What can I do about my "beer belly"?

Q. It seems like more men are developing "beer bellies" as they age, including me. What causes it, and is it just a cosmetic problem?

A. It's unclear when the term "beer belly" originated, but in the distant past, keg-shaped abdomens were uncommon. They tended to occur in men who drank heavily, especially high-calorie beers.

Today, excessive beer drinking can still play a role in men's expanding girth. However, most men with beer bellies do not overuse alcohol. So why is it happening? Experts believe the unintended consequences of an old public health message and the conveniences of modern living are the two primary reasons.

Decades ago, public health advocates pushed the importance of decreasing the intake of dietary fats to help control the rising rate of cardiovascular disease, but with little or no emphasis on choosing healthy versus unhealthy fats. In response, food companies moved to products with "no" or "low" fat. But instead, they created products with higher amounts of simple carbohydrates, especially added sugars. Many experts think this is a significant cause of the rising obesity problem.

During this same time, the conveniences of modern life led to less daily physical activity. And many men have not dedicated time for the recommended 150 minutes per week of moderate-intensity exercise.

Regarding cosmetic versus health issues from a beer belly, it matters where the body fat is deposited. Subcutaneous fat lies under our skin. Fat accumulating around our organs deep inside our abdomen is called visceral or belly fat. Any excess body fat can lead to a higher risk of health issues, like knee and hip osteoarthritis. However, extra visceral fat is more dangerous because it is closely linked to a greater chance of developing diabetes and heart disease.

There's another much less common but important reason for a round belly: fluid accumulation within the abdomen known as ascites. Ascites most often happens in people with cirrhosis of the liver. But it can also signal heart failure or (rarely) cancer.

Although not precise, one way to determine if your beer belly consists primarily of subcutaneous fat, visceral fat, or ascites is how the fat moves and feels. Fat that is soft and jiggles is more likely just under the skin, while a harder belly tends to indicate more visceral fat or perhaps ascites.

If your waist size measured at your navel is 40 inches or more, it's best to let your doctor help determine the cause of your beer belly. Unless it's due to ascites, you probably already know what your doctor will advise: consume fewer calories, cut out the simple carbs, and schedule time for daily exercise. And, of course, cut back on the beer.

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