Washboards. Six-packs. No matter what they're called, muscular, lean abdominals are an obsession for some Americans.
And there is no shortage of methods to get them. Some fitness programs encourage countless crunches while others back special diets. Some promoters suggest more sleep or even adding calcium to the diet.
"So many people have the tummy pooch because it's a hard area to tone," said Dr. Susan Lewis, an orthopedic surgeon at St. Francis Memorial hospital in San Francisco. "Even a thin person will be a little flabby if they're not working on the area."
The biggest motivating factor for getting rid of belly fat should be general health, said David Zinczenko, editor in chief of Men's Health magazine.
He devoted his book "The Abs Diet" to the health benefits of tight abdominals, citing research that links belly fat to diseases such as diabetes, heart disease and cancer. This is partly because abdominal fat isn't limited to subcutaneous fat, the flab that hangs over the belt.
The fat found deep in the body, around organs, can lead to serious health problems. Some visceral fat is necessary for proper bodily functioning, acting as a cushion between organs and keeping you warm. However, too much can lead to problems.
"Abdominal fat bears the blame for many health problems because it resides within striking distance of your heart, liver and other organs — pressing on them, feeding them poisons and messing with their daily functions," Zinczenko wrote.
He says the answer to having good abdominals isn't eating fewer carbohydrates or doing hundreds of sit-ups, but simple and consistent diet and exercise.
Part of the reason people gain weight around their middle is because they might be insulin-resistant, said Dr. Fred Pescatore, author of "The Hamptons Diet." Insulin is the chemical that regulates sugar in the blood. When the body can't produce enough insulin to handle all the incoming sugar, it becomes insulin-resistant.
Pescatore said Americans eat so much refined sugar — about 150 pounds per person per year — that after a while the pancreas can't work fast enough to process it all and it gets stored as fat.
It stays there partly because of genetics — ancient bodies were conditioned to hang onto every calorie possible in case of famine. It's only in the last century that people began eating processed food.
"Our lifestyles may have changed, but genetics don't change in just 100 years," Pescatore said.
He says one of the easiest ways to get rid of belly fat is to cut processed sugar and white flour from the diet. That includes everything from sodas to pretzels.
"Even the skinniest of skinny people can lose about 5 pounds this way," he said. Fruits, vegetables and whole grains are good choices since they are loaded with fiber and will make you feel full.
Dr. Carol L. Otis, a sports medicine physician in Portland, Ore., suggests small lifestyle changes, such as cutting 200 calories a day. That's the equivalent of about one regular soda or one candy bar. She also suggests burning an extra 200 calories a day, the equivalent of walking for about half an hour.
She said people can't forego exercise in firming up abdominals, but they also can't expect to address it with spot-training alone. Instead, they have to lose weight all over to see results. That means increasing cardiovascular exercise and weight-training, which helps increase metabolism.
She cited recent research that shows focusing on stabilizing the body's core is an effective way to tone abdominals. She said that exercises that focus on the deep abdominal muscles, the gluteus maximus as well as the back can improve strength as well as posture.
"We're finding that the core of the body is in that lower trunk area," she said. "When those muscles are toned and worked out, then even simple things such as lifting groceries is easier."
Once the fat starts to melt away, the muscle underneath will start to show. However, all the exercise in the world may not take away every ounce of fat. People might have to accept that they might be genetically predisposed to having a little tummy pooch. Even some Olympic athletes can have little pockets of fat.
"In all the studies, no one has ever shown that there is one special trick that will make you lose weight in one certain area," Lewis said. "It's all about calories in and calories out."
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