Who is more likely to die early?

A. An overweight person with a flat stomach.

B. A normal-weight person with a big stomach.

Answer: B.

Surprisingly, a normal-weight man or woman who has a big stomach is more likely to die early from heart disease than an overweight or even obese man or woman who has a flat stomach.

You could call it the Big Belly Paradox.


Mayo Clinic researchers examined data on about 15,000 adult men and women who were followed over 14 years. They had data not only on overweight/obesity as measured by the body mass index (BMI), but also waist-to-hip ratio, which measures how big your stomach is compared with your waist.

The healthiest combo, of course, was a normal weight and a flat stomach. But it’s also possible for a normal weight man or woman to have a paunch—and some folks who are heavy carry their excess weight more on their backsides than on their bellies. Here’s where the results get interesting…

• Normal-weight men with big stomachs had twice the mortality risk of men who were overweight or obese but had flat stomachs.

• For women, those with normal weights but big stomachs were 40% more likely to die than overweight woman with flat stomachs—and 32% more likely to die than obese women with flat stomachs.

What’s so bad about big bellies? A waist-to-hip ratio that’s 0.85 or higher (for women) or 0.90 or higher (for men) is a sign of “central obesity”—the kind of fat that’s inside the abdomen and other internal organs rather than just under the skin. This “visceral” fat accumulates around the pancreas, heart and other organs that aren’t designed to store fat. That can lead to excess insulin, high blood sugar, high cholesterol and problems in the functioning of the heart. The result is an increased risk for heart disease, diabetes and other metabolic diseases.

Researchers have known about these increased risks of a big belly for a long time. But they thought it primarily a problem only if you were already overweight or obese. The new research suggests that a big belly is a serious problem whatever your weight.

To be sure, having a high waist-to-hip ratio is more likely if you are overweight or obese. Only 3% of women and 11% of men who were normal weight had central obesity, for example, compared to rates among the overweight of 12% (women) and 37% (men).

But it’s clear that this is a risk factor that everyone who wants to live a long healthy life should pay attention to. Here’s how to find out where you stand.


While medical facilities have sophisticated methods of measuring central obesity precisely, measuring your waist-to-hip ratio is proven to be accurate, and it’s something you can do yourself…

• First, find your true waist—it’s not necessarily where your belt falls. Locate your hip bone on one side, and then move upward until you can feel the bones of your bottom rib. Halfway between your hip and that first rib bone is your waist. For most people, it’s where the belly button is.

• Measure your waist with a tape measure.

• Measure your hip with a tape measure.

• Divide the waist measure by the hip measure. For example, if your waist is 28 and your hip is 36, you’d divide 28/36 to get a ratio of 0.78.

Here’s a shortcut: For most women, a waist of 35 inches or above, and for most men 40 inches and above, is a good quick indicator of central obesity, according to the American Heart Association.

If you do have a big belly, you know what to do—lose weight. The good news is that belly fat is the easiest to lose. It’s the first to come off when you start to lose weight by changing your diet and exercise habits. Get started with Bottom Line’s Lose Weight Fast: 9 Simple Ways.