The Belly Fat Burden: Reducing Your Waist Circumference

When diet and exercise aren't helping you lose belly fat, medications and surgery may do the job.

From the WebMD Archives

You've probably read the health news: Belly fat -- a big waistline -- can raise your risks for heart disease, diabetes, and stroke.

And belly fat can be a sign of something more: Metabolic syndrome, a group of health problems that include too much fat around the waist, elevated blood pressure, blood sugar, triglycerides, and low "good" HDL cholesterol -- all boosting your risks of disease.

Making matters worse, losing belly fat can sometimes seem daunting. For many people, diet and exercise don't always work. Luckily, we've got options like FDA-approved weight loss medications and even surgery.

"All fat is challenging to get off, period," says Howard J. Eisenson, MD, medical director of Duke Diet & Fitness Center at Duke University Medical Center. But "belly fat is not particularly tenacious fat to get rid of... it actually comes off fairly easily. Frankly, if you reduce calories and exercise more, you will lose weight everywhere -- including your abdomen."

While Eisenson considers diet and exercise the most effective weight loss strategies, he acknowledges that there's a role for medical treatments.

Keeping the weight off is what's most difficult, he says. "Very commonly, people start to gain the weight back. A year out, and they have regained 30% to 50% of the weight they lost. If a drug can help people keep off what they've lost, that's meaningful."

Fortunately there are a few weight loss drugs that help in that regard.

Losing Belly Fat With Weight Loss Drugs

Meridia, Phentermine, and Xenical are the most commonly used FDA-approved drugs for treating obesity. They are used for people with a BMI of 30 and above, or those who have a BMI of 27 and other obesity-related medical conditions. Both drugs are considered "moderately effective" in weight loss, with an average of 5 to 22 pounds over a one-year period.

Meridia works by increasing brain chemicals like serotonin, norepinephrine and dopamine so people feel full sooner after they eat. Xenical binds to fat cells in the gastrointestinal tract to prevent them from being absorbed, so the body eliminates about 30% of fat that is consumed.

"Xenical and Meridia tend to help for about [the] first six months on average," says Eisenson. "Then their main benefit is as a weight loss maintenance aide, which is not a trivial thing. That's how Xenical and Meridia work best... helping people keep the weight off."

The drugs work best when combined with lifestyle changes, research suggests. In one study, obese men and women lost far more weight by changing eating and exercise habits -- and taking Meridia -- compared to those who relied on either lifestyle modification or medication alone.

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To Lose Belly Fat -- What Else Works?

The diabetes drug Byetta is also showing great promise in weight loss, says Eisenson. "I know that diabetologists are very excited about this drug for the overweight diabetic."

Byetta delays "gastric emptying" -- essentially keeping food in the intestine a bit longer, so you feel full longer, he explains. Patients taking Byetta don't need as much insulin, a good thing, since insulin can increase appetite, Eisenson explains. Low-grade nausea is a side effect, which may help curb appetite, too.

Other types of medications have been investigated for weight loss, but have not shown much promise: the antidepressant Wellbutrin, the antiseizure drug Topamax, and the diabetes medication Glucophage. "The weight loss effect with all those is pretty modest," says Eisenson.

Over-the-Counter Products for Belly Fat

As for "Ultimate Fat Burner" and similar over-the-counter products, "I pretty much dismiss all of them with a broad stroke," Eisenson says. "Their great catchy names don't correspond with the reality. When there is effectiveness, it's very modest indeed -- and not enough to justify the cost."

There are safety concerns with these products, he adds. "Because they're not FDA regulated, you don't know about their strength and purity. A lot of these products are jam-packed with plant and herbal ingredients. You don't know really what you're getting -- how much is in there. There's the potential for interaction with prescriptions people are taking."

Also, there are concerns about stroke and heart attack risk, Eisenson tells WebMD. "Some of these products have a stimulant effect that may cause appetite suppression but also stimulates the cardiovascular system. The bottom line I tell my patients: I don't think any of these products can be recommended."

Bariatric Surgery: Belly Fat's Last Resort

For many people, bariatric weight loss surgery is a good option as a last resort, says Eisenson. These procedures can shrink the stomach's volume so people feel full sooner and lose weight. Bariatric surgeries (also called gastric bypass) can also reduce the absorption of nutrients, causing weight loss.

"If your back is against the wall, you're suffering from health problems, and your quality of life is significantly compromised, it's an appropriate option," he tells WebMD. "If you're unable to achieve meaningful and lasting weight loss through nonsurgical measures, you owe it to yourself to consider bariatric surgery."

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One study looked at 197 obese people who underwent gastric bypass surgery. It compared their weight loss and risk factors to a similar group of obese patients who did not have the procedure. Everyone was on a strict diet and exercise program to help them lose weight.

At the end of three years, there were striking differences. The surgery group lost an average of 77 pounds, while the others barely lost any weight. Also, LDL cholesterol levels dropped 40 points, body mass index dropped 15 points, and 19% fewer people had diabetes. Their need for cholesterol-lowering medication dropped by 61%, too.

Another study investigated gastric surgery for mild-to-moderately obese people. In this surgery, patients had an adjustable band placed around the opening of the stomach, creating a small pouch. After two years, patients who had the gastric banding lost an average of 21% (45 pounds) of their body weight. The other group lost 5.5% (12 pounds) via strict calorie restriction, weight loss drugs, and other lifestyle interventions.

New research is showing that gastric bypass surgery also has a dramatic impact on the hormones that drive hunger. A study of nine morbidly obese patients found that, just six weeks after surgery, secretions of the hunger-reducing hormones peptide YY(PYY) and glucagon-like peptide 1 (GLP-1) were significantly altered. These hormones have been shown to play a role in appetite control by signaling the body that it is no longer hungry after meals.

Bariatric surgery has indeed shown impressive results, Eisenson says, adding that the procedure is safer and more effective than most of us realize. "I'm pretty envious of the results that can be achieved pretty quickly. It can profoundly reduce health risks related to obesity.

WebMD Feature Reviewed by Brunilda Nazario, MD on June 30, 2007

Sources

SOURCES:

Howard J. Eisenson, MD, medical director, Duke Diet & Fitness Center, Duke University Medical Center.

WebMD Medical Reference provided in collaboration with Cleveland Clinic: "Weight Loss: Prescription Weight Loss Medicine."

WebMD Medical News: "Drugs+Diet Best for Weight Loss," "Study: New Weight Loss Drug May Help Dieters," "Acomplia Shows 'Modest' Weight Loss," "Can New Diet Pill Keep the Weight Off?" "Obesity Surgery May Cut Heart Risk," "Is Surgery an Option for Mildly Obese?" "Obesity Surgery: Hunger Hormone Impact."

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