Classic Female and Male Fat Patterns

The Classic Female Fat Pattern
There are many nicknames for female fat. We downplay it by using cute
or nonoffensive labels such as saddlebags, chunky body, looking healthy,
or dimples in the hips and thighs. Or we try to tame it, cover it up, or hold
it in using a whole range of garments from girdles to control-top panty
hose to baggy clothing. Entire cosmetic industries have arisen to help
women get rid of unsightly cellulite and stretch marks, while attractive
women’s fashions in large sizes are making their mark in stores and in fashion
magazines designed for those with a “generous” figure. Most women
wage a lifetime battle with fat, as can be seen by the hundreds of diet
books for women that fill bookstore shelves. In fact, at any given time,
three out of four women are either trying to lose weight or keep it off.
While I would agree with the self-help authors who tell female readers
that the key to self-esteem is to love your body, I believe that a woman
should find a balance between accepting her body just as it is and paying
serious attention to the significant health risks of being overfat. There is
nothing life-affirming about having type 2 diabetes, painful and overstressed
joints, and an increased risk of heart disease after menopause. As
we have seen, being overfat also increases the risk of certain types of cancers.
For example, a recent report published by the National Cancer Institute
showed that women with a Body Mass Index (BMI) of 30 or greater
were twice as likely to develop cervical cancer. Women with the lowest
waist-to-hip ratio, indicating a significant accumulation of abdominal fat,

were eight times more likely to develop this disease than women with a
normal waist-to-hip ratio.
To better understand how a woman’s body fat can become a risk for
her, let’s take a look at the physiological and hormonal processes involved
in female fat storage.
The Importance of the Body Fat–to–Lean Muscle Ratio
Even though most women equate being overfat with how many pounds
they weigh, the scale does not tell the whole story. While scale weight is
certainly an important factor and will give you some information about
your general health, it is even more important for you to determine your
body composition—that is, how many pounds of fat you carry in relationship
to how many pounds of lean muscle. The following table categorizes
body fat percentages for women:
Body Fat (%) Level
<14 Athletic
14–17 Good/lean
18–22 Average
23–27 Fair/fat
27+ Obese
If you compare these figures with the body fat percentages of men,
you will see that healthy women tend to carry approximately 10 percent
more body fat. This is nature’s way of giving women a small and muchneeded
fuel surplus for pregnancy, breast-feeding, and child rearing.
Most women believe that it is inevitable that their body fat–to–lean
muscle ratio will rise as they age and experience the hormonal changes
associated with menopause. In fact, the tables you see in some health
books, on the Internet, or in your doctor’s office will reflect this belief,
allowing for a higher “healthy” percentage of body fat in older people. But
women do not have to settle for a higher fat percentage as they reach
midlife and their later years. The amount of body fat is directly related to
diet, exercise, lifestyle, and hormonal balance.
While it’s unlikely that a seventy-year-old woman is going to have 14
percent body fat, she shouldn’t be content to settle for an unhealthy
amount of fat. It is never too late to improve your body composition
through a good nutritional and exercise program. And, I might add, it’s

never too early. In recent years in my Fat-Burning Metabolic Fitness Plan,
I have been seeing women in their twenties and thirties with a high percentage
of body fat. One thirty-eight-year-old female client who is 5 feet
8 inches and weighed 158 pounds didn’t really consider herself to have a
weight problem until we tested her and she saw that her body fat was 34.5
percent, which made her technically obese.
In contrast, since I work with many world-class female athletes, I often
see clients whose larger, more muscular bodies cause them to weigh more
than the average woman of their height and frame size. In their case,
however, they have a very low percentage of body fat and a higher-thanaverage
percentage of lean muscle. A good example would be a female
body builder or a competitor in any type of sport where strength is required.
Chapter 4 has a simple at-home test to measure your body fat–to–lean
muscle ratio.
The Classic Female Body Type
By now it should be clear that the most important issue is not just how fat
you are but if your level of body fat is within the healthy range. Where do
you carry your fat and when does fat become a problem?
The classic female body type is the gynoid shape—that is, fat storage
below the waist in the hip and buttocks areas, causing a pear-shaped silhouette.
Since weight below the waist presents less of a health risk than
abdominal fat, an overweight woman actually has a lower risk than an
overweight man for certain illnesses such as heart disease. An article in the
British Medical Journal states, “Recent studies have also shown that a
preferential accumulation of body fat in the glutofemoral region [hips and
thighs], commonly found in premenopausal women and initially described
by Vague [a French physician] under the term ‘gynoid obesity’ is not a
major threat to cardiovascular health.”
Learn the Dangers of the Reverse Fat Pattern
All bets are off, however, when a woman begins to develop what I have
described as a reverse fat pattern—that is, fat in the abdominal region.
Although many people think of cardiovascular disease as a man’s disease,
it kills more than half a million women per year. It just affects women ten
to fifteen years later than the average high-risk male. A woman’s risk for
heart attack gradually increases following menopause precisely because
that is the time when she is most likely to be storing excess fat in the

abdominal region. One of the reasons is that her body is producing less of
the hormone estrogen, which has a positive effect on fat mobilization.
Even though women have their first heart attacks later than men, they
are more likely to die from them. Within one year of having an attack, 25
percent of men die, but 38 percent of women die. According to a recent
article in Health Day News, women are also more likely than men to be
physically disabled by a stroke and/or to have speech difficulties, visual
impairment, and difficulty chewing and swallowing. On average, women’s
hospital stays were longer by three days. These are all good motivations to
lose that excess abdominal fat.
Women are also less likely to experience the traditional chest pains
that warn of heart problems in men. Instead they will complain of abdominal
discomfort, nausea, vomiting, fatigue, and shortness of breath. The
American Heart Association warns that even though heart attacks are more
likely to kill women after they turn sixty-five because they have lost much
of the protective value of estrogen and other hormones, coronary events
kill 20,000 younger women each year because they do not recognize the
gender-specific symptoms of heart problems. Of course, the more obese a
younger woman is and the more weight she carries in her abdominal area,
the more at risk she will be.
A woman with a reverse fat pattern, whatever her age might be, is also
at greater risk for developing type 2 diabetes; certain types of cancer;
problems with weight-supporting joints in her hips, knees, and ankles; and
foot problems because of the greater constrictive design of women’s
footwear.
In my Fat-Burning Metabolic Fitness Plan, I work with many women
who have a reverse fat pattern caused by being overfat. Many of them suffer
from significant hormonal imbalances. The primary hormones affected
are estrogen, testosterone, progesterone, and human growth hormone
(HGH). A significant number of these morbidly obese women also experience
the symptoms of hypothyroidism.
Cushing’s Syndrome
In rare cases the appearance of the reverse fat pattern in women can be
caused by Cushing’s syndrome. Dr. Richard Milani, the vice chairperson
of the Department of Cardiology at the Ochsner Heart and Vascular Institute,
New Orleans, Louisiana, says that Cushing’s syndrome is a relatively
rare hormonal disorder caused by prolonged exposure to high levels of
cortisol, a hormone produced by the adrenal gland. It usually results in

abdominal obesity with sparing (thin or slender) of the arms and legs.
There is often rounding of the face and thickening of the fat pads around
the neck. Additionally, there are pronounced pink-purple stretch marks
as well as thin and fragile skin. Women usually have excess hair growth
on their face, chest, abdomen, and thighs. Irritability, anxiety, and depression
are common. There are various causes of excess cortisol production
including tumors that secrete or stimulate cortisol production. Cushing’s
syndrome can also be caused by prolonged use of high doses of prednisone.
This condition can be evaluated by blood tests, and treatment is
based on the cause in a given individual.
Further Dangers of Abdominal Fat:
Metabolic Syndrome X
Overfat women often exhibit one or more of a whole cluster of symptoms
that doctors call Metabolic Syndrome X. These include a waist circumference
of 35 inches or more, triglycerides greater than 150 mg/dl, HDL
(good cholesterol) less than 50 mg/dl, a fasting glucose greater than 110
mg/dl, and blood pressure greater than 135/85 mm/Hg. Anyone who has
three or more of these symptoms is diagnosed with metabolic syndrome X.
In chapter 4, I include a questionnaire to help you determine whether you
have this syndrome. It is important because this combination of symptoms
can be a strong indicator that you are at risk within the next ten years for a
major cardiovascular event such as heart disease.
The Pros and Cons of the Waist-to-Hip Ratio
Since women naturally store excess fat in the hips and thighs, traditionally
one of the best indicators of whether you are overfat is your waist-to-hip
ratio. In chapter 4, I show you how to accurately measure your waist-tohip
ratio. I have found, however, that when a woman begins to exhibit a
reverse fat pattern with abdominal fat, this measurement can often become
inaccurate.
In a recent article published in the British Medical Journal, Dr. Jean-
Pierre Despres of the Quebec Heart Institute pointed out the weakness of
the waist-to hip ratio as a reliable indicator of risk for disease in women
who have adopted a male fat pattern. Such individuals tend to keep gaining
fat equally in the waist and the hips while their ratio remains within the
“safe” range. His conclusions were based on a twenty-year study that
found that once a woman begins gaining weight above the waist, her waist-
to-hip ratio is no longer an accurate determination of how much body fat
she is carrying: “Simultaneous increase in waist and hip measurements
means ratio is stable over time despite considerable accumulation of visceral
adipose tissue. . . . Thus, waist circumference provides crude index
of absolute amount of abdominal adipose tissue whereas waist:hip ratio
provides index of relative accumulation of abdominal fat.”
For this reason, even though the waist circumference has been considered
the gold standard for predicting obesity in men and the waist-to-hip
ratio the gold standard for women, the waist circumference is a vitally
important evaluation tool for both genders. A waist circumference of 35
inches or more spells trouble for women.
The British Medical Journal article also points out that when a woman
experiences the reverse fat pattern, especially before menopause, it can
indicate that she is a candidate for hypertriglyceridemia, which indicates
an increase in the level of triglycerides in the blood, again increasing her
risk for cardiovascular disease.
Gender Differences in Fat Mobilization
A cell receptor can be thought of as the parking space in which a hormone
sits and does its work of turning cell function off and on. The two main
types of cell receptors where epinephrine, a fat-mobilizing hormone, can
“park” and act on the cell are called alpha receptors, which inhibit the
breakdown of triglycerides (a.k.a. the storing of fat), and beta receptors,
which stimulate the burning of fat.
Research has shown that both men and women have more beta receptors
in the abdominal area, meaning that fat is easier to lose in that part of
the body. But women have more alpha receptors in the hip and thigh areas
than men, which explains why they tend to store more fat in those areas
and why it is harder for them to lose fat.
Another factor contributing to gender differences in fat storage may be
the concentration of lipoprotein lipase (LPL) in various tissues. LPL,
which also regulates the mobilization of free fatty acids, is located in the
walls of blood vessels throughout the body. Women have a greater concentration
of LPL in the hips and thighs and a smaller concentration in the
abdominal area than men.
The female hormone estrogen may have a positive effect on fat mobilization
because it inhibits the fat-storing action of LPL, enhances the production
of the fat-mobilizing hormone epinephrine, and stimulates the
production of human growth hormone (HGH), which inhibits the storage
of excess glucose by the body’s tissues and increases the mobilization of
free fatty acids from adipose tissue.
Kim Cummins: Watching the Inches Melt Off
I was scheduled to do three makeovers for an article in Let’s Live magazine
and was looking for people willing to undergo my twelve-week Fat-
Burning Metabolic Fitness Plan. One day at lunch while I was watching
my executive assistant, Kim Cummins, having a margarita, fried soft-shell
crabs, and ice cream, I was suddenly hit with the inspiration that she would
be the perfect candidate. When Kim had come to work for me five years
earlier, she weighed 140 pounds, but since then she had gained 36 pounds,
mostly because of lifestyle choices such as eating a lot of fried foods and
fast foods. The joke when we went out for a meal together with clients or
athletes was always “Don’t eat the way Kim does; eat the way Mackie
does,” and “See, Kim’s eating the disaster meal, but I want you to eat the
Mackie Meal.”
Kim would always laugh at me because she was young (she had just
turned thirty) and felt that she could get away with anything without it
adversely affecting her health. Kim ate whatever she pleased and never
exercised. I remember a couple of years ago when we both had our resting
metabolism tested. Kim teased me because hers was greater than mine:
“See, my metabolism is a better fat burner than yours.” I said, “But Kim,
my body fat is 6 percent. You can joke around now, but someday in the
future your lifestyle is going to come back to haunt you.”
Sure enough, when my doctor gave her a health evaluation at the start
of my Fat-Burning Metabolic Fitness Plan, she had some unpleasant surprises.
Her body fat was 35.1 percent, her LDL (bad cholesterol) was high
at 154.2 (ideally it should be between 100 and 129), and her waistline was
36 inches (remember, anything above 35 represents significant health
risks). Kim knew that abdominal fat was a big strike against her. Most
alarming was her C-reactive protein, which was 6.56 (the normal range is
between 0 and 0.3). C-reactive protein at this level is an indicator of
inflammation, which points toward a greater risk of heart attack. “My
blood work was my wake-up call,” she told me. “I was only thinking of
doing the program before this. I thought it would be fun to work with a
trainer and look good in my swimsuit when I went to Miami for my vacation.
But the results of the blood work really decided me.”
Kim never ate breakfast but ate a large lunch and dinner. It was a bit of
a challenge for my nutritionist to get her on the Fat-Burning Metabolic Fit-
22 The Fat-Burning Bible
ness Nutritional Plan with enough fiber because she did not like vegetables
and hated breakfast foods. Kim said, “If you can make spinach taste like
ice cream, I’ll eat it. Otherwise, forget it.” I told her that if she would learn
to eat fiber-rich vegetables, she would see a rapid decrease in her body fat.
She even agreed to go to a hypnotist to see if she could overcome her aversion
to vegetables, but to no avail.
In spite of this obstacle, we managed to find a food plan with which
Kim felt comfortable, and she began eating three large meals and two
snacks a day. At first it was a challenge for her to eat all that food, but she
was so determined to follow the plan that she actually set an alarm clock to
remind her to stop work and grab a snack. She knew it was important for
her to eat at least every four hours to boost and stabilize her metabolism.
Within a very short time, Kim noticed a dramatic change in her energy.
She told me, “My energy increased unbelievably. Food had never been an
obsession with me. My problem was that I didn’t eat often enough. Come
afternoon, I’d be so tired that one time I actually fell asleep at the wheel of
my car at a red light. It was only for a second, but it totally freaked me out.
I knew if I’d taken my foot off my brake I would have hit the person in
front of me.” But now she never feels that afternoon slump. Her sleep has
also become more restful. Even though she’d always been a heavy sleeper
who had trouble getting out of bed in the morning, Kim told me that she
was waking up filled with energy before her alarm clock went off.
We took photos at the beginning of the Fat-Burning Metabolic Fitness
Plan, then at one-month intervals. A second turning point came for Kim
when she compared her before picture with her after picture at one month.
Kim told me that she really wasn’t expecting much after only thirty days.
She’d noticed that her muscles were getting harder, especially her legs,
which had never been muscular before, and that she was losing inches, but
she’d only lost 5 pounds of scale weight. I told her not to worry because I
could see that she was losing fat and gaining lean muscle.
When Kim actually compared the two pictures, she burst into tears. “I
didn’t realize how fat my face had become. You always lose weight in the
last place you put it on. My face had gone from being round and fat to real
slender and skinny. I just couldn’t believe how big it had been and how
much of a difference there was now. I was only expecting small changes in
the second photo. When I saw the results, I realized that I had been expecting
that much change at the end of three months. It was a dramatic difference
after only one month. I was in shock.”
At the end of three months, Kim was feeling great. Her statistics
demonstrate the changes her body went through:

Measure Start End
Waistline 36 in. 32.75 in. (a loss of 3.25 in.)
Hip 43 in. 41 in. (a loss of 2 in.)
BMI 25.46 24.11 (a drop of 1.35 points
into the lower-risk range)
C-reactive protein 6.56 3.73 (a drop of 2.83 points)
Total cholesterol 223 209 (a drop of 14 points)
LDL 154.2 130 (a drop of 24.2 points)
HDL 50 50 (still within the healthiest
range for women)
Lipoprotein a 20 11 (a loss of 9 points)
Although she had only lost 10 pounds of scale weight at that point, she
had lost much more than that in actual pounds of body fat. I often see this in
clients—a kind of conversion process where the fat melts off and they lose
inches all over their body as they replace it with lean muscle. When we
measured Kim’s fat–to–lean muscle ratio, she had 22 pounds of fat and 144
pounds of lean muscle, which made her very happy. She told me that she
looked so slimmed down that everyone thought she’d lost about 50 pounds.
Kim is indicative of many young women who fall into the trap of eating
poorly, who give up exercise in favor of working long hours at a career
they enjoy, and who start experiencing a metabolic slowdown with its
accompanying gradual accumulation of body fat at an early age. These
lifestyle choices are a one-way ticket to disaster.
To this day, Kim continues to follow the Fat-Burning Metabolic Fitness
Plan because it has made such a difference in her life. She feels better
than she’s felt in years and looks great. Most important, she’s stopped a
trend in body fat gain that would have greatly lessened the quality of her
life as she reached middle age and quite probably might have resulted in
serious illness later on and a much shorter life span.
The Classic Male Fat Pattern
Fat in men has been christened with a variety of names. We call it the beer
belly, the spare tire, or simply the gut. We joke about it, calling it Dunlap’s
disease (“His stomach done lapped over his belt”) or give it a playful label
such as love handles. But there is nothing humorous about abdominal fat.
It is a dangerous health risk that can lead to complications such as cardiovascular
disease, some types of cancer, hypertension, type 2 diabetes, and
erectile dysfunction.

To better understand the dangers of abdominal fat, let’s take a look at
what body processes are involved in male fat storage.
The Importance of the Body Fat–to–Lean Muscle Ratio
When most people think about how fat or thin they are, they think about
how many scale pounds they weigh. While your weight on the scale is certainly
important and will give you some information about your general
health, it is even more important for you to determine your body composition—
that is, how many pounds of fat you carry in relationship to how
many pounds of lean muscle. The following table categorizes body fat percentages
for men:
Body Fat (%) Level
<11 Athletic
11–14 percent Good/lean
15–17 percent Average
18–22 percent Fair/fat
22+ percent Obese
Most men believe that it is inevitable that their body fat–to–lean
muscle ratio will rise as they age and experience the hormonal changes
associated with andropause. In fact, the tables you see in some health books,
on the Internet, or in your doctor’s office will reflect this belief, allowing
for a higher “healthy” percentage of body fat in older people. But men do
not have to settle for a higher fat percentage as they reach midlife and their
later years. The amount of body fat is directly related to diet and exercise.
While it’s unlikely that a seventy-year-old man is going to have 11 percent
body fat, he shouldn’t be content to settle for an unhealthy amount of
fat. It is never too late to change your body composition through a good
nutritional and exercise program. And, I might add, it’s never too early. I
have seen men in their twenties and thirties with high percentages of body
fat, especially in sports such as football where large size is important. Chapter
4 has an at-home test to measure your body fat–to–lean muscle ratio.
Scale Weight Does Not Tell the Whole Story about Fat
If your percentage of fat versus lean muscle is the true indicator of whether
you have a healthy body composition, then how much you weigh on the
scale does not really give you an accurate idea of how overfat you may be.
Let’s look at two athletes who weigh 240 pounds.
The first man, Jon, is a body builder with 10 percent body fat; all the
rest is lean muscle. Jon’s metabolism is very efficient because lean muscle
is metabolically very active. His appearance is firm and muscular, his
waistline is trim, and his abdomen is flat. His general health is excellent,
his lipid profile (triglycerides and cholesterol) is well within the normal
range, and he feels energized and alert throughout the day.
The second man, Paul, has 40 percent body fat and looks and feels
completely different. Even though he is an NFL lineman, his metabolism
is not as efficient as it should be because body fat is not metabolically
active. His body looks overfat, his waistline measures 48 inches, and his
stomach bulges over his belt. His cholesterol and triglyceride levels are
dangerously high. Because he carries so much weight in the abdominal
area, he is seriously at risk for type 2 diabetes and cardiovascular disease
(if he doesn’t already suffer from these diseases not yet diagnosed). Even
though he is a professional athlete, his body does not feel fit and his heavy
stomach puts a strain on his lower back. He often complains of back, knee,
and hip pain from all of the extra fat he drags around.
Where Do You Carry Your Weight?
By now it should be clear that the most important issue is not just how fat
you are but where you carry your fat and the point at which it becomes a
problem.
The classic male fat pattern is the apple or android shape—weight
above the waist. Therefore, the waist measurement in a man is one of the
most accurate indicators of how much at risk he is for a variety of serious
diseases. In 2002, when the American Heart Association published their
revised “Guide to the Primary Prevention of Cardiovascular Diseases” in
Circulation magazine, they warned that a waist measurement of 40 inches
or more in a man indicated a greater chance of developing cardiovascular
disease. Dr. Sidney C. Smith, the association’s chief science officer, was
quoted as saying, “It’s turned out that waist circumference is as good a predictor
of risk as body mass index.”
In my Fat-Burning Metabolic Fitness Plan, I have found that waist circumference
is a better indicator of health risks than BMI. For example, the
waistline measurement is an especially good tool in evaluating older men
who have not gained weight but have undergone unhealthy changes in
body composition. I have seen many clients in their sixties and seventies
whose weight has not gone up in years—that is, their BMI has not
changed—but they have gained inches in the waistline, indicating a loss of
lean muscle and an increase in body fat. Some people swear by the waistto-
hip ratio as a good evaluation tool, but I always look primarily at the
waist measurement in men, because when a man has a reverse fat pattern,
his waist-to-hip ratio can remain constant over time while he is actually
storing quite a bit of fat in that part of the body.
Vulnerability to certain diseases can even be present in a man whose
waistline is less than 40 inches. Depending on how clients measure up during
their initial health evaluation and how much body fat–to–lean muscle
they have, my doctors usually suggest that some men take a glucose tolerance
test or a hemoglobin A1C test, which follows a person’s blood sugar
over a two- to three-month period if his waistline has reached 37 inches.
This is because there is such a high correlation between excess abdominal
fat and insulin resistance, a precursor to type 2 diabetes.
I have also seen a direct correlation between erectile dysfunction and
abdominal fat. A 2000 study funded by the National Cancer Institute found
that men with a waistline measurement of 42 inches or more were twice as
likely to suffer from erectile dysfunction than men with a waistline measuring
32 inches. Men who were inactive were also more prone to this
problem than men who exercised at least thirty minutes a day.
This information was confirmed by the results of a 2003 study of
nearly 32,000 men aged 53 to 90 reported in the Annals of Internal Medicine.
Researchers found that one out of three older men suffered from
erectile dysfunction. However, men who were not overfat and who exercised
regularly were 30 percent less likely to have this condition.
Further Dangers of Abdominal Fat:
Metabolic Syndrome X
Overfat men often exhibit one or more of a whole cluster of symptoms that
doctors call Metabolic Syndrome X. These include a waistline of 40
inches or more, triglycerides greater than 150 mg/dl, HDL (good cholesterol)
less than 40 mg/dl, a fasting glucose greater than 110 mg/dl, and
blood pressure greater than 135/85 mm/Hg. Anyone who has three or more
of these symptoms is diagnosed with Metabolic Syndrome X. In chapter 4,
I include a questionnaire to help you determine whether you have this syndrome.
It is important because this combination of symptoms can be a
strong indicator that you are at risk within the next ten years for a major
cardiovascular event such as heart disease.

In a recent article published in the British Medical Journal, Dr. Jean-
Pierre Despres of the Quebec Heart Institute referred to Metabolic Syndrome
X as hypertriglyceridemia and confirmed the risk for heart disease
that the symptoms above represented when coupled with a waistline of
over 40 inches. Dr. Despres also pointed out the weakness of the waist-tohip
ratio as a reliable indicator of risk for disease, since men who had
adopted a female fat pattern tended to keep gaining fat in the waist and
hips while their ratio remained within the “safe” range.
Don’t Be Defeated by the “Beer Belly Gene”
I have heard many men make the excuse that they carry abdominal fat
because of their DNA. Every man in their family has a huge gut and therefore
they themselves are doomed to this “genetic” condition of being
overfat.
In most instances, I have discovered that this is not the case. Overfat
individuals almost always grow up in—and continue to live in—an environment
where their family, friends, and loved ones all have poor eating
and exercising habits. They are obese because of their lifestyle and
unhealthy nutrition habits, not because of some mysterious fat gene.
However, in a minority of men, scientists have found something that
they have dubbed the “beer belly gene.” A recent study conducted by a
team of researchers at the University of Naples and published in the
Annals of Internal Medicine found that of 959 men between the ages of
twenty-five and seventy-five, a small percentage did have a genetic variation
that predisposed them to develop abdominal fat.
This genetic predisposition does not spell doom, however. The bottom
line was that these men had a greater propensity to develop an unhealthy
amount of abdominal fat if and only if they led an unhealthy lifestyle.
None of these men got beer guts from eating nutritious foods and exercising
regularly. And they had just as much chance of losing fat and increasing
their lean muscle mass as men without the beer belly gene. In the case
of these men, if they wanted to keep the fat off, they would just have to be
a bit more vigilant in their lifestyle.
Learn Why Exercising Increases Fat Loss
We’ve seen the many health risks associated with abdominal fat. Now for
the good news: abdominal fat is the easiest type of body fat to lose.

Fat is stored in cells in the form of triglycerides. You’ve heard that
exercise increases the body’s ability to burn fat, but probably you’ve never
really understood why that happens—or, for that matter, why you should
even bother to exercise if you’re already on a good food program.
Shouldn’t just eating correctly be enough? In reality, appropriate exercise
greatly enhances your body’s ability to burn stored fat.
Epinephrine is a fat-mobilizing hormone released by your sympathetic
nervous system. Studies have shown that during exercise there is a significantly
greater concentration of this hormone in your body. When epinephrine
binds to specific receptors on fat cells, it stimulates hormone-sensitive
lipase, also known as HSL, to break apart triglycerides within the cells and
release them into the bloodstream where they can be used as energy. And
that’s precisely what you want to happen. You don’t want that fat to just sit
around in your body; you want to get it mobilized.
When you engage in aerobic exercise, HSL becomes even more sensitive
to epinephrine since your body temperature is rising. The greater your
aerobic endurance, the less concentration of epinephrine it will take to
activate HSL and release stored fat. If you are obese, however, it will take
significantly higher amounts of this hormone to stimulate the breakdown
of triglycerides.
Another hormone affected by exercise is leptin, a peptide hormone
produced by the adipose (fatty) tissue that plays a role in the storing of
body fat and in overall energy balance. A recent study published in the
Journal of Nutritional Biochemistry states that exercise combined with
dieting is the most effective combination to reduce levels of leptin in the
body, with a resulting loss of body fat.
The Secret to Abdominal Fat Loss: Alpha Receptors
and Beta Receptors
A cell receptor can be thought of as the parking space in which a hormone
sits and does its work of turning cell function off and on. The two main
types of cell receptors where epinephrine, a fat-mobilizing hormone, can
“park” and act on the cell are called alpha receptors, which inhibit the
breakdown of triglycerides (a.k.a. the storing of fat), and beta receptors,
which stimulate the burning of fat.
Research has shown that both men and women have more beta receptors
in the abdominal area, meaning that fat is easier to lose in that part of
the body. But women have more alpha receptors in the hip and thigh areas
than men, which explains why they tend to store more fat in those areas.
The core body exercises in this book are specifically designed to
enable your body to mobilize its fat-burning capacity to reduce the abdominal
area of your body.
Dangers of the Reverse Fat Pattern
The most unhealthy areas in which a man can gain fat are in the hips and
buttocks. This is known as the reverse fat pattern, because it mimics the
classic areas where women most often gain weight. By the time a man has
crossed over into a reverse fat pattern, his waistline usually measures 50
inches or more and he is considered to be morbidly obese. As already
stated, it is much more difficult for a man to mobilize fat in this part of the
body than it is in the abdominal region.
I work with many men who have a reverse fat pattern. Many of them
suffer from significant hormonal imbalances. They exhibit low testosterone,
higher than normal levels of estradiol (which is the primary hormone
in females), lower sex drive, erectile dysfunction, and low thyroid.
The lowered testosterone and higher estradiol levels often result in
gynecomastia, in which a man’s breasts become soft and prominent like a
woman’s. As a man’s body becomes “feminized” by excess fat, he has a
much lower than average percentage of lean muscle and suffers from
decreased strength, irritability, and chronic exhaustion.

Success in Combating the Reverse Male Fat Pattern
Douglas Daniels, a forty-one-year-old New Orleans French Quarter nightclub
performer, was a classic example of the reverse fat pattern. When
Douglas first entered my Fat-Burning Metabolic Fitness Plan to be evaluated,
he was so morbidly obese that our doctors gave him five years maximum
to live. Here are his health statistics before beginning my plan:
Height 5'8"
Weight 368 lb.
Cholesterol 201
Triglycerides 567
Glucose 283
Waist 61 in.
Hips 66 in.
BMI 57.88
Notice that Douglas’s hips are 5 inches larger than his waist, indicating
a reverse fat pattern where he not only carries fat in his abdomen but in
his hips and buttocks.
Douglas was a two-pack-a-day smoker, increasing his potential risk of
heart disease and cancer, and he suffered from sleep apnea, a disease that
can damage the heart if left untreated. He had to take an oral medication
called glucophage for type 2 diabetes. He suffered from low testosterone
and hypothyroidism. He was a walking time bomb, and I knew that I had
to motivate him to save his own life—fast.
Our doctor immediately put him on thyroid medication and enrolled
him in our Ochsner Cardiac Rehabilitation Program, where he worked to
increase his aerobic fitness. During that time he did resistance exercises
with light dumbbells and exercises to strengthen and stabilize the core area
of his body. One of the most important steps was to dramatically overhaul
his nutritional regimen, which then consisted of large amounts of fatty
fried foods and rich, high-calorie pasta dishes that his mother and his
fiancée cooked for him. Douglas and his girlfriend learned how to make
delicious low-fat Italian dishes and healthier “N’awlins”-style meals and
to enjoy the low-glycemic, low-saturated-fat Mackie Meals that nutritionist
Molly Kimball and I have developed for my clients (see chapter 10).
After six weeks, Douglas continued with the food program and graduated
to performing an exercise program that contained added cardio and
interval training to his resistance and core exercises. I also gave him tools
for reducing stress and staying motivated.
By the end of the twelve-week makeover for the Discovery Health
Channel show, Health Cops New Orleans, Douglas’s statistics had changed
dramatically:
Weight 310 lb. (a loss of 58 lb.)
Cholesterol 142 (a loss of 59 points)
Triglycerides 95 (a loss of 472 points!)
Glucose 107 (a loss of 176 points)
Waist 52 in. (a loss of 9 in.)
Hips 54.5 in. (a loss of 11.5 in.)
BMI 48.75 (a drop of 9.13 points)
Douglas has quit smoking, no longer snores, and no longer has to take
his medication for diabetes. He has faithfully followed the program and
continues to lose weight and build lean muscle mass. Twenty weeks after
he started, he had lost an additional 33 pounds, bringing him to a grand
total of 91 pounds of scale weight lost!
If my Fat-Burning Metabolic Fitness Plan can work on someone who
was as far gone as Douglas, you know it can work for you. If he and literally
hundreds of other overfat men and women with significant health risks
can turn themselves around using the plan presented in this book, what are
you waiting for? There’s really no excuse not to begin today.

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