Abdominal obesity

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Central obesity
)
Abdominal obesity
Other namesCentral obesity, truncal obesity; see also
Prader-Willi syndrome

Abdominal obesity, also known as central obesity and truncal obesity, is the human condition of an excessive concentration of

metabolic and vascular diseases.[2]

waist circumference show a strong association with type 2 diabetes.[3]

Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the

perirenal fat. An excess of adipose visceral fat
is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped" in which fat is deposited on the hips and buttocks.

Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease,

computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-abdominal fat and subcutaneous fat.[4]

Abdominal obesity is linked with higher cardiovascular events among South Asian ethnic population.[5]

Health risks

Heart disease

Abdominal obesity is typically associated with a statistically higher risk of

type 2 diabetes (see below).[6] With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well.[7] Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, full-blown diabetes, and increased risk of developing cardiovascular disease.[8][9][10][11] It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.[4][12]

Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and that

BVI calculations correlate significantly with all biomarkers of cardiovascular risk.[13]

Diabetes

There are numerous theories as to the exact cause and mechanism in

impair glucose tolerance. But adiponectin, an anti-inflammatory adipokine, which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus (T2DM).[14][15]

adiposity (obesity) raises serum resistin levels,[18][19][20][21] which in turn directly correlate to insulin resistance.[22][23][24][25] Studies have also confirmed a direct correlation between resistin levels and T2DM.[18][26][27][28] And it is waistline adipose tissue (central obesity) which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin.[29][30] Conversely, serum resistin levels have been found to decline with decreased adiposity following medical treatment.[31]

Asthma

Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. Obesity causes decreased tidal volumes due to a reduction in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragm.[32] It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air.[33] People with obesity are also more likely to be hospitalized for asthma. A study has stated that 75% of patients treated for asthma in the emergency room were either overweight or obese.[34]

Alzheimer's disease

Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear.[2] A study by Debette et al. (2010) examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of dementia.[35][36][37] Alzheimer's disease and abdominal obesity has a strong correlation and with metabolic factors added in, the risk of developing Alzheimer's disease was even higher. Based on logistic regression analyses, it was found that obesity was associated with an almost 10-fold increase risk of Alzheimer's disease.[2]

Other health risks

Central obesity can be a feature of

glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.[39]

Ghroubi et al. (2007) examined whether abdominal circumference is a more reliable indicator than

knee osteoarthritis in obese patients.[40] They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. (2007) concluded that a high abdominal circumference is associated with great functional repercussion.[40]

Research published in The Lancet (2023) found that high levels of visceral fat were related to poorer cognitive performance. The findings suggest that maintaining a healthy weight and metabolic health may be important for preserving cognitive function.[41]

Causes

Diet

See also: Diet and obesity

The currently prevalent belief is that the immediate cause of obesity is net

free fructose is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar glucose consumption.[46]

Intake of

trans fat from industrial oils has been associated with increased abdominal obesity in men[47] and increased weight and waist circumference in women.[48] These associations were not attenuated when fat intake and calorie intake was accounted for.[49][50] Greater meat (processed meat, red meat, and poultry) consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories.[51][52] Conversely, studies suggest that oily fish consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant.[53][54] Similarly, increased soy protein consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.[55][56]

Numerous large studies have demonstrated that

ultra-processed foods have a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women.[57] Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among American,[58] Canadian,[59] Latin American,[60] Australian,[61] British,[62] French,[63] Spaniard,[64] Swedish,[65] South Korean,[66] Chinese[67] and Sub-Saharan African[68]
populations.

Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high-carbohydrate diets.[69][unreliable source?] It has also been shown that quality protein intake during a 24-hour period and the number of times the essential amino acid threshold of approximately 10 g[70] has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.[71]

Visceral fat cells will release their metabolic by-products in the

portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there. In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'.[72]

Alcohol consumption

A study has shown that

alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women. After controlling for energy under-reporting, which have slightly attenuated these associations, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants – but not in the small number of female participants (2.13%) with elevated alcohol consumption, even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol. Further research is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol.[73]

A systemic review and meta-analysis failed to find data pointing towards a dose-dependent relationship between beer intake and general obesity or abdominal obesity at low or moderate intake levels (under ~500 mL/day). However, high beer intake (above ~4 L/wk) appeared to be associated with a higher degree of abdominal obesity specifically, particularly among men.[74]

Other factors

The prevalence of abdominal obesity is increasing in Western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.[75][76]

Other environmental factors, such as

endocrine-disrupting chemicals may be important also.[77]

Hypercortisolism, such as in Cushing's syndrome, also leads to central obesity. Many prescription drugs, such as dexamethasone and other steroids, can also have side effects resulting in central obesity,[38]
especially in the presence of elevated insulin levels.

Diagnosis

Silhouettes and waist circumferences representing normal, overweight, and obese

There are various ways of measuring abdominal obesity including:

  • Absolute waist circumference (>102 cm (40 in) in men and >88 cm (35 in) in women)[78]
  • Waist–hip ratio (the circumference of the waist divided by that of the hips of >0.9 for men and >0.85 for women)[1]
  • Waist-stature ratio
    (waist circumference divided by their height, >0.5 for adults under 40 and >0.6 for adults over 50)
  • Sagittal Abdominal Diameter[79]
Overweight teenage boy holding his excess abdominal fat

In those with a body mass index (BMI) under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat.[80] Intra-abdominal or visceral fat has a particularly strong correlation with cardiovascular disease.[1]

BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. Waist measurement (e.g., for BFP standard) is more prone to errors than measuring height and weight (e.g., for BMI standard). BMI will illustrate the best estimate of one's total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease.[81] It is recommended to use both methods of measurements.[82]

A man with abdominal obesity

While central obesity can be obvious just by looking at the naked body (see the picture), the severity of central obesity is determined by taking waist and hip measurements. The absolute waist circumference 102 centimetres (40 in) in men and 88 centimetres (35 in) in women and the

Index of Central Obesity (waist-to-height ratio, WHtR), where a ratio of >=0.5 (i.e. a waist circumference at least half of the individual's height) is predictive of increased risk.[84]
Another diagnosis of obesity is the analysis of intra-abdominal fat having the most risk to one's personal health. The increased amount of fat in this region relates to the higher levels of
lipoproteins as per studies mentioned by Eric Poehlman (1998) review.[4]
An increasing acceptance of the importance of central obesity within the medical profession as an indicator of health risk has led to new developments in obesity diagnosis such as the
Body Volume Index
, which measures central obesity by measuring a person's body shape and their weight distribution. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.

Index of central obesity

Index of Central Obesity (ICO) is the ratio of waist circumference and height first proposed by a Parikh et al. in 2007[85] as a better substitute to the widely used waist circumference in defining metabolic syndrome.[86] The National Cholesterol Education Program Adult Treatment Panel III suggested cutoff of 102 cm (40 in) and 88 cm (35 in) for males and females as a marker of central obesity.[78] The same was used in defining metabolic syndrome.[87] Misra et al. suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm (35 in) and 80 cm (31 in) for males and females.[88] Various race specific cutoffs were suggested by different groups.[89] The International Diabetes Federation defined central obesity based on these various race and gender specific cutoffs.[90] The other limitation of waist circumference is that it the measurement procedure has not been standardized and in children there are no, or few, comparison standards or reference data.[91]

Parikh et al. looked at the average heights of various races and suggested that by using ICO various race- and gender-specific cutoffs of waist circumference can be discarded.[86] An ICO cutoff of 0.53 was suggested as a criterion to define central obesity. Parikh et al. further tested a modified definition of metabolic syndrome in which waist circumference was replaced with ICO in the National Health and Nutrition Examination Survey (NHANES) database and found the modified definition to be more specific and sensitive.[86]

This parameter has been used in the study of metabolic syndrome[92][93] and cardiovascular disease.[94]

Central obesity in individuals with normal BMI is referred to as normal weight obesity.

Sex differences

There are sex-dependent differences in regional fat distribution.

Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.[95] When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women.[96][97]

In women,

ovaries declines, fat migrates from their buttocks, hips, and thighs to their belly.[99][100]

50% of men and 70% of women in the United States between the ages of 50 and 79 years now exceed the waist circumference threshold for central obesity.[101]

Central obesity is positively associated with

coronary heart disease risk in women and men. It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk.[102] Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women.[103]

Management

A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity.

UK,[107] the EU,[108] Australia,[109] Canada,[110] Hong Kong,[111] and Thailand.[112]

A 2006 study published in the International Journal of Sport Nutrition and Exercise Metabolism,[113] suggests that combining cardiovascular (aerobic) exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat. An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol, a hormone that leads to more belly fat deposits and leptin resistance.[114]

Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics. In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat. As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer. Specifically it is the deepest layer of belly fat (the fat that cannot be seen or grabbed) that poses health risks, as these "visceral" fat cells produce hormones that can affect health (e.g. increased insulin resistance and/or breast cancer risk). The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity. For example, fat next to the liver drains into it, causing a

catecholamines
.

In the presence of

"pathologic" abdominal fat (visceral fat), and therefore may be prescribed for diabetics with central obesity.[115]
Thiazolidinedione has been associated with heart failure and increased cardiovascular risk; so it has been withdrawn from the market in Europe by EMA in 2010.[116]

Low-fat diets may not be an effective long-term intervention for obesity: as Bacon and Aphramor wrote, "The majority of individuals regain virtually all of the weight that was lost during treatment."[117] The Women's Health Initiative ("the largest and longest randomized, controlled dietary intervention clinical trial"[117]) found that long-term dietary intervention increased the waist circumference of both the intervention group and the control group, though the increase was smaller for the intervention group. The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.2 kg (P<.001) and was 2.2 kg less than the control group change from baseline at year 1. This difference from baseline between control and intervention groups diminished over time, but a significant difference in weight was maintained through year 9, the end of the study.[118]

Society and culture

Myths

There is a common misconception that

abdominal exercises are useful in building the abdominal muscles, but they have little effect, if any, on the adipose tissue located there.[119]

Colloquialisms

A large central adiposity deposit has been assigned many common use names, including "spare tire", "love handle", "paunch", and "potbelly".[120] Several colloquial terms used to refer to central obesity, and to people who have it, refer to beer drinking. However, there is little scientific evidence that beer drinkers are more prone to central obesity, despite its being known colloquially as "beer belly", "beer gut", or "beer pot". One of the few studies conducted on the subject did not find that beer drinkers are more prone to central obesity than nondrinkers or drinkers of wine or spirits.[121][122] Chronic alcoholism can lead to cirrhosis, symptoms of which include gynecomastia (enlarged breasts) and ascites (abdominal fluid). These symptoms can suggest the appearance of central obesity.

Deposits of excess fat at the sides of one's waistline or obliques are commonly referred to as "love handles".

Economics

Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31,840 subjects aged 50–64 years of age with different waist circumferences. Their study showed that an increase in just an additional centimetre above normal waistline caused a 1.25% and 2.08% rise in health care costs in women and men respectively. To put this in perspective, a woman with a waistline of 95 cm (approx 37.4 in) and without underlying health problems or co-morbidities can incur economic costs that are 22%, or US$397, higher per year than a woman with a normal waist circumference.[123]

See also

  • Bariatrics, the branch of medicine that deals with the causes, prevention, and treatment of obesity
  • Lipoatrophy, the term describing the localized loss of fat tissue
  • Muffin top
  • Normal weight obesity, normal BMI with excessive fat, usually centrally localized
  • Panniculus, hanging belly fat
  • Steatosis, also called fatty change, fatty degeneration or adipose degeneration

References

  1. ^
    S2CID 30811593
    .
  2. ^
    S2CID 24351283
    .
  3. PMID 15562212
    .
  4. ^
    S2CID 57778374
    .
  5. S2CID 52020830
    – via PubMed.
  6. PMID 19046737
    .
  7. PMID 18378623
    .
  8. S2CID 11944065
    .
  9. PMID 11368702
    .
  10. ^ Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant D, for the Conference Participants. Definition of metabolic syndrome: report of the National, Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433-438.
  11. ^ "American Heart Association's description of Syndrome X". Americanheart.org. Retrieved 2013-01-05.
  12. PMID 21461943
    .
  13. ^ Romero-Corral, A. Somers, V. Lopez-Jimenez, F. Korenfeld, Y. Palin, S. Boelaert, K. Boarin, S. Sierra-Johnson, J. Rahim, A. (2008) 3-D Body Scanner, Body Volume Index: A Novel, Reproducible and Automated Anthropometric Tool Associated with Cardiometabolic Biomarkers Obesity A Research Journal 16 (1) 266-P
  14. PMID 25685286
    .
  15. PMID 26287420
    .
  16. ^ Duman BS, Turkoglu C, Gunay D, Cagatay P, Demiroglu C, Buyukdevrim AS (2003). "The interrelationship between insulin secretion and action in type 2 diabetes mellitus with different degrees of obesity: evidence supporting central obesity". Diabetes Butr Metab. 16 (4): 243–250.
  17. PMID 12351432
    .
  18. ^
    PMID 14962997
    .
  19. PMID 14602788
    .
  20. S2CID 20609673
    .
  21. PMID 15229336
    .
  22. S2CID 1659156
    .
  23. PMID 15220189
    .
  24. PMID 14514348
    .
  25. PMID 12829623
    .
  26. PMID 14687894
    .
  27. PMID 14671216
    .
  28. S2CID 4358808
    .
  29. S2CID 8649208
    .
  30. PMID 11994397
    .
  31. PMID 15045687
    .
  32. PMID 24719380
    .
  33. PMID 16297979
    .
  34. S2CID 13138899
    .
  35. PMID 20695006
    .
  36. ^ "'Beer belly' link to Alzheimer's". BBC News. 2010-05-20.
  37. ^ Mitchell S (2008-03-26). "Bulging belly now could mean dementia later". NBC News. Retrieved 2013-01-05.
  38. ^
    S2CID 24643796
    .
  39. PMID 31730482
    .
  40. ^
    PMID 17445932
    .
  41. ^ Dolan, Eric W. (2023-06-04). "New research indicates visceral fat has a profoundly negative effect on cognitive abilities". PsyPost. Retrieved 2023-06-04.
  42. PMID 20388133
    .
  43. PMID 12399260
    .
  44. S2CID 4344197
    .
  45. PMID 19244571
    .
  46. ^ "Fructose sugar makes maturing human fat cells fatter, less insulin-sensitive, study finds". ScienceDaily. Retrieved 2021-03-08.
  47. PMID 14522729
    .
  48. PMID 23154296
    .
  49. PMID 18996687
    .
  50. S2CID 4835948
    .
  51. PMID 20592131
    .
  52. ISSN 0002-9165
    .
  53. PMID 28490771
    .
  54. PMID 20932294
    .
  55. PMID 17412329
    .
  56. PMID 23113160
    .
  57. PMID 28322183
    .
  58. ^ "Processed foods highly correlated with obesity epidemic in the US". ScienceDaily. Retrieved 2021-03-08.
  59. PMID 30238324
    .
  60. ISBN 978-92-75-12032-3
    . Retrieved 15 March 2021.
  61. PMID 33279939
    .
  62. PMID 32357191
    .
  63. PMID 32853224
    .
  64. PMID 32784758
    .
  65. S2CID 22016427
    .
  66. PMID 33671557
    .
  67. PMID 34444957
    .
  68. PMID 33868911
    .
  69. S2CID 83758966
    .
  70. S2CID 22609751
    .
  71. PMID 22284338
    .
  72. ^ President and fellows of Harvard College. (2006). Abnormal obesity and your health. Retrieved from http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml Archived 2013-03-15 at the Wayback Machine
  73. S2CID 7185367
    .
  74. PMID 23356635
    .
  75. ^ Carey D.G.P. (1998). Abdominal Obesity. Current Opinion in Lipidology. (pp. 35-40). Vol. 9, No 1. Retrieved on April 9, 2012.
  76. doi:10.1093/eurheartj/sul002
    .
  77. ISBN 978-1-4419-7033-6. {{cite book}}: |journal= ignored (help
    )
  78. ^ a b National Cholesterol Education Program (2002). Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report). National Institutes of Health. p. II–17. Archived from the original on 2005-05-24. Retrieved 2011-05-14.
  79. PMID 17041127
    .
  80. ^ U.S. Preventive Services Task Force Evidence Syntheses (2000). HSTAT: Guide to Clinical Preventive Services, 3rd Edition: Recommendations and Systematic Evidence Reviews, Guide to Community Preventive Services. Archived from the original on 2009-07-04. Retrieved 2017-08-29.
  81. ^ Abdominal obesity and your health. (2006). Retrieved from http://www.health.harvard.edu/fhg/updates/abdominal-obesity-and-your-health.shtml Archived 2013-03-15 at the Wayback Machine
  82. ^ "Abdominal obesity and your health". Health.harvard.edu. Archived from the original on 2013-03-15. Retrieved 2013-01-05.
  83. S2CID 11796524
    .
  84. PMID 21331161
    .
  85. S2CID 31913449
    .
  86. ^
    PMID 19558273
    .
  87. ^ National Cholesterol Education Program (2002). Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report). National Institutes of Health. p. II–27. Archived from the original on 2005-05-24. Retrieved 2011-05-14.
  88. PMID 20156066
    .
  89. ^ Boston, 677 Huntington Avenue; Ma 02115 +1495‑1000 (2012-10-21). "Abdominal Obesity Measurement Guidelines for Different Ethnic Groups". Obesity Prevention Source. Retrieved 2021-03-31.{{cite web}}: CS1 maint: numeric names: authors list (link)
  90. S2CID 30586927
    .
  91. ^ Boston, 677 Huntington Avenue; Ma 02115 +1495‑1000 (2012-10-21). "Measuring Obesity". Obesity Prevention Source. Retrieved 2021-03-31.{{cite web}}: CS1 maint: numeric names: authors list (link)
  92. PMID 18700281. Archived from the original
    on 2017-10-11. Retrieved 2011-06-04.
  93. doi:10.2478/v10011-011-0006-6
    .
  94. PMID 18051732. Archived from the original
    on 2017-10-12. Retrieved 2011-06-04.
  95. PMID 9950792
    .
  96. PMID 8379501
    .
  97. ^ Carey DG, Campbell LV, Chisholm DJ (1996). "Is visceral fat (intra-abdominal and hepatic) a major determinant of gender differences in insulin resistance and dyslipidaemia?". Diabetes. 45: 110A.
  98. PMID 21451731
    .
  99. ^ [1] Archived October 24, 2007, at the Wayback Machine
  100. ^ "Abdominal fat and what to do about it. Visceral fat more of a health concern than subcutaneous fat". Harvard Health Publications. Health.harvard.edu. Archived from the original on 2011-09-28. Retrieved 2013-01-05.
  101. ^ [Li C, Ford ES, McGuire LC, Mokdad AH. Increasing trends in waist circumference and abdominal obesity among US adults. Obesity (Silver Spring) 2007;15 (1) 216- 224]
  102. PMID 2331775
    .
  103. PMID 8994444
    .
  104. ^ "Even a Little Exercise Fights Obesity". Webmd.com. 2009-11-06. Retrieved 2013-01-05.
  105. ^ "Weight Management". Washington.edu. 2012-11-26. Archived from the original on February 9, 2013. Retrieved 2013-01-05.
  106. ^ Rockoff JD, Dooren JC (October 8, 2010). "Abbott Pulls Diet Drug Meridia Off US Shelves". The Wall Street Journal. Archived from the original on 11 October 2010. Retrieved 8 October 2010.
  107. ^ "Top obesity drug sibutramine being suspended". BBC News. 2010-01-22. Archived from the original on 25 January 2010. Retrieved 2010-01-22.
  108. ^ (in German) Sibutramin-Vertrieb in der Europäischen Union ausgesetzt [2] Archived 2012-07-19 at archive.today. Abbott Laboratories in Germany. Press release 2010-01-21. Retrieved 2010-01-27
  109. ^ "Sibutramine (brand name Reductil) Information - Australia". Abbott Laboratories. 2010. Archived from the original on 14 October 2010. Retrieved 2010-10-08.
  110. ^ "Health Canada Endorsed Important Safety Information on MERIDIA (Sibutramine Hydrochloride Monohydrate): Subject: Voluntary withdrawal of Meridia (sibutramine) capsules from the Canadian market". Hc-sc.gc.ca. 2010-10-14. Retrieved 2013-01-05.
  111. ^ "De-registration of pharmaceutical products containing sibutramine" (Press release). info.gov in Hong Kong. November 2, 2010. Retrieved 2010-11-08.
  112. ^ "Thai FDA reveals voluntary withdrawal of sibutramine from the Thai market" (PDF) (Press release). Food and Drug Administration of Thailand. October 20, 2010. Archived from the original (PDF) on May 11, 2011. Retrieved 2010-12-22.
  113. PMID 17136940
    .
  114. PMID 22523670
    .
  115. PMID 14678865
    .
  116. ^ 23/09/2010 European Medicines Agency recommends suspension of Avandia, Avandamet and Avaglim http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/09/news_detail_001119.jsp&mid=WC0b01ac058004d5c1
  117. ^
    PMID 21261939
    .
  118. PMID 16391215
    .
  119. ^ Jensen M (2007-01-19). "Belly fat in men: What you need to know". Mayoclinic.com. Archived from the original on 23 March 2008. Retrieved 2008-04-07. Sit-ups will make your abdominal muscles stronger, sure. And, you may look thinner by building your abdominal muscles because you can hold in your belly fat better. But strengthening your stomach muscles alone will not specifically reduce belly fat.
  120. ^
    • "spare tire". Merriam-Webster. Retrieved August 2, 2021.
    • "paunch". Merriam-Webster. Retrieved August 2, 2021.
    • "potbelly". Merriam-Webster. Retrieved August 2, 2021.
  121. PMID 14506485
    .
  122. ^ Staff writer (2003-10-12). "Why the beer belly may be a myth". BBC News.
  123. ISSN 1662-4025
    , 2008, Volume 1, Issue 3, pp. 146–154.

Further reading

External links
Retrieved from "https://en.wikipedia.org/w/index.php?title=Abdominal_obesity&oldid=1213671305"