Belly Up to the Truth

The link between stroke risk and your expanding waistline.

Illustration by Dáv BordeleauWant to gauge your chances of having a stroke? Don’t hop on the scale or check your cholesterol—get out the tape measure. Researchers at the National Institute of Health (NIH) found that women with a waist larger than 34.6 inches were three times as likely to die of vascular disease. (NIH sets the healthy waist size for men at 40 inches.)

No other risk factors—smoking, high blood sugar, high cholesterol or obesity—are as potentially deadly as belly fat. It isn’t how much you weigh that counts; it’s where you carry the excess fat on your body.

“The most dangerous weight gain is around the middle—looking more like an apple than a pear,” says cardiologist Dr. Kelly Spratt of Penn Health for Women in Radnor and Philadelphia. “Belly fat secretes protein and hormones, which cause a build up of plaque in the arteries. Plaque may eventually result in the blockage of blood flow. A stroke occurs when the blockage is in the brain. However, belly fat increases the risk for all vascular disease—including heart attacks—and it’s also a precursor of diabetes.”

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More than 70,000 Americans will have a stroke this year. Most will survive, but the majority will require extensive rehabilitation. They’ll suffer paralysis, lose the ability to speak, or experience numbness in parts of their bodies. Many people, however, won’t even know they’ve had a stroke if their blood flow returns to normal within 24 hours. It’s called a TIA, or mini-stroke, and people who’ve had one are at a much greater risk of having a full-blown stroke.

If you’re loath to take the tape-measure test, you’re not alone. Women’s waistlines have increased 2 inches in the last decade. The NIH study looked at 44,600 females aged 40-65 for 16 years. It concluded that, when it comes to stroke, the canary in the mine shaft is the waist-hip circumference ratio. To calculate your ratio, divide your waist measurement by your hip measurement. The ideal waist-hip ratio is less than .88.

“Even a small amount of excess belly fat is a concern,” says Spratt, adding, “Liposuction won’t help. It removes superficial fat but not the fat in your organs.”

Spratt sees the problem every day in her practice. “Thirty to 50 percent of my patients have excess belly fat.”

The problem is age-related. “As you get older, you get heavier,” she says. “Your metabolism slows down, and you eat the same calories, but are less active, perhaps due to arthritis pain.”

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With national obesity climbing to 30 percent, it’s no coincidence that one of the leading fashion trends mimics maternity wear. Loose-fitting tops that go almost to the knees, and balloon-shaped dresses, are all the rage. You diet. You exercise. But you haven’t tucked your shirt inside your jeans for five years. What’s a gal to do? Consider a hospital-based weight management program.

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“Women come to us because they don’t have the skills to create the environment for a more active life and healthier food habits,” says nutritionist Andrea Diamond, program director of the Albert J. Stunkard Weight Management Program at Penn Medicine at Radnor and the Hospital of the University of Pennsylvania. “We focus on abundance, rather than restriction, to lay a new foundation. The emphasis is on more fruits and veggies, moderate amounts of lean protein, and a very small intake of fats.”

Many weight-loss programs get people thinking that if they just get down to a certain weight, they’ll reach their goal. The real challenge is not getting to a particular weight, but maintaining a healthy calorie level for life. Diamond encourages participants to integrate new healthy habits one at a time, rather than implementing a major change in lifestyle all at once. Losing 10 percent of one’s body weight is usually a turning point in reducing risk factors for stroke, heart disease and diabetes. It might take a woman who weighs 160 pounds nine months to one year to lower her weight to 130.

“One of the biggest challenges to maintaining a healthy weight is dining out, especially on the Main Line,” says Diamond. “The more often you dine out, the more calories you consume. In restaurants, we lose sight of portion control. Someone might watch their calories during the week, and if they attend just one weekend event, they have sabotaged their calorie intake.”

And there’s been a dramatic increase in the size of the foods we buy off the shelves. Twenty years ago, bagels were 3 inches in diameter; today, they measure 6 inches. That’s an increase of 310 calories. Coffee that used to be served in 8-ounce cups now comes in 16-ounce containers with 305 more calories. Muffins are as big as baseballs and contain 500 calories or more.

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As for artificial sweeteners, “the data suggests that even sugar-free beverages and foods can change your insulin levels,” says Spratt, who doesn’t drink diet sodas and suggests that her patients do the same. “Their use can lead to a pre-diabetes metabolic syndrome that causes elevated blood pressure, an increase in bad cholesterol and a decrease in [good cholesterol].”

For women on the run 24/7, burning off belly fat can be done incrementally. Take the stairs at work. Ride bikes with your kids. Make Rover happy and take him for a 30-minute walk. Don’t spend lunch hour at your desk—get up and move.

Slow and steady is best. Aim for losing 1-2 pounds a week for several months, and maintaining the loss throughout life.

Age is also a factor. “As we age, we experience hormonal changes, and fat settles around the gut,” says Diamond. “So the goal is to come closest to an ideal weight for your age. If you were 120 in college, your ideal at 50 might be 135.”

In addition to changes in diet and increased exercise, participants in Penn’s program are encouraged to seek out the involvement of co-workers and family. “They won’t change unless they have a supportive food environment at home and work,” says Diamond.

When it comes to weight, every loss brings a gain. People find their energy level increases, along with their self-confidence and sex drive. They also develop a greater awareness of what it means to have a healthy lifestyle, not just for themselves but
also for their children and grandchildren.

Continued on page 3 …, a website from the U.S. Department of Agriculture, offers an online guide to healthy eating and a menu planner that can be personalized to meet specific goals. Penn at Radnor’s weight management program offers group sessions that meet once a week for seven to 10 weeks, as well as private counseling. “We encourage the use of food diaries and, starting in January 2009, we will offer calorie-controlled meals, shakes and cereals,” says Diamond.

To learn more about Penn at Radnor’s Albert J. Stunkard Weight Management Program, visit

Stroke Glossary

Embolic Stroke: Occurs when a piece of clot or plaque breaks off and gets stuck in a smaller part of an artery, cutting off blood flow.
Hemorrhagic Stroke: A rupture of a diseased artery caused by high blood pressure or by a ballooning or weakening of the artery wall. Also known as an aneurysm.
Stroke: An interruption of blood, oxygen or sugar supply to the brain. The loss of bodily functions—speaking, coordination, vision, feeling—depends on what part of the brain is damaged.
Thrombotic Stroke: Prompted by a clot on the wall of an artery; may be caused by hardening of the arteries.
Thrombolytics: Clot-busting drugs.
TIA (Transient Ischemic Attack): Or “mini-stroke.” Diagnosed when the blockage from an embolic stroke is relieved on its own within 24 hours.

Stroke Symptoms

Trouble walking: Stumbling, sudden dizziness or loss of balance. Often when elderly people fall, it was precipitated by a stroke.
Trouble speaking: Slurred words or trouble coming up with the right word.
Numbness: Loss of feeling, weakness or paralysis on one side of the body.
Vision problems: Blurred vision or seeing double.
Headache: A sudden, severe headache that may be accompanied by a stiff neck, facial pain, pain between the eyes or vomiting.

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