Big bellies can lead to big problems

Measuring a patient’s abdominal height zeroes in on visceral fat.

mcclatchy newspapers

ST. LOUIS — The scene plays out repeatedly in Dr. George Griffing’s Brentwood, Mo., office: Big round bellies come through his exam-room door well before the rest of his patients’ bodies.

That’s when Griffing, professor of internal medicine at St. Louis University Medical School, pulls out a ruler — or a yardstick as the case may be.

He has those patients lie flat on their backs on an exam table. Then he measures their Sagittal Abdominal Diameter, which is the vertical height of their bulging midsection from table top to tummy top.

“I’d like to use a ruler, but with a lot of patients I have to use a yardstick,” he says. “What we’re really looking for is how much fat is in the abdomen and the liver. It’s simple and accurate and reveals a lot of information.”

Medical experts have long suspected that people with excess deep-belly fat are at an increased risk for cardiovascular disease and type 2 diabetes, and ongoing research bolsters that belief.

In 2007, the National Institutes of Health reported that studies at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston show that deep belly fat — also known as visceral adipose tissue — produces higher levels of a protein that appear to reduce insulin sensitivity regardless of age, gender or body mass index.

Levels of the protein, called RBP4, were three times higher in people who were obese than those who were lean.

Griffing believes that measuring abdominal height is more efficient and accurate at predicting the risks of diabetes and cardiovascular disease than more commonly used methods such as calculating body mass indexes, waist-to-hip ratios or measuring the circumference of patients’ waists.

Those all factor in subcutaneous fat on arms, legs and hips, which is not as bad for you as fat in the gut, Griffing says. And that includes love handles on the side of the waist. Measuring a patient’s abdominal height, he notes, zeroes in on visceral fat, which oozes between organs, bathing the liver in fatty acids.

Though not yet standardized, Griffing says, most studies have found that abdominal heights that measure more than 10 inches in women and more than 12 inches in men triples the chance of cardiovascular disease.

He measured patient Dale Bremer’s midsection recently. Bremer, 50, of Cape Girardeau, Mo., found it odd, yet logical.

“You’re used to doctors using scientific methods like blood tests, not a simple ruler,” he says. “But it kind of makes sense. The bigger a person’s stomach is when they are lying down, well, maybe their eating styles aren’t the best.”

Bremer also reckons that some people — men especially — aren’t considered overweight by numbers on a scale, but they still carry too much weight in their abdomen. For the record, his midsection measurement was 12 inches, and he feels OK about that.

“I do a lot of walking on a treadmill and riding a stationary bike, so I feel confident in that,” he said.

Another patient, Tom Groll, 59, recently dropped about five pounds, most of it from his abdomen.

His abdominal height has decreased from 14 inches to 12 inches, and his blood-sugar levels have dropped from about 180 to 160, which means he’s getting his diabetes under control.

Both the American Diabetes Association and the American Heart Association endorse using the midsection-measuring technique. On its Web site, the American Diabetes Association calls it a simple, cheap and noninvasive tool, but added that more research is needed.