If you are a man with a beer belly (of any size) and you look at the bathroom scales each morning then please stop. Throw them out. Bathroom scales miss the point. They give you no insight into your health. When I say health I mean important health matters such as avoiding heart disease. Heart disease is the leading cause of death among men and it’s progression is largely silent… until it is not silent (see my earlier blog on this).
Why should you throw out your bathroom scales?
Your body is essentially made up of muscles, fat and bones. Bathroom scales will not tell you what mix of these bits you are made of (i.e., your ‘body composition’). They don’t tell you if you have adequate muscle for aging, they don’t identify where you are storing fat, and they tell don’t tell you about the health of your bones. These are incredibly important factors when determining if your weight is ‘healthy’ or not.
Example of the 150kg man
This is best illustrated with an extreme example of different 150kg men. All three men weigh exactly the same but their body composition profiles would likely reflect very different levels of health.
The men include:
a huge tall football player with muscles bulging from his arms;
a couch-potato with jelly like fat spread all over his body; or
a pub-going man with slim legs, size 36 inch waisted trousers, and a big hard beer belly poking out over the top of his trousers.
This example may seem obvious. But what about you? What about your partner? What is their body composition? The distribution of muscle, fat and bones in ‘normal’ people is less clear.
Focus on muscle mass first, NOT FAT!
Muscle mass is hugely important to health and it becomes something you must focus on after the age of 40. From age 40, your overall muscle mass declines at 3-8% per decade (roughly 1% per year). This is called sarcopenia. To make matters worse, gaining muscle mass as you age, becomes increasingly difficult.
Unless action is taken, most men will experience a slow and progressive loss of muscle mass. This has health implications. Most obviously, it increases frailty and the risk of falls. Less obviously, it negatively impacts the bodies’ ability to ‘deal with’ glucose (think sugar) from foods and drinks. Over time this can lead to insulin resistance and eventually conditions such as type 2 diabetes.
The bathroom scales tell you nothing about your muscle mass.
PS – If you are over the age of 40 and your weight is not changing then you are probably losing muscle and gaining fat. Unless you proactively do something about muscle mass after age 40 (i.e. doing weights or resistance exercises such a squats), then no change in weight can only mean your muscles are turning into something else (i.e. fat!).
Why fat mass (and location) matter
A secondary consideration is fat mass, which should be around 10-17% in men. The bathroom scales will not tell you anything about fat mass.
That’s okay because fat location is WAY more important than this number.
Human fat can be stored in underneath the skin (subcutaneous fat). This is the fat you can squish with your hands and is a useful storage site for excess energy. This is good healthy fat. Our modern society may not think it is ‘beautiful’ to look at, but it is healthy, provided it isn’t excessive. Fat can also be stored as visceral fat or liver fat or ‘fat around the middle’ deep inside the stomach wall. This fat is physically hard to touch. This is unhealthy fat. It surrounds internal organs and compromises their ability to do their job and becomes an organ in its own right. This ‘organ’ then secretes stuff (hormones) which send bad-health-messages around your body causing inflammation.
Most of us can store lots and lots of subcutaneous fat without too many health problems – up to around 10kg is okay. By contrast, it doesn’t take much of the latter two fats (visceral and liver fat) cause havoc to health. You only need around 2kg or 600g respectively or each of these fats to hit problems. If you have ‘unhealthy fat’ stored around the middle then your risk of cardiovascular disease, which is a significant risk for men, diabetes, high blood pressure, metabolic syndrome, and many other conditions. The worst thing is that fat around the middle has no immediate or obvious negative symptoms.
Men are prone to storing fat around their middle. This is why men get beer bellies. But not all men get beer bellies. Some slim men may successfully hide their fat. These men are known as TOFI. Thin on the inside, fat on the outside.
Better alternatives to measuring ‘health’
There are several better ways of assessing your health than using bathroom scales.
Body mass index (or BMI) is a commonly used metric which uses weight and height. Although easy to calculate – there are lots of online calculators –this is a relatively unhelpful measure of health as it doesn’t differentiate between fat and muscle (e.g. the 150kg football player versus couch-potato could have identical BMIs). The reason BMI is used in most medical settings and research is because of its ease of calculation without human error. It is difficult to get height and weight wrong. A BMI of above 25 is classed as overweight, above 30 as obese and above 40 as morbidly obese. If you measure above in these categories then you may want to try some of the other tests below as BMI is a useful marker of health, but it is far from definitive.
Waist circumference is an excellent and little-talked-about measure of health as it indicates where fat is located. However, doing a proper measurement is prone to human error. Try doing it for yourself and you may get a wide range of different results. The best trick is to put a cloth/plastic tape measure (not a metal one from your toolbox) about 2-4cm above your stomach button and then, keeping it horizonal, measure around the body. Top tips are to measure in the same way every time (e.g. get the same person to do it or do it in front of a mirror) and don’t breathe in! Waist circumference is NOT measured by looking at trouser size which sit below the waist. If you measure above 102cm then a trip to the doctor may be warranted.
Body composition scans offered by gyms, where you stand on scales and hold bars with your hands, also give useful insight into body composition. These rely on electric currents flowing through the body, with the amount of blockage or impedance of the current identifying the amount of liquid (e.g. blood) versus solid mass (i.e. bone) versus fat. This method is called biometric impedance analysis (or BIA). While this is quick, easy and cheap and gives a reasonable estimate of muscle, fat and bone mass, it is only an estimate. The fluid in your body at the time of measurement can have a big impact on your results because the machines count everything that isn’t bone or fat as muscle. This means that if you are full of water at the time of scanning (e.g. you drank a big glass of water and did not urinate before when you had a full bladder) you will appear more muscly (and less fat) than you really are.
Body composition scans using DEXA (Dual-Energy X-ray Absorptiometry) is a relatively inexpensive gold standard method – meaning the most reliable – way to measure body composition in different parts of the body. Using low grade x-ray energy it accurately measures fat, muscle and bones and how it is distributed in different parts of the body (i.e. arms, trunk, waist, hips and legs) with low radiation and costs. Not only is it a more reliable measure of total fat, bones and muscle, but it also helps identify where fat is stored so that we know if it is ‘dangerous’ fat or not.
What are the best diet changes for belly fat and beer bellies?
When it comes to belly fat (visceral and liver fat) sugar and alcohol are the low hanging fruit as they are the direct cause of fat in this area. The fructose component of sugar and alcohol are metabolised by the liver (and the liver alone) which is around the middle of the body. An excess of sugary food and alcohol will put significant pressure on your liver and if it is unable to cope then excess will flow into the surrounding organs causing fat. (This is obviously a very simple explanation… but you get the point).
Cutting out sugar and alcohol completely is the best solution, but if you want to continue to enjoy life then there are a few tools for eating and drinking that can allow you to continue to enjoy them in moderation, while having a much better health impact.
Conclusion: what to do
If you have a husband partner or man in your life with a belly please don’t wait for something to go wrong before doing something. Buy them a 3 month Man Belly Package (which includes gold standard DEXA body composition scans at the start and finish, 3 x nutrition consultations (by phone/online), and plenty of support in the middle). Packages like this can be incredibly motivating for men and often offer the hard evidence they need to make some changes in their life.
The package can easily be given as a gift.
References Juo Y, Livingston EH. Testing for Nonalcoholic Fatty Liver Disease. JAMA. 2019;322(18):1836. doi:10.1001/jama.2019.10696
Lee, J., Chung, D. S., Kang, J. H., & Yu, B. Y. (2012). Comparison of visceral fat and liver fat as risk factors of metabolic syndrome. Journal of Korean medical science, 27(2), 184–189. https://doi.org/10.3346/jkms.2012.27.2.184
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