat or round, jiggly or rock hard—it’s yours, and it's powerful. It's probably the center of some of your most profound: memories. Think about it... the laughter you've shared, the romantic dinners you've had, the butterflies you've felt, the children you may2 have carried. All thes sct up house in—yes—your belly. And for that it deserves jon. And mare than a little love and kindne your respect. Your appr even when you're struggling to button your jeans. OW DOI FEEL ABOUT MY BELLY? I conside: my core strength, and | love to feel it move, twist, support me as I go through life's business. It’s where food (one of life's greatest pleasures, yes?) touches down, and there are few things as peaceful for me as that not-stuffed-not-hungry- butjust-full feeling. It’s also my meditative center, and I sense the calm over- taking me when | fill my middle with deep breaths. ‘Then, of course, there's the role it played in my pregnancy with twins. Anything willing to expand to host two precious, growing, kicking girls earns a special place in my heart for all time. But the belly betrays. If T'm puffy the morning after a sushi dinner, that’s where my outfit feels tight. If PMS strikes, my belly moans and groans. When L gal pounds off, that’s where they stay. One of the be: from all of you and learning—clearly and quickly—that I am not alone in my 5 pounds, that’s where it shows. And, of course, when T go to take those 5 things about being editor-in-chief of Prevention is love/hate affair with this fascinating, troublesome part of the body. Many of you have told me that when look at yourself in the mirror, you overlook your fumil beautiful features, the favorite nuances of your physique. Instead, your eye travels directly to the areas where your fat resides. And for most of us, that’s the belly. For countless reasons that I will outline throughout this book, the belly starts letting us down around age 40. Sometime between our 35th and 55th birthdays (Some earlier, some later, and some, God willing, never), the belly pooches, puffs, and starts spilling over our waistbands. First we suck it in, yet it refuses to achieve its formerly flat shape. Then we crunch until our necks scream, while the fat over the culpted abs mu remains, And eventually we diet, thenwatch with frustration as the weight disappears from our breasts and our faces and the belly fat stays put. Eventually, belly fat starts to feel like our destiny— something that even hours on the treadmill or the strictest diet in the world won't budge. ... Until now. ¥ QUEST TO FIND THE ABSOLUTE BEST WAY to blast belly fat started when I hired Prevention's nutri- tion director, Cynthia Sass, MPH, RD. Her first ehal- lenge was to comb the latest research, combine it with her vast clinical experience, and develop a diet that would target abdominal fat specifically. I made a good decision—Cynthia is not only a phenomenal magazine editor but also a registered dietitian with two graduate degrees and 15 ars of experience, including countless hours of work- ing with women in the real world, And here's the best part: She is passionate about food! I knew that any diet I asked her to construct would be satisfying d delicion s, that it would be a way of eating that women could embrace for a lifetime. And boy, was I right. She has developed a belly-sh king eating plan that is grounded in the latest and most credible science (that you won't find anywhere else!) —and offers the most filling, ng, and delicious meals that you will ever have the pleasure of eating. But my vision for this Flat Belly Diet went beyond food. 1 know that any suc- cessful diet acknowledges that we eat for emotional reasons as well as physical s. Not only does the Flat Belly Diet deliver a health satisfying way of eat- ing—one that will rid your body of fat in the place you told us you want to slim down most—but it will teach you how to want to eat this way forever. The men- tal tricks, tips, and strategies are culled from the latest research and are designed to inspire you, motivate you, and set you up for a better relationship with food for the rest of your life!4 B Belly Fat Defined Wun [ross anounp the words “belly fat,” Lim actually sg about two dif ferent types: subcutaneous and visceral. Subeutaheous fat is best, though per haps not most scientifically, defined as the fat that you ean see, the “inch you ean pinch.” Subcutaneous means “beneath” (swab) “the skin” (cutaneous), and it’s no big secret that this fat resides all over. In some spots—your thighs, under- arms, tummy, anyone?—it may be thicker than in others, but for the most p: it's everywhere, even on the soles of your feet. A moderate amount of subeutane- ous fat is essential for life—for one thing, it keeps you from freezing to death in the winter. But too much of it causes dissatisfaction with how we look (which ), sive amounts of subcutaneous fat funetion as a visible sign of being overweight studies show leads to even more dangerous health behaviors). And worse: Exces- or obese, which doctors know raises your risk for many diseases. But I have some great news: Subcutaneous fat responds immediately to this diet plan. Before you happily skip pages and move to the dict, let's talk about the sec- nd difficult to lose. visceral—which is much more dangerous Visceral fat resides deep within your torso and is sometimes referred to as “hid- den” belly fat. I prefer the term “deadly.” Because of its proximity to your heart and liver, exeess visceral fat ean inerease your risk of all sorts of diseases, from heart disease and diabetes to eancer and Alzheimer's disease. And the most frustrating part? You can cut calories and exercise religiously and still be left with too much of it. In fact, the only way to minimize both visceral and subcutancous fat simul- taneously is to eat the right... fat. The New Belly-Flattening Nutrient Ar Prevention, we've been talking about the healthfulne rated fat—the kind found in olive oil, nuts, and avocades—for decades. Nearly LLY DIET‘every issue contains some tip or strategy for getting more in your dict. In fact, s that we have a ‘re on such intimate terms with monounsaturated fatty a nickname for them—MU FAs (pronounced MOO-fahs). But it wasn’t until the spring of 2007 that we realized just how amazing these fats are.'That was when Spanish researchers published a study in the journal Diabetes Care showing that cating a dict rich in MUFAs ean actually help prevent weight gain in your belly. ‘The researehers looked at the effect of three different diets—one high in sat- urated fat, another high in carbohydrates, and a third rich in MUFAs—on a group of patients with “abdominal fat distribution,” or, in language the rest of us nonscientists can understand, belly fat. All three diets contained the same number of calories, but only the MUFA diet was found to reduce the accumula tion of belly fat and, more specifically, visceral belly fat. Bear in mind: No other nutrient can. do this. And that’s what makes the Fat Felly Diet unlike any other diet book you've ever read. It presents the only diet ta sive MUFAs center stage, to make them an essential part of every single meal. And that means it’s the only diet that helps you ose fat in the belly specifically! In Chapter 3, you'll read more about MUFAs and their various health benefits, but until then, let’s take a broader look at this truly groundbreaking diet plan. The Flat Belly Diet Program ‘Tae Fiat Beity Diet is made up of two parts—the Four-Day Anti-Bloat Jumpstart and the Four-Week Eating Plan. The whole thing together takes just 32 days, which studies show is just enough time to make any dietary change a lifestyle. Then, after you've mastered the program and seen the desired changes in your weight and m surements, I give you the tools to keep your belly flat for life. Even though you may be tempted to follow one part without the other, 1 want you to start with the Anti-Bloat Jumpstart, then move straight inte the Four-Week Eating Plan. He why,|THE FOUR-DAY ANTI-BLOAT JUMPSTART isn't just about beating bloat; it’s also extremely important in sparking your emotional commitment to the entire program. The 4-day plan includes a prescribed list of foods and drinks that will help flush out fluid, reduce water retention, and relieve digestive iss slike gas and c ily. You'll drink C fruits, vegetables, and whole grains. When we tested this diet on our group tipation, which can make your belly puff unnecessar- nthia’s signature Sassy Water and cat healthy foods like of volunteers, one of the participants lost an amazing 7 pounds and 5 inches in the first 4 days (that’s just 96 hours Losing the bloat isn't just a way to fit into your favorite dress again. It’s about feeling confident, powerful, and proud of your body. Dropping even a few pounds of unnecessary water weight can be thrilling and can give you a major confidence boost—essential for success on any diet plan. Plus, I've added k at every meal. These second element to the 4-day plan: a Mind” quick and easy healthy-eating triggers will serve as mealtime reminders that you have embarked on a new way of life—a new way of living with and caring for yo r body, What about Exercise? lexercise every day, walking 50 minutes as part of my commute. (I also strength-train every weekend and try to fit in a weekly Pilates class or yoga session, too.) And | encourage everyone to make exercise a part of his or her lifestyle, To that end, asked Prevention’s fitness director, Michele Stanten, to devise the exercise program in Chapter 10 for you to follow as you embark on the Flat Belly Diet. Adding a fitness program to the eating plan and mental strategies will mean faster results (it certainly did for some of our testers). But what makes the Fiat Belly Diet truly special is that you don’t need to exercise to reap the benefits. f you do exercise, you will most certainly see results faster, and youll THE FOUR-WEEK EATING PLAN begins the morning after you complete the Anti-Bloat Jumpstart, and it's the centerpiece of this book, Every day you'll enjoy three supersatisfying 400-calorie meals and one 400-calorie Snack Pack. Each just the right amount of MUFA to make that belly fat meal and snack contai disappear. Hows that? No calorie counting. No math! We chose the qu tity of 1,600 calories per day because that's the precise amount an adult woman of average height, frame, size, and activity level needs to get down to her ideal body weight while maintaining a high energy level, health tem, and strong muscles. It also. ensur you won't feel tired, cranky, irritable, moody, or hung But because no plan fits all, we've provided two different versions: The first ‘one’s perfect for people who have little time to spend in the kitchen. In Chapter 7, you'll find 84 different 400-calorie, MU FA-packed Quick-Fix Meals and 28 different 400-calorie Snack Pack options. Choose three meals and one Snack Pack a day and you're done. In a month, you'll have a flatter belly and I'll have done my job. Sometimes, however, you'll want a more involved home-cooked meal, whether it’s family night, or the weekend, or you're just a good cook who likes to flex her will gain secondary benefits like improved cardiovascular health and stronger, more toned muscles. But you can still expect to shrink your bellyand lose both subcutane- ‘ous and visceral Fat—by simply following the eating plan. IF you do not already exercise regularly, you don't have to start doing so right away. I have always been a big believer in the phrase “small changes, big results.” To me, it's more important that you do something to reduce your belly fat than it is to do everything, only to find that too many changes are too overwhelming to maintain. If you do not already have a workout rou- tine, incorporating a new way of eating into your lifestyle may be change enough for the first 32 days.8 B culinary museles now and then, In Chapter 8, you'll find more than 80 recipes that all provide the requisite number of calories and MUFAs per serving, so they can be swapped in for any of your required three meals a day. Like the Four-Day A nti-Bloat Jumpstart, the Four-Week Plan isn’t only about 11 journal—a key predictor of success on any diet. Every day, I'll prompt you to what you eat. Its about how you think. In Chapt you to keep a da reflect on a particular aspect of your relationship to food, your belly, your body, d your goals. I call these reflections Core Confidences—not only beeause your belly lies at the physical center, or core, of your body, but also because your atti- tude is at the core of your ability to suceeed . . at anything. ‘Throughout this book, look for the boxes titled Did You Know? to learn more about fat, weight loss, and general health. These are quick tips, strategies, and bits of information that experts and readers tell me are useful. And dontt forget to read the entries titled Sass fram Sass. Cynthia wrote these to share her thoughts and advice about how to achieve success on this amazing program. You'll also find incredible success stories from the women (and men) who participated in our Flat Belly Diet test panel—and who have a flatter belly to prove it! If [know one thing for certain after years editing Prevention, it’s that main- taining a healthy mind and body are the absolute most important things I ean do for myself—and my fam you Finis . [hope that by the ti h reading this book and following this plan, you will have fallen in love with your flatter bell vitality that comes with better health! your healthier, wholesome way of eating, and the amazing energy and LLY DIETee) a THIS PAGE Flat Belly Diet! > The Four-Day Anti-Bloat Jumpstart A full 96 hours is all it takes to spark your commitment to the Fiat Belly Diet—and lose a few pounds! The Jumpstart consists of A DAILY DOSE OF SASSY WATER Created by Cynthia, this make- ahead concotion helps guard against dehydration A MIND TRICK AT EVERY MEAL Fast mental fixes help get your brain in the Flat Belly game > The Four-Week Plan Twenty-eight days of delicious MUFA-packed meals and recipes that you can mix and match. The plan consists of: FOUR 400-CALORIE MEALS A DAY Choose from our meal selections or recipes, and be sure to make one meal a Snack Pack A MUFA AT EVERY MEAL These superhealthy fats keep you feeling full and ensure every meal is exceptionally tasty. ONE DAILY CORE CONFIDENCE REFLECTION Spend 15 minutes @ day exploring your relationship to food and desire to reach your goals. > An Optional Exercise Program Fat-burning walks, a Metabolism Boost, and a Belly Routine will help you build muscle and maximize calorie burn.10 READ A FLAT BELLY SUCCESS STORY Mary Anne Speshok AGE: 55 POUNDS LOST: 15 IN 32 DAYS ALL-OVER INCHES LOST: At press time: POUNDS LOST IN 5 MONTHS! THE PLAT 2 LY DIET! I'M NOT A KID ANYMORE, says 55-year-old Mary Anne Speshok. But you'd never know it from listening to her describe the effect of her new weight loss on her husband of 5 years. “He's chasing me around the room! Like I'm his toy! He looks at me and says, “Wow! | can’t believe what I'm seeing!" Mary Ann says her husband was as happy as she is with her results from the first 4 weeks on the Flat Belly Diet. in just 32 days, she had lost 3/2 inches off her hips, 31% off her stomach, 3 inches off her back—(that little place that hangs over the bra strap), and an inch on each thigh. “On the scale today, | lost 2 more pounds. | feel as if the weight is melting off of me. People tell me I'm walking with more confidence in my step. It’s terrifi The administrative assistant has a message for anyone considering the Flat Belly Diet: “The only thing you have to do is start it. All the tools are there.” She calls it a revolutionary, doable winner—doable, she says, because the MUFAs keep you satisfied. “Most people, including me, don't stay with a diet plan because they get hungry between meals. The difference with this diet is you literally don't get hunger pains. it's revolutionary because you start seeing results so fast that you want to keep going.” And the winner part? “Well,” she adds, “just look at what I've lost.”Mary Anne has committed herself to doing the Flat Belly Workout in Chapter 10 along with the diet. Even though she works full-time and commutes an hour each way to and from work, she still manages to get in her paces. She usually walks 30 minutes at lunchtime, but on days when she can't, she stops at the gym even before she goes home and does her 30 minutes of walking there. At home, she either does floor exercises or uses hand weights, She says her energy level is so high these days that exercising is easy. And like so many recently thin women, Mary Anne has just discovered how great itis to fit into a nice, slim pair of jeans. “I never even owned a pair before," she says. “I liked them, but just not on me." Not anymore, though. She says she just went out and bought three different styles of jeans because they all looked so good an her. In fact, Mary Anne's closet is getting a full workout these days. She's buying new clothes to fit her new body. And she’s adding bracelets and necklaces, “which | love. When I felt so big, | just wore my wedding ring and my watch You don't want to call attention to yourself because you don't feel pretty. But now, bring on the jewelry! The more the better!” She and her husband are renewing their vows soon, and she's looking forward to wearing a beautiful gown that she hasn't been able to fit into for a long time. “What a prize for reaching your goal,” she exclaims. “To fit into something that sat in your closet, just waiting. This beautiful gown ... and a size smaller.”THE SKINNY ON BELLY BODY FAT |S ESSENTIAL. Without it, you couldn't survive. Your cells wouldn't be able to hold together or absorb nutrients from the food you ate. Your organs wouldnt be able to produce the hormones that make you distinctly fernale. You would freeze to death on a cold day. You'd run the risk of damaging your internal organs just by bumping into a doorknob. And forget ever finding your keys again. Without fat, your brain probably wouldn't even be able to figure out what a key is. In effect, yow wouldn't be you without fat. Body fat, whether it’s found on your thighs or buttocks or within the intricate coils of your brain, plays a role in nearly every single biological funtion in your body, and it’s impossible to live without it, Of course, there's a fine line between having just the right amount of body fat and having too much. HE SKINNY (1314 B The Trouble with Belly Fat Scientists ave KNowN for some time now that excess body fat isn't good for yo deadly u're getting a rough indication of how heavy you are, but you ean tell how fat Obesity—which, technically speaking, means “overfat”—is considered noking, ale, ording to some ys . When you step on a y you are. The body mass index (BMD gets you closer to figuring it out. Here's how to calculate it. Multiply your weight in pounds by 703. Divide that number by your height in inches. Divide that number by your height in inches again. Awoman who weighs 145 pounds and is 67 inches tall (5'7") has a BMT of 22.7. Awoman who weighs 260 pounds and is 67 inches tall hi BMI of 40,7. You can also visit the BMI calculator at flatbellydiet.com for an instant calculation. If your BMI is 25 or higher, youre considered “overweight,” but if your BMI is, 30 or above, you're “obese.” If it's 40 or above, youre “morbidly obese,” and your health is at great risk. A BMI below 18.5 is “underweight"—that’s also cause for concern, beeause it indicates too low a percentage of body fat to ensure healthy funetioning. An index between 18.5 and 24.9 just right. However, one of the problems with the body mass index is that it doesn't account for your muscle mass. As a result, some athletes—who have a much lower percentage of body fat and higher percentage of musele—ean compute to be overweight or, in some rare eases, obese. More recently, studies have begun to show that while being obese in general is unhealthy, ca: ing excess body fat specifically around your belly is really, really unhealthy. Studies show that women who have waistlines measuring 35 inches or more are at greater risk for heart disease and diabetes than those whose waistline measurements are smaller. For men, a waistline measurement of 40 or above can be an indicator of the same health risks, Heart disease is the number one killer of American women, and rates of diabetes have reached epi- LLY DIETdemic levels. The connection between the measurement of your waist and your tisk of dying from one of these diseases is no mere coincidence, According to a study reported in the New England Journal of Medicine, people with large hips and small waists produce higher levels of HDL cholesterol, the protective form, than do those with large bellies. (Ilike to remember the two types of cholesterol in this way: HDL is the “healthy” kind, LDL is the “lousy” kind.) ‘Women typically have higher HDL levels—whieh is linked to fewer heart attacks— than men do. But that all changes after menopause, when body fat distribution changes due to hormone shifts and a woman's risk for heart attack increases. If you're overweight or obese, take your pick of things to blame—Alfredo sauce, for one. Not to mention ice cream and soda, and cake and cheese and— well, you get the picture. Eating too much of any food ean make you fat. Cutting back on cardiovascular exereise is another way to add inches all over, as is skip- ping a strength-training routine. And for some of us, genctics plays a role. But something happens to us after age 40 that makes it easier to put on beély fat in particular: Our hormones go haywire. As estrogen levels decline, your body struggles to maintain its hormonal DID YOU KNOW We're all born with the same number of fat cells (about 40 billion, give or take). As we grow up, the number of fat cells we have increases until after our pubescent and adolescent years, when they are pretty much set.in the past, it was assumed that the only difference between over- C ‘weight people and thin ones was that overweight or obese people had all their fat cells filled to maximum capacity. It’s now known that we can—and do, in fact—"grow" more fat cells in adulthood. This is because when fat cells expand to their maximum size, they divide and increase again the number of fat cells. Some obese people have more fat cells than nonobese people, But in the end, both the number and the size of the fat cells determine the amount of fat someone has. HE SKINNY ON BELLY RAT, 1516 balance. In the process, body fat—which is extremely important in manufactur- ing estrogen and other sex hormones, not to mention preserving bone mass— becomes more valuable and thus harder to get rid of. As you enter perimenopause d hit menopause, your body fat distribution starts to look more like a man’s d less like a woman What do I mean by that? Well, you've heard of the term beer belly? Male body fat tends to concentrate around the belly area—and it doesn't really have much to do with beer, exeept for the fact that, because beer is a source of excess calories, it’ generally a catalyst for weight gain. Female body fat, on the other hand, tends to concentrate around the hips, thighs, and butt during the years that we're most likely to reproduce. Some researchers theorize that as estrogen levels decline, a woman's body stops laying down fat in these trouble zones and starts ‘ing down fat near the belly, like man’s body does. Not every woman ends up with excess midsection weight in midlife. Although some women with small waists and large hips a midsection large enough that i women keep the “pea shape forever. Fo n with time develop becomes the broadest part of her body, other them, the weight gained in the mid- An LDL/HDL Primer ‘There are several types of cholesterol, but in most cases, the American Heart Association concentrates on two—namely, HDL and LDL. LDL is known as the “bad” cholesterol because it builds up on artery walls and can lead to increased risk for cardiovascular dis- ease and stroke, The American Heart Asso- ciation considers a level of 130 mg/dL {milligrams per deciliter of blood) or less ‘optimal for most people. HDL is the healthy cholesterol. It transports LDL cholesterol out of the bloodstream and deposits it in the BELLY DI liver, where it can be processed and excreted High amounts of HDL (60 mg/dL or higher) give some protection from heart disease. The ratio of HDL to total cholesterol is a very good way of measuring cardiovascu- lar risk, Most physicians consider a ratio of 4 or under excellent. A person with total cholesterol of 200 mg/dL. and an HDL of 50 mg/dl (total/HDL ratio = 4) has a lower risk of heart disease and stroke than some- one with a total of 180 mg/dL and an HDL of 30 ma/dL (total/HDL ratio = 6).section around menopause is new, but subeutancous fat is still stored in the hips, thighs, or elsewhere. V Is for Vicious VISCERAL FAT GtTs its name from the term viscera, which refers to the inter- nal organs in the abdomen. It lies cloaked deep inside your body, where it wraps around your heart, liver, and other nearby major organs. Beeause it’s sequestered beneath a layer of muscle, and it doesr’t jiggle when you walk or always show up in your girth, so Jden fat.” In fact, people call it “I 's possible to be relativel thin and still have too much visceral fat. But this kind of fat can do far move than add inches to your waist: It ean subtract years from your life, Carrying eral fat is one of a complex group of symptoms collectively called metabolic syndrome, or syndrome X. The other symptoms are high cholesterol, high blood pressure, and elevated insulin levels. Having just one of these condi- tions contributes to your risk of serious disease, but your risk grows exponen- tially as the number of symptoms grows. Visceral fat has been linked to a long list of adverse health conditions, the most serious of which are: High blood pressure, stroke, and heart disease Diabetes Breast cancer Dementia One of the main reasons visceral fat is so deadly is its role in inflammation, a natural immune response that has lately been tied to almost every chronic disease you've ever heard of. Visceral fat secretes precursors to an inflamma- tory chemical that helps fuel the systemic process that exacerbates early syinptoms of disease.18 In fact, according to a study published in Circulation: Journal of the American Heart Association,” vi ral fat may have a greater impact on the cardiovascular health of older women than overall obesity, Danish researchers found that women with exe than tho: Here's why. © The proximity of visceral fat te your terol—remember, the “Io plaque, a waxy substance. whose fat was stored mostly ” kind—which collects in your sive belly fat had a greater risk of atherosclerosis thei: 1d buttocks. hips, thighs, a er boosts production of LDL choles- rteries and forms © Over time, this waxy plaque becomes inflamed, causing swelling that narrows the arteries, rest © The narrowing passagew: and potentially d © The inflammation further inereas¢ break loose and cause stroke. Jamaging tiny capillari ng the passage of blood. 's increase blood pressure, straining your heart Se our risk of blood clots, which can. But it gets worse. Visceral fat also contributes to insulin resistance, an early precursor to diabetes. Insulin resistance is a condition in which cells do not How Fat Cells Work A fat cells like a tiny, expandable capsule— so tiny, it can't hold but a microscopic drop of fat. But fat cells prefer not to live alone; they cluster together like little gangs to become fatty tissue. They generally just chill out until they're called inte action by precise biochemical signals, usually hor- mones and enzymes. When hormones and enzymes signal fat cells, they become BELLY DI active, releasing fat into the bloodstream to be used for different purposes. When you overeat, those extra calories will travel right back into those deflated fat cells and fill them back up. No matter how much weight you lose or how many hours you spend in Spinning class, your fat cells will never disappear. A deflated balloon is still a balloonDID YOU KNOW A Harvard study published in the Journal of the American Medical Association followed more than 50,000 women for 6 years and found that for every 2 hours spent watching television, obesity increased by 23 percent and the risk of type 2 diabetes jumped by 14 percent. This was partly due to increased eating while watching TV. as well as being @ more sedentary.” respond to insulin and the pancreas is foreed to increase production to clear the bloodstream of glucose. Ov insulin resistance can lead to full-blown diabetes, which can severely compromise the entire circulatory system and cause long-term issues with vision, memory, and wound healing. As if that weren't enough, a Kaiser Permanente study comparing people with different levels of abdominal fat showed that those who had the most abdomi- nal fat were 145 percent more likely to develop dementia, compared with people with the least amount of abdominal fat.! Why? Inflammation again, suggest researchers. The One Number You Need to Remember ‘Tne NaTIONAL INSTITUTES OF HEALTH (NIH) have stated that a waist mea- surement of above 35 inches for women and 40 inches for men—70 matter how much you actually weigh—is an unhealthy sign of excess visceral fat? A measurement that specifically reflects the concentration of fat around your belly is the waist-to-hip ratio, as opposed to me: ig around your hips or thighs. In other words, it’s just slightly more targeted to belly fat. Analyzing data from 27,000 people in 52 countri ientists found that heart attack sufferers had BMIs similar to, but waist-to-hip ratios higher than, those whodnever had a heart attack. Which number would you rather track? ‘The wais ‘o-hip ratio compares the measurement of the narrowest part of your waist to the broadest section of your hips. Your waist measurement should be taken in the spot that falls between the rib cage and the hip bone, viewed from the front. Your hip measurement is truest if you turn sideways to the mirror and make st e you incorporate your derriere in the measurement. Now divide your waist measurement by your hip measurement. For example, a woman with a 30-inch waist and 37-inch hips has awaist/hip ratio of 0.81. Aceording to the Centers for Disease Control and Prevention, a healthy waist- to-hip ratio for women should not exceed 0.8." Other Ways to Measure Visceral Fat Prorie can nave high amounts of visceral fat despite being at a normal weight because most of that fat is stored around the abdominal organs. ‘This understanding i relatively new and describes those who are thin on the outside but have excess fat on the inside. It’s hard to imagine that one could be thin and fat at the same time, but Jimmy Bell, PhD, a professor of molecular imaging at The Benefits of Fat From2to 5 percent ofaman’s body weight rote comes from essential fat, whereas for —_ertility women, it's 10 to13 percent. Fat is essential in humans for: 9 vital organs Bone growth Body fat only becomes a problem when Energy there's too much of it, At that point, it puts a SIDES Co ea Donnan Sg strain on your heart and other organs and Regulating body temperature starts to interfere with your body confidence. 20 THE FLAT BELLY DIDID YOU KNOW In research published in the medical journal Lancet, doctors concluded that a person's waist measurement is a more accurate forecaster of heart attacks than the BMI? e Imperial College, London, has shown that it is possible.* Dr. Bell and his team have been using magnetic resonance imaging (MRI) machi s to scan nearly 800 people in an effort to produce what they call “fat maps.” His findings will surprise you: About 45 percent of the thin women and 65 percent of the slim men he tested carried excess visceral fat. As we understand more about the dangers of visceral fat, researchers are developing increasingly more accurate—and expensive—ways to measure it. ‘The latest test, as we go to press with this book, is one that detects levels of a protein called RBP4 (retinol binding protein 4), which produced in higher quantities in visceral fat, compared with subcutaneous fat. In overweight peo- ple, blood levels of RBP4 are double or triple the amount found in normal- weight people. But other tests are also used, ineluding: BIOELECTRICAL IMPEDANCE ANALYSIS BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) is portable, easy to use, and low- cost, compared with other procedures. A BIA involves circulating a very faint ance the electrical current through the body. A device then calculates the resi: current encounters as it travels through the body, computing body fat pereentage based on height, weight, and speed of the current. A faster current translates to. a lower body fat percentage because electricity travels faster through muscle (a greater percentage of water is found in muscle) than it does through fat.22 SONOGRAM/ULTRASOUND ULTRASOUND MACHINES SEND out high-frequency sound waves that reflect off body structures of different densities to create a picture called a sonogram. There is no radiation exposure with this test. A clear, water-based conducting, gel is applied to the skin over the area being examined to improve the trans- mission of the sound waves. The ultrasound transducer (a handheld probe) is then moyed over the abdomen to produce an image of what's inside, DEXA DUAL-ENERGY X-RAY ABSORPTIOM less radiation than a CT scan to ceral fat and is less expensive. It’s typically used to a sess bone mineral density but can also be a valuable tool in assessing body composition. MRI MAGNETIC RESONANCE IMAGING (MRI) us s powerful magnets and ra waves to create pictures without the use of radiation. Images generated by MRL are generally superior to—but also generally more expensive than—computed tomagraphy (see next page) because they are more finely detailed. DID YOU KNOW Arecent Mayo Clinic study found that even a modest gain in visceral fat causes dysfunction of blood vessel linings. Even more surprising: The study participants were all lean and healthy. So you don'thave to be “fat” to have an enemy in visceral fat” e BELLY DI