A woman stretches her jeans away from her body to show how big they are.
Don’t assume that people with a normal BMI are not at risk of heart problems. (For Spectrum Health Beat)

Even if you’re not obese, too much belly fat could harm your ticker, researchers report.

“People with a normal weight but a fat belly have more chance of heart problems than people without a fat belly, even if they are obese according to BMI (body mass index),” said study author Dr. Jose Medina-Inojosa. He’s with the Mayo Clinic’s division of preventive cardiology, in Rochester, Minn.

The study included 1,700 people who were aged 45 and older at the time of enrollment and were followed from 2000 to 2016.

Those with a normal BMI (an estimate of overall body fat based on height and weight) but high levels of belly fat were about twice as likely to have a heart attack, procedures to open blocked arteries, or to die from heart problems during the follow-up than people without belly fat.

The findings were to be presented Friday at a European Society of Cardiology meeting, in Ljubljana, Slovenia. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.


Our Take

Even if you have always had a flat stomach, or mostly gained weight below your waist, you may have noticed that has changed as you’ve reached middle age (and beyond). A common complaint Diana Bitner, MD, hears from women who visit her practice is that they gain belly fat easily and have a difficult time losing it.

Why is belly fat so bad? There are several reasons, including both medical and personal issues, with belly fat:

  • Belly fat makes you feel unhealthy.
  • Belly fat can change your mood from cheerful to irritable.
  • Belly fat greatly increases your risk for heart disease, diabetes and overall weight gain.
  • Belly fat adds more insulation, which can cause or worsen hot flashes and night sweats.

In addition, belly fat is extremely powerful because it is inside your abdominal cavity, not just under the skin like fat elsewhere on your body.

Learn more.

“The belly is usually the first place we deposit fat, so people classified as overweight BMI but without a fat belly probably have more muscle, which is good for health,” Medina-Inojosa explained in a meeting news release. “Muscle is like a metabolic storehouse and helps decrease lipid (fat) and sugar levels in the blood.

“If you have fat around your belly and it’s greater than the size of your hips, visit your doctor to assess your cardiovascular health and fat distribution,” he said. “If you have central obesity (belly fat), the target will be waist loss rather than weight loss.”

Medina-Inojosa offered some belly-busting suggestions.

“Exercise more, decrease sedentary time by taking the stairs or getting off the train one stop early and walking, increase your muscle mass with strength and resistance training, and cut out refined carbohydrates,” he advised.

He added that doctors shouldn’t assume that people with a normal BMI are not at risk of heart problems.

“Our study provides evidence that doctors should also measure central obesity [belly fat] to get a better picture of whether a patient is at risk,” Medina-Inojosa said.