Having a pot belly – even if you are not overweight – poses a greater risk of death from heart problems than being generally obese, warn doctors. A ‘spare tyre’ around the waist is uniquely dangerous because it is packed with ‘bad fat’, research shows.Â
The US study found that those who were not overweight but had a bulging midriff were 2.75 times more at risk of dying from cardiovascular disease than normal weight and a proportionate waistline. They were also at 2.08 times the risk of dying prematurely from all causes.Â
Most strikingly, people with a healthy overall weight but too much abdominal fat were even more likely to be heart victims than generally obese people, whose risk was 2.34 times more than those of normal weight with a regular waistline. Middle-aged spread – known as central obesity – is partly responsible for the development of heart disease and diabetes.
 Fat packed around the organs in the abdomen is more dangerous than fat on the hips because it’s ‘metabolically active’, releasing more of the inflammatory, toxic chemicals that raise heart disease risk. Many experts now want waist circumference or waist-to-hip ratio, which indicates levels of abdominal fat, adopted as a more accurate guide than body mass index (BMI), which relates weight to height.
 Dr Francisco Lopez-Jimenez, senior author on the study and a cardiologist at the Mayo Clinic in Rochester, Minnesota, said: ‘We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight.Â
‘This group has the highest death rate, even higher than those who are considered obese based on BMI. From a public health perspective, this is a significant finding.’Â
 The latest study looked at data on 12,785 people aged 18 and over, who were divided into three categories of BMI – normal, overweight and obese – then divided by whether waistlines were normal or larger. Over 14 years, there were 2,562 deaths, of which 1,138 were cardiovascular-related. The highest risk of death was in people with normal BMI and large waistlines.Â
Dr Karine Sahakyan, who is a cardiology research fellow at the Mayo Clinic, presented the findings yesterday at the European Cardiology Congress in Munich. Dr Lopez-Jimenez added: ‘Our research shows that if a person has a normal BMI, this by itself should not reassure them that their risk for heart disease is low.
 ’Where their fat is distributed on their body can mean a lot, and that can be determined easily by getting a waist-to-hip measurement, even if their body weight is within normal limits.’
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