Sadly obesity is becoming the new norm in our societies with three out of five Canadians presently overweight (3). Between 62% and 75% of the world’s population now carry body fat levels that will impair their health and the number of obese people worldwide exceeds those who are underweight for the first time in human history (1). Alarmingly though, there is an even more concerning problem that is less obvious than general obesity – a burgeoning pandemic of people who have an excessive body fat to lean muscle ratio, especially around the belly. This distressing state of affairs has recently been christened with a new name – “overfat”. Researchers from New Zealand and the United States determined that up to 90% of men, 80% of women and 50% of children in thirty developed countries are now overfat and their number is steadily increasing (4). In Canada, an estimated 84.5% of men, 68.5% of women, 48.1% of boys and 44.2% of girls are overfat (3).
This situation is starting to get confusing. We already have the terms overweight and obese. Where does overfat fit in? The terms overweight and obese refer to body weight in general. They describe someone who is over the average weight for their sex, age and height. The measure includes the weight of lean tissues such as muscles, internal organs, bones and water as well as body fat. Because muscle is heavy it is very possible that a muscular person might be overweight. However they are not necessarily overfat. Overfat focuses on the amount of actual fat in the body compared to lean body tissue, especially fat in the abdominal area. The overfat category usually encompasses those who are overweight and obese; it can also include people of normal weight including physically active people. Being overfat means having sufficient excess body fat to impair health.
The increased incidence of abdominal obesity is the main reason for increasing rates of overfat. Abdominal or visceral fat is the unhealthiest form of excess body fat, the type of fat most linked to serious disease. The fat is packed closely around the internal organs within the abdomen of the body and carries with it distinct and more severe negative health effects than do other types of body fat such as the subcutaneous fat that builds up just under the skin (4). Because the large portal vein that leads directly to the liver is also imbedded in the abdomen, the metabolic products of visceral fat easily reach the liver. Enlarged visceral fat cells are stuffed with excess triglycerides and they release free fatty acids which almost immediately make their way into the liver and then on into the pancreas, heart and other organs. Copious amounts of free fatty acids in the liver influence the production of blood lipids and create high levels of total cholesterol and LDL cholesterol with all their destructive consequences. More importantly though, because the organs receiving the excess fatty acids are not designed to store fat their function is compromised. So begins the insidious development of metabolic syndrome. This whole process is called lipotoxicity (11,12,13).
Metabolic syndrome starts with insulin resistance (body cells no longer responding to insulin which gives rise to high blood sugar) and chronic, low-grade systemic inflammation and then spirals into a vicious cycle where fat storage accelerates the rate of further fat storage, escalating organ dysfunction and dysregulation. These circumstances are directly linked to many chronic diseases such as Type-2 diabetes, hypertension, coronary heart disease, dyslipidemia, stroke, cancer, gallbladder disease, non-alcoholic fatty liver, osteoarthritis, gout, polycystic ovaries, pulmonary diseases, sleep apnea and increased risk of early death (2,4,5). Being overfat will impair health even in people of normal weight.
Metabolic syndrome is characterized by five conditions. If you have at least three of them you will be diagnosed with metabolic syndrome (17). The conditions are;
1 A large waist circumference (overfat, having an “apple shape”)
2 A high triglyceride level (triglycerides are a type of fat found in the blood)
3 A low HDL cholesterol level. HDL is sometimes called “good cholesterol” because it helps in the removal of cholesterol from your arteries.
4 High blood pressure that can damage the heart and lead to atherosclerosis (plaque build-up in arteries).
5 High fasting blood sugar
Ways to measure for overfat
Traditional means of assessing body fat such as stepping on a scale or calculating Body Mass Index (BMI) are ineffective at measuring for the state of being overfat. More enlightening is a measurement of the waistline at belly button level compared to height. The waist measurement should be less than half of the height to rule out overfat.
A more technological method to measure body fat percentage is through assessment by a DEXA Body Composition Scan. DEXA stands for dual-energy X-ray absorptiometry and it does come with low doses of radiation. However, the radiation emitted during a DEXA scan is among the lowest from the commonly used medical X-ray machines, lower even than a standard chest X-ray (14). If you are interested in this, keep your eyes and ears open for a chance to be assessed by a DEXA Body Composition Scanner. Oftentimes hospitals or community groups will run a body fat clinic, offering this service free of charge.
In this day and age of technology and gadgets, many of us have access to weigh scales that claim to measure percent body fat. These are called bioelectric-impedance scales and they work on the principle that electricity flows differently through fat and muscle. Muscle contains more water than fat and so it conducts electricity more efficiently. Bioelectric-impedance scales use no radiation. An imperceptible current of electricity is sent through the body by the scale, mainly to the arms, legs or both, and the resistance to this flow is measured. The greater the resistance, the higher the body fat. From this measurement of resistance plus other data entered into the machine (height, weight, age, gender) and the use of a formula, the scale estimates a body fat percentage.
There are a few problems with these fancy bioelectric-impedance scales (16).
1 Many of these devices do not measure belly fat, the very type of fat that we are trying to assess.
2 Bioelectric-impedance scales are not very accurate. The different models produce widely varying readings. Results can be affected by many variables such as the environment surrounding the scale, the ethnicity of the person using the scale and even the menstrual cycle phase. Dirty or heavily calloused feet can skew the reading. Scales that use only foot electrodes underestimate body fat in people with high levels of body fat and overestimate it in leaner people. The devices are less accurate for the elderly, highly trained athletes, children and people with osteoporosis.
3 These scales are sensitive to level of hydration. If you step on them after a workout when you are most likely dehydrated they will overestimate your body fat.
Setting these drawbacks aside, a bioelectric-impedance scale can provide a good week-to-week comparison of body fat percentage as long as the measurements are taken at about the same time of day and not after exercising. If you are really serious about following your percent body fat in detail, look for newer models that use four to eight electrodes with multi-frequency electrical levels to get more accurate results. Devices with hand held electrodes also tend to be more precise. Two recent models that incorporate eight electrodes and have proven their worth in several studies and also in federal government agencies such as the armed forces in the USA are the GE Healthcare InBody 720 (multi-frequency) and the Tanika BC 418 MA (single frequency) bio-impedance scales. The InBody 720 is one of the only models available that measures leg, arm and belly fat (15).
In reality however all this discussion about high-end scales and DEXA scans is irrelevant. Electronic devices are not necessary. More important than total body fat is the distribution of the fat. The excess fat in abdominal areas (an “apple-shaped” body) is much more ominous than fat located in the thighs and hips (a “pear-shaped” body). The simple, quick and inexpensive waist to height measurement will provide more than enough information to let you know where you stand.
For what it’s worth, here are some guidelines of ideal percentages of body fat to which to aspire. Aim for at least a level on the low “Average” side. “Fit” and “Athlete” levels are even better.
Athlete 14 – 20% 6 – 13%
Fit 21 – 24% 14 – 17%
Average 25 – 32% 18 – 24%
Obese 33% or higher 25% or higher
How can we improve body fat percentage?
Where does the extra fat come from? Quite simply it is the result of our sedentary lifestyle and our love, or as some declare, our addiction to fatty, sugary, highly processed, calorie-dense foods. Losing weight is the only answer and the loss of any weight will inevitably include some visceral fat.
Though losing weigh may seem practically impossible to people who have tried popular weight loss diets and found themselves fighting hunger and suffering yoyo ups and down in their body weight, this scenario does not have to be. As it happens, a plant-based diet is particularly efficient at decreasing body fat. Studies show that the type of diet you eat makes a big difference to your risk for metabolic syndrome. Research shows that highest risk comes with eating non-vegetarian while semi-vegetarians have intermediate risk. Vegetarians have the lowest risk of metabolic syndrome, a risk that is less than half that of non-vegetarians. These results persist even after adjustment for other lifestyle factors such as smoking and exercise (10).
Other investigations tell similar stories. For example, the following study enrolled 31 overweight men. During the 21-day study subjects ate completely plant-based and enjoyed daily mild to moderate exercise. The number of subjects testing positive for metabolic syndrome (by World Health Organization criteria) decreased from 48% at the start of the study down to 19% by the end of three weeks. There were also significant reductions in cholesterol, serum fasting glucose, fasting insulin and insulin resistance (6).
Diets that include whole-grains have been shown to aid in decreasing both body fat percentage and cardiovascular risk factors in men and women who are overfat. Study participants were instructed to decrease their calorie intake by 500 kcal per day. They were randomized into two groups, one which avoided whole-grain foods altogether and the other which obtained all their grain servings from whole grains. At the end of the 12-week study, body weight, waist circumference and percentage of body fat were considerably reduced in both groups. However there was a significantly greater decrease in the group eating whole-grains. Additionally C-reactive protein, a marker of inflammation in the body, was reduced by 38% in the whole-grain group and unchanged in the group eating only refined grains (7).
Another set of studies demonstrated that eating a plant-based high-fiber low-fat diet rich in whole grains along with moderate exercise significantly reduces inflammation. Within two or three weeks of eating in this healthy way the level of C-reactive protein decreased by 45% among women (8), 39% among men (6) and 41% among children (9).
If your waist to height measurement does not come out well for you do not be alarmed or discouraged. You CAN get rid of the excess fat in your abdomen and at the same time decrease your risk for many of the chronic diseases that are now plaguing our society. Eat plants (vegetables, fruits, legumes, whole grains, nuts, seeds), do not eat animal-sourced foods (meat, poultry, seafood, dairy) and watch that overflowing belly diminish while you gain a whole new lease on life.
1 Maffetone, P.B., Rivera-Dominguez, I., Laursen, P.B. Overfat and underfat: new terms and definitions long overdue. Front Public Health (2016) 4:279
2 WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser (2000) 894:i–xii, 1–253.
3 Vogel, L. Overweight or overfat? Many Canadians are both. CMAJ September 18, 2017; 189 (37): E1202-1203
4 Maffetone, P.B., Rivera-Dominguez, I., Laursen, P.B. Overfat Adults and Children in Developed Countries: The Public Health Importance of Identifying Excess Body Fat. Frontiers in Public Health, July 2017; 5
5 Romero-Corral, A., Somers, V.K., Sierra-Johnson, J., Korenfeld, Y., Boarin, S., Korinek, J., et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J (2010) 31:737–746.
6 Roberts, C.K., Won, D., Pruthi,S., Kurtovic, S., Sindhu, R.K.,Vaziri, N.D., Barnard, R.J. Effect of a short-term diet and exercise intervention on oxidative stress, inflammation, MMP-9, and monocyte chemotactic activity in men with metabolic syndrome factors. Journal of Applied Physiology May 2006; . 100(5): 1657-1665.
7 Katcher, H., Legro, R.S., Kunselman, A.R., Gillies, P.J., Demers, L.M., Bagshaw, D.M., Kirs-Etherton, P.M. The effects of a whole grain–enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr January 2008 ; 87(1): 79-90
8 Wegge, J.K., Roberts, C.K., Ngo, T.H., Barnard, R.J. Effect of diet and exercise intervention on inflammatory and adhesion molecules in postmenopausal women on hormone replacement therapy and at risk for coronary artery disease. Metabolism. 2004 Mar;53(3): 377-381.
9 Chen, A.K., Roberts, C.K., Barnard, R.J. Effect of a short-term diet and exercise intervention on metabolic syndrome in overweight children. Metabolism. 2006 Jul; 55(7):871-878.
10 Rizzo, N.S., Sabaté, J, Jaceldo-Siegl, K., Fraser, G.E. Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the adventist health study 2. Diabetes Care. 2011 May; 34(5):1225-1227.
11 Estadella, D., da Penha Oller do Nascimento, C.M., Oyama, L.M., Ribeiro, E.B., Dâmaso, A.R., de Piano, A. Lipotoxicity: Effects of Dietary Saturated and Transfatty Acids. Mediators of Inflammation 2013; 2013 Article ID 137579, 13 pages.
12 Hamdy, O., Porramatikul, S., Al-Ozairi, E. Metabolic obesity: the paradox between visceral and subcutaneous fat. Curr Diabetes Rev. 2006 Nov; 2(4):367-373.
13 Bosma, M., Kersten, S., Hesselink, M.K.C., Schrauwen, P. Re-evaluating lipotoxic triggers in skeletal muscle: Relating intramyocellular lipid metabolism to insulin sensitivity. Progress in Lipid Research 2012; 51:36–49.
14 Li, Y.-C., Li, C.-I., Lin, W. -Y., Liu, C.-S., Hsu, H.-S., et al. Percentage of Body Fat Assessment Using Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry in a Weight Loss Program for Obese or Overweight Chinese Adults. PLoS One. 2013; 8(4): e58272.
15 Wang, L., Sai-chuen, S. Validity of Four Commercial Bioelectrical Impedance Scales in Measuring Body Fat among Chinese Children and Adolescents. BioMed Research International 2015; Article ID 614858, 8 pages.
16 Dehghan, M., Merchant, A.T. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J. Sept 2008; 7: 26.
17 https://www.nhlbi.nih.gov/health/health-topics/topics/ms; What is Metabolic Syndrome?
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