h. belly fatIt’s one of your clients’ top requests, and one of the trickiest things to achieve: losing fat around the belly. But it’s not just a matter of eating less food and exercising more: fat in this zone is both a caloric and hormonal issue… and the main players are insulin and cortisol.

Insulin and cortisol
There are two enzymes responsible for how fat cells function: lipoprotein lipase (LPL) – responsible for fat storage – and hormone-sensitive lipase (HSL) – responsible for fat release. A few hormones affect LPL and HSL, including insulin, cortisol, oestrogen, progesterone and testosterone (to name a few). The key things to remember are that:
o LPL activity increases in response to insulin and cortisol
o HSL activity is supressed by insulin, and
o Cortisol increases HSL activity.
In a nutshell, it’s really important to work with these hormones in an effective way that enables the HSL enzymes to release fat.

Cortisol and belly fat
If your client has had high amounts of cortisol over a long period of time, they are particularly prone to building up belly fat. This is because of the relationship between cortisol and appetite: for example, cortisol is associated with craving palatable food, desiring less healthy food, and higher calorie intake than is required for energy needs. Cortisol also causes fat cells to become larger and mature. Overall, it’s not cortisol in isolation that is responsible for belly fat, but when combined with insulin they can both create some challenging hormonal issues to unpack.

Oestrogen, progesterone, and testosterone
Besides insulin and cortisol, oestrogen, progesterone and testosterone all have a part to play. In women, oestrogen and progesterone both have anti-cortisol effects; higher levels of testosterone in women can contribute to increased belly fat. For men, lower levels of testosterone can contribute to belly fat. Managing these sex hormones also contributes to getting belly fat under control.

Why diets are disasters when it comes to belly fat
Teta refers to research showing that 66% of dieters actually gain back more fat than when they commenced dieting – and typically, this weight is often stored In the belly region. She suggests that rather than an “eat less, exercise more” approach to weight loss – which often increases the cortisol response – weight loss professionals can suggest either an “eat more, exercise more” strategy or an “eat less, exercise less” approach.

In men, since raising testosterone can help reduce belly fat, this approach might include weight training and carbohydrate moderation. And for women, the key to reducing belly fat is lower testosterone, higher oestrogen and progesterone (and both these hormones can be reduced in response to stress). The trick, Teta argues, is to focus women in particular on stress reduction, as well as moderate calorie and carbohydrate intake.

Sample meal strategy for belly fat loss
Teta names the concept 3:2:1 – three meals per day, two of which are based on high protein, high fibre, low starch and one meal per day with heavier starch, which is ideally eaten after a workout. To this, daily walking for pleasure, and short weight training sessions (maximum 40 minutes) 2-3 times per week are recommended.

Activities to lower cortisol
One of the great things about lowering cortisol levels is that these are rewarding, pleasurable ‘prescriptions’ you can give your clients. You can start by focussing on sleep quality and stress management. Activities like sex, hot showers, long baths, meditation, massage, and laughter also help to reduce cortisol.

Measuring progress
If you have established that hormones are playing a factor in your clients’ weight loss efforts, one approach to measure if their changes are working effectively is measure hunger, craving and energy levels on a weekly basis. Ask your clients to rate each of these aspects on a scale from 1 (low) to 10 (high). Hunger and cravings should be rated less than or equal to 5; and energy should be 6 or higher. If not there may be some further adjustments to be made.
Another way to assess progress is to calculate waist to hip ratio (for women) or waist to chest ratio (for men). In women, the ideal ratio is 0.7, so any changes that move towards this indicate that your approach is working. In men, the idea ration is 0.77. Ratios that don’t change, or move towards 0.8 (or higher) indicate that further hormonal management is required.

Reference: Teta, J. (2014). How to Help Clients Beat Belly Fat. IDEA Fitness Journal, 11(3), 44-51.

How deeply do you explore stress management with your clients, and what of the ideas in this article can you introduce into your weight loss practice? Share your thoughts in the comments below.