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Female Belly Fat: Stress, Menopause & Other Causes

If you are a female that stores fat primarily in your belly, an apple instead of a pear, then this blog is for you. And if you are not the type that likes all the science, then skip to the bottom and just read the “action steps” section. :-)

The other day in the clinic a patient of mine asked me the following question: “I hear people constantly talking about how women store fat in the lower body, and men store fat in their stomach. But I don’t store fat like the typical woman. My main issue is belly fat. I have a leaner lower body compared to my middle. I am an apple shape. What does this mean? Why do I store fat this way?”

I have been asked a variation of this exact question at almost every talk or lecture I give on female fat loss. Another interesting thing about this patient is that she is not fat by anyone’s standard. In fact she is underweight compared to the average. And if it were not for the fact that I know her measurements, I would have probably dismissed her observation as another example of poor body image.

BTW, as an aside and because I don’t think it is said enough, I happen to think women of all sizes and shapes are beautiful. We need to talk about this more in health and fitness. Sometimes I think all we are doing is making people neurotic when talking about body change. Discussing “fat loss” often gets misinterpreted as if we are saying women “should” look a certain way. Nothing could be further from the truth. Excess fat, especially around the belly has health implications and losing it is beneficial, but beauty, to me anyway, goes far beyond a particular look or shape.

Female belly fat and hormones

There are a few hormones we need to talk about in regards to belly fat in women. And before the calorie Woman Measuring Stomachzealots get in an uproar, I am not saying calories don’t matter. What I am saying is that it is the hormonal situation that determines where fat is stored, and belly fat is no different.

To lose fat you need both a caloric deficit and hormonal balance. To lose stubborn fat, particularly stubborn belly fat, you need to understand the hormones involved.

In women those hormones are: insulin, cortisol, estrogen, progesterone, and testosterone. And of course the major fat burning hormones, the catecholamines.

When you think of hormones, realize they never work in isolation. In other words, it is wrong to think about the action of a single hormone because hormones behave differently depending on the “hormonal social environment” they find themselves in. For example, insulin and cortisol “socializing with” high testosterone and low estrogen and/or progesterone, have a unique outcome that make women more likely to store belly fat. Here are how these hormones work in bullets to make it easier:

  • Estrogen is insulin sensitizing making it less likely excess calories are stored as belly fat and more likely a calorie deficit results in fat loss rather than muscle loss.
  • Estrogen and progesterone both oppose the fat storing action cortisol has on the belly.
  • Cortisol is associated with stress, and more stress reactive women release more cortisol and have higher amounts of belly fat whether they are thin or overweight.
  • Catecholamines (adrenaline and noradrenaline) are released during intense exercise and have a strong fat burning impact on visceral belly fat (deep stomach fat), and a weaker fat burning impact on subcutaneous belly fat (this is because sub Q belly fat has more ANTI-fat burning alpha adrenergic receptors while visceral fat has more fat burning beta receptors).
  • Testosterone is tricky because men with low testosterone have larger bellies, but just as estrogen is responsible for giving women smaller waists testosterone may be the reason men have bigger waists. This testosterone to estrogen ratio is critical for women.  Women with higher testosterone levels, like those with PCOS, have thicker waists.

The Female Fat Belly Formula & Stress

  • The female formula for belly fat looks something like this:  [(Insulin + Cortisol) x Testosterone] – Estrogen= belly fat
  • Which means this:  Insulin & cortisol combined along with excess testosterone & low estrogen = belly fat
  • And could be translated further to this: (F + SS) X ST = A Fat Belly. Where F= fat, SS= sugar/starch, ST= stress.

Female Belly FatThe greatest impact on the hormone insulin is excess calories in the context of starch/sugar. Foods that combine fat and sugar have the greatest number of calories and the most negative impact on fat storing hormones (for more on that mechanism see this BLOG & this BLOG).

When stress is added on top of this, you have cortisol added to the mix. Cortisol added to insulin is a bad combination and the most problematic hormonal combination for belly fat. But when stress becomes chronic or extreme in a female, the hypothalamus & pituitary (the command and control center of your hormones) becomes “irritated” (for lack of a better word), and you get downstream effects on thyroid, adrenal, and ovarian hormone production. Chronic stress in women leads to increased testosterone and lower estrogen and progesterone. (A nice free science overview on this mechanism can be found HERE)

The other aspects of stress are more hidden. Not only does stress raise testosterone, lower estrogen, and negatively impact insulin in women, it also causes increased hunger, constant cravings, and a physiology that is more likely to lose muscle. If you are not familiar with how stress leads to weight loss resistance and more of that mechanism, check out this BLOG.

The Perfect proportions

The typical fat distribution for women is to store more fat in the bust and hips/butt/thighs and less fat in the waist. This is the primary role estrogen plays in female physiology.

Many are not aware, but a large amount of study has been done on female body shape and attractiveness (a lot has been done on the male body too, but that is for another blog). What is interesting is this research shows that across cultures both males and females have a particular shape they prefer on the female physique. The hourglass shape.

Research has even pinpointed the female proportions that are preferred by men and women. Those proportions are a waist to hip ratio (WHR) of between .7 to .8, and a waist to chest ratio (WCR) that is also between .7 to .8. The perfect female proportions would be something like this 36:26:36 (chest:waist:hips). Based on the proportions, women could be smaller, larger, taller, or shorter. The relative proportions of waist to chest and hips dominate the attractiveness factor for females. For more on the studies I chose one good review article HERE.

This is important because as the waist to hip ratio (WHR) rises much above .8, this is an indication that the hormonal situation is changing. Menopausal women will tell you this first hand. They may not gain weight, but their bodily proportions change. This is the influence of estrogen and progesterone. As estrogen/progesterone fall, and testosterone, cortisol, and insulin rise, the bodily proportions change. When attacking female belly fat it is these proportions that tell you the most about your progress, not your weight on the scale.

Overweight and underweight women both struggle with belly fat

Thin Woman Belly FatHere is the final understanding to get. Bigger bellies (i.e. higher waist to hip ratios) are found in both thin women and overweight women. I took a picture right out of the pages of this STUDY so you could see what I mean by this. This can be a bit counter-intuitive to people without seeing it.

This drives home the point that belly fat is not a simple matter of gaining or losing fat. Calories matter, but hormones matter more when it comes to where we store fat and how to attack stubborn areas of body fat unique to us.

If you are a woman doing everything right and still struggling with female belly fat, and especially a thin woman suffering from belly fat, you need to understand that the primary issue for you is stress management. It’s NOT too many calories. It’s NOT too many carbs. It’s NOT because you are not doing enough exercise. It is stress!!!

In fact, the dieting mentality of eat less and exercise more is exactly the wrong approach to take to attack STUBBORN female belly fat. This simply makes the physiological stress greater, and there is much evidence that suggests dieting may actually be making your fat parts (i.e. your belly) fatter.

BTW, when I use the term “stress” it is important people understand what I mean. For some reason we equate stress with emotional upset. So we think if we do not feel anxious or depressed we are not stressed. This is a dangerous misconception to have when it comes to belly fat.

Let’s take a mother who just gave birth to her first child. She is happy, elated, and in awe. This may be one of the happiest and most incredible moments of her life. Is she stressed? Probably more than anyone else on the planet! She is sleep deprived (stress). She is nutritionally depleted from growing a baby and supplying the baby with milk (stress). She has a whole new life impossible to be prepared for (stress). This shows you can be as happy as can be, but stressed to the max.

Over exercising, chronic and extreme dieting, worries of body image, work worries, relationship tension, sleep deprivation, and on and on….. all forms of stress. And what we know conclusively from women suffering from stubborn belly fat is that they are more stress reactive and less able to adapt to stress than women without (the STUDY). In other words, female belly fat is an issue of stress above all else. For a women suffering from stubborn belly fat she can’t get rid of, another hour in bed may be a better strategy than another hour on the treadmill!

Actions steps

OK, so what the hell do you do about it? Here are your action steps:

  • Remember that female fat belly formula? (Fat + Sugar/Starch) X Stress= fat belly. The stress is the most important part. So prioritize rest and recovery workouts. What I call R & R workouts.
  • Follow a 3:2:1 exercise program to keep from over stressing through exercise. 3 R & R workouts per week (these lower cortisol and will help re-balance estrogen and testosterone). 2 Traditional weight training workouts per week (these help use testosterone for muscle building not belly storing). 1 hour of leisure walking (not power walking) on all or most days. Leisure walking is the best exercise for those with female stubborn belly fat.
  • What are R&R workouts? They last preferably an hour and include a massage, spa time, sauna therapy, hot baths, sex/physical affection, time with pets, leisure walking (not power walking), restorative yoga (not power yoga), tai chi, naps, meditation, etc.
  • What is leisure walking? A slow walk – 3.0 or less on a treadmill. It should feel relaxing and give you time to take in the scenery which lowers cortisol further.
  • Don’t go too low calorie, too low carb, or too low fat. Any type of short, extreme, or continuous chronic dieting is a stress. Don’t do it. Find balance in your nutrition. Here is one useful thing to study to master this: The Carbohydrate Tipping Point.
  • You may want to avoid other more “stressful” approaches to body change. Many do well on things like very low carb, intermittent fasting, or other approaches.
  • Prioritize sleep. You will have to make a choice whether your late night TV habit is more important than a flat tummy because sleep deprivation is a huge issue for belly fat. If you can’t sleep then nap. If you can’t nap then meditate. If you can’t do any of that, then simplify your life so you can. Stress management has to be made a priority.
  • Don’t eat less and exercise more. A better approach is to either eat less and exercise less, OR eat more and exercise more (both can also create the environment for fat loss: a caloric deficit and hormonal balance). You will likely find the best results with an eat less, exercise less approach. That means the 3:2:1 workout schedule described above.
  • I hesitate to give you a nutrition plan to follow because you will likely follow it to a T and forget that it is not about following a diet, it is about creating the diet perfect for you. But I will do it anyway……reluctantly. Start with a 3:2:1 diet approach to go along with your 3:2:1 workout approach. 3 meals per day. 2 of them protein shakes and 1 free meal a week. This is a super simple formula to follow. This will assure a low calorie diet, with plenty of protein and a balanced hormonal state.
  • BTW, if you are now complaining in your head about the recommendation of protein shakes because they are not “real food”, then this is an indication you really need to stop taking all this stuff so seriously (quit stressing out over trivial stuff). Do what you like. Just make sure the meals have high protein & fiber above all else (they keep you full and keep you from losing muscle). Of course, real food is ALWAYS preferred, but high stressed individuals need to prioritize simplicity and convenience at all times.
  • One final trick. Stress is a very tricky thing and can be wreaking havoc on your metabolism without you knowing it. There are a few supplements that have been shown to help the hypothalamus/pituitary control center resist stress. These include curcumin, fish oil (preferably krill oil since it contains phospholipids), and rhodiola.

WANT FEMALE SPECIFIC FAT LOSS

Tired of diet and exercise advice that does not take your unique female physiology into account? Check out our 8-week online program designed specifically for women

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About Jade Teta

Integrative Physician, Author The Metabolic Effect Diet, Founder CEO Metabolic Effect Inc., Health, Fitness and fat loss expert. Find on Google+

11 Responses to "Female Belly Fat: Stress, Menopause & Other Causes"

  • comomx3
    August 18, 2013 - 11:36 AM

    Hey- I think I know the answer to this question but in regards to the 3-2-1 plan for eating; you mean 2 protein shakes a week, right? Not have 3 meals a day and 2 of those meals should be protein shakes. Correct?

    • Jade Teta
      September 16, 2013 - 7:57 PM

      Yes, that is correct. only 3 meals per day, but two of those meals will be shakes

      • supermomjessie
        September 24, 2013 - 12:42 PM

        to follow on the previous comment (and I realize I’m falling right into the “i dont want to give you a meal plan” persona) if I’m only doing 2 protien shakes a day, and a regular meal, how many calories should I be attempting a day? Snacks added in? (I fit the above description to a T! btw) I’m trying to stay above 1200 cals a day, I’m getting around 130g protien- but I’m only hitting that number of cals by snacks. If I were to only 2 protien shakes, at ~150-200 cals, and a regular meal… I’d probably only hit 800? cals a day? If that?

        • Jade Teta
          October 12, 2013 - 4:23 PM

          Hi supermomjessie. Here is an answer from a similar question by someone our facebook page that may help you:

          “great question and thanks for asking it. First, let me cover some assumptions you are making with your question.

          1) It is an assumption that we advocate an 800 calorie a day diet. That is your number not ours. We typically do not advocate counting calories at all. What we advocate is a diet that controls hunger, balances energy, reduces cravings and results in fat loss and optimal health. If an 800 calorie a day diet creates this effect than great. In reality the typical person following this approach eats between 1200 and 1500 calories per day which is still probably too low for most people looking at this through the lens of eat less, exercise more. But read on.

          2) If you know anything about our approach to health and fitness you would know that we really don’t give defined diet plans and hard and fast rules. If hunger, energy and cravings are out of control that is a sure sign the approach is not working. Our clients and those familiar with metabolic effect know this and would adjust accordingly. So, the idea that we would tell someone to follow this approach blindly and forever again is wrong.

          3) A low calorie diet with high output exercise IS a potential problem (not for everyone), BUT is a very different animal compared to a low calorie diet with low exercise output. The latter rarely causes problems (for the vast majority) and is actually very healing for the body (again not for everyone but for the vast majority). We have thousands of hours of clinical experience to back this up. The research also supports us as these types of low cal, no exercise programs have been studied pretty extensively. We are using extra protein and weight training in our to circumvent some of the downside seen in the studies.

          4) This one, #4, is the biggest assumption and misunderstanding which is why I am so glad you asked this question. For some reason there is this myth out in the diet and exercise world that eating less will “slow the metabolism” and cause issues. The common mantra is, “if you are not losing weight you need to eat more” or “your not eating enough”. This is only partly true and is probably not good advice if you have an understanding of metabolism. (again certainly for some it may be entirely true, not for most though)

          If you want to lose fat you need to create a caloric deficit AND generate hormonal balance. The popular way of doing this is to eat less and exercise more. This is what typically causes the metabolic compensation people are worried about…. because it gets half of the equation correct (i.e. lower calories) but it gets the other half wrong (it causes an imbalanced metabolism. again not in everyone but in many). How do you know if the metabolism is compensating? hunger, energy and cravings become imbalanced and fat loss stalls or reverses.

          Then what happens is people look around at fit athletic individuals and see that they eat more than the average person. But forget that they also exercise more. If these individuals adjust there food intake up to match their exercise output (the way athletes do) the metabolism kicks into gear again. This is an eat more, exercise more approach and there is more going on than simply eating more. it is the exercise and food combo causing the beneficial effect. Calories matched to output. And that works beautifully because is causes the caloric deficit AND balances the metabolism.

          But it is not the only way to create this effect. There is another way to cause that calorie deficit and balance the metabolism and that is to eat less and exercise less (very much like our grandparents did. They ate less food and certainly did not hoist weights and run miles every day). In this case hunger, energy and cravings are controlled and the body uses its own fat stores to make up the deficit. Even if this was 500 or 800 calories a day for a few days it is not a big deal at all because the body manages it. If you are astute you will know when/if that becomes an issue because the body will tell you. As soon as hunger goes up, energy goes down and cravings become out of control it is time to adjust. The idea that people should stay on extremely low calorie diets indefinitely while exercising excessively is what causes issues and that is very different than what we are talking about here.

          I hope this clarifies things and again thanks for giving us the opportunity to answer it. I am sure others had a similar question.

          If you are interested in this discussion you may want to look at some of the work on intermittent fasting as it will cover some of the wrong assumptions related to diets etc. I recommend Eat Stop Eat by Brad Pilon—Jade”

  • Healing_Words
    October 13, 2013 - 9:06 PM

    I’m wondering about the “2 Traditional weight training workouts per week.” Are these 1 hour each also? And regards to the comments above, it is in fact 2 protein shakes per day, not per week, yes?
    Thanks

    • Jade Teta
      October 14, 2013 - 5:16 AM

      Hey Healing_Words

      The typical workout we use for these sessions is 4-5 sets of 10 reps using a 10 rep max of Squat, Chest Press, Back Row, and Shoulder Press. Rest periods between sets are typically between 1-3 minutes. So, it would depend on your pace how fast you would finish. Typically this takes between 40 and 60 minutes. Yes, these shakes are 2 per day. Hope that helps.

  • nathanh
    November 18, 2013 - 3:38 PM

    Great article – managing our hormonal responses is an area that many health professionals fall short when offering advice on fat loss.

    Would the hormonal response from the foods we intake be more important than focusing on the calorie deficit? After all, a ‘calorie’ is merely the heat potential of food and paints a very small picture of digestion which is a chemical response.

    • Jade Teta
      November 18, 2013 - 3:43 PM

      It depends on your goal. If you want short-term results than calories are more important. However, if you want to address the issues more fully and make the results last, my opinion is you must add a hormonal understanding to the calorie considerations. Both are important of course.

      • nathanh
        November 18, 2013 - 3:50 PM

        Agreed. Thanks for the response and for a great article.

  • belinda-holzhauser@live.com.au
    December 6, 2013 - 8:18 PM

    Hi Jade,
    I feel that I have this stubborn belly fat although I am one of the athletic belly fat candidates.
    I am just wondering how I can use this protocol on an eat more exercise more approach as I lift weights 5 times a week to build muscle and am not sure I will be able to control the hunger on only 2 shakes a day.
    Would it be wise to include high protein snacks e.g tuna or boiled eggs for in between the shakes?
    Thanks =)

    • Jade Teta
      December 6, 2013 - 8:36 PM

      3:2:1 is an eat less exercise less approach. You would want to use an eat more exercise more approach. I define this bytthe 3:2:2 ratio. Three meals. Two protein shake snacks and 2 x the starch at the meal after a workout. The meals too can be thought of in terms of a 3:2:2 proportion. 3 parts veg, two parts protein and 2 parts starch.

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