World Obesity Day: Belly fat may predict heart attack risk better than weight, here’s how to reduce it

Every year, World Obesity Day brings back the same question: Is weight the real enemy? For years, body weight and BMI have dominated health charts. But growing evidence shows that where fat sits in the body may matter more than how much it weighs.

A flat weighing scale cannot tell the difference between muscle and fat. It also cannot show whether fat is wrapped around vital organs.That hidden fat around the abdomen, often called belly fat, may quietly raise the risk of heart attack, even in people who look “normal” by BMI standards.

Why belly fat behaves differently from other fat

Not all fat tissues act the same way. Fat stored around the hips and thighs is less harmful. But fat stored deep inside the abdomen, around the liver, pancreas, and intestines, behaves like an active organ.

It releases inflammatory chemicals. It disturbs insulin action. It raises blood pressure and worsens cholesterol balance.Dr Varun Bansal, senior consultant, cardiothoracic and vascular surgery, robotic surgery, Indraprastha Apollo Hospitals, explains, “While many people are focused on the figure displayed on the scale. However, when we talk about heart health and the distribution of fat in the body, the distribution of weight is much more critical than the weight.

The distribution of abdominal fat, which is reflected in an increased waist circumference, has been particularly critical in the assessment of heart health. Abdominal fats play a critical role in the development of chronic inflammation, insulin resistance, hypertension, and abnormal lipid levels.

These are critical risk factors for heart attacks and coronary artery disease.”In simple terms, belly fat creates the exact internal environment in which heart disease grows.

India’s silent risk: Normal weight, high danger

The concern is sharper in India.The ICMR-INDIAB study, conducted by the Indian Council of Medical Research, found that a large number of Indians had increased waist circumference along with high blood sugar, abnormal cholesterol, and high blood pressure, even when their body weight appeared normal.This condition is called “normal weight obesity” or “metabolic obesity.”Dr Bansal highlights this clearly, “In other words, a person can be of normal weight and yet can have excess abdominal fats that can have a direct effect on heart health.

This is why waist size is considered a better measure of heart health than weight and BMI. Central obesity has been consistently related to heart disease risk, including in people who are not considered obese.”The message is uncomfortable but important. A slim face and average weight do not always mean a healthy heart.

The waist measurement that matters

For Indians, heart risk begins at lower waist sizes compared to Western populations.According to Indian guidelines and research:Men: Waist should be below 90 cmWomen: Waist should be below 80 cmMeasuring it is simple. Place a tape measure around the abdomen at the level of the navel.

Stand straight. Breathe out gently. Do not pull the tape too tight.It takes less than a minute. Yet it may reveal more than a weighing scale ever could.

What global health bodies say about abdominal obesity

The World Health Organization has repeatedly warned that abdominal obesity increases the risk of cardiovascular disease, type 2 diabetes, and stroke.Similarly, the National Institutes of Health notes that waist circumference is an independent predictor of cardiovascular risk, even after adjusting for BMI.The pattern is consistent across countries. Central fat predicts trouble.

How to actually reduce belly fat, not just weight

Crash diets shrink weight quickly. But they reduce muscle along with fat. That slows metabolism and makes regain easier.Reducing abdominal fat needs a more focused approach.Strength training at least three times a weekMuscle improves insulin sensitivity. It reduces visceral fat over time. Compound exercises such as squats, push-ups, and rowing movements are effective.Prioritise proteinAdequate protein helps preserve muscle and control hunger. Include lentils, eggs, paneer, tofu, fish, or lean meats in daily meals.Cut ultra-processed carbohydratesRefined flour snacks, sugary drinks, and packaged sweets spike insulin. High insulin promotes fat storage around the abdomen.Sleep at least 7 hoursPoor sleep raises cortisol. High cortisol drives belly fat accumulation.Manage stress consciouslyChronic stress pushes fat storage toward the abdomen. Deep breathing, walking, prayer, journaling, or mindful breaks help.The conversation must shift from “How much do you weigh?” to “Where is the fat stored?”A tape measure may reveal risk earlier than a weighing machine.Dr Bansal stresses that prevention should focus on abdominal fat reduction, not just weight loss. That change in thinking can help prevent heart attacks before they occur.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr Varun Bansal, senior consultant, cardiothoracic and vascular surgery, robotic surgery, Indraprastha Apollo HospitalsInputs were used to explain that managing belly fat is not about crash diets or unverified “fat-burning” supplements, but about medically guided lifestyle changes and metabolic risk assessment.