The American Heart Association (AHA) reports that a high waist circumference among individuals with normal weight appears to be a more reliable predictor of risk for heart attacks than just being overweight (Circulation, April 22, 2021). The AHA recommends using the ratio of waist circumference to body height or the waist-to-hip ratio to warn about increased heart attack risk. Doctors can also check for fat in the liver by ordering a liver sonogram.

Waist to Height Ratio Calculator
Waist to Hip Ratio Calculator

Excess belly fat is associated with high blood pressure, insulin resistance and high cholesterol. Overweight people who do not have excess belly fat are at lower risk for heart attacks. The authors cited articles showing that:
• a combination of dietary change and exercise has been shown to help reduce abdominal obesity even without weight loss, and
• three to five exercise sessions per week for 12 to 52 weeks reduced belly fat, even if the subjects did not lose weight.

In addition to increasing risk for heart attacks, excess belly fat increases risk for:
• diabetes (BMC Public Health, November 18, 2019),
• cancers (Oncogene, August 7, 2017),
• dementia (J Am Geriatr Soc, June 2017;65(6):1282-1288; Neurology, September 30, 2008;71(14):1057-1064).

What Excess Belly Fat Means
Storing fat primarily in your belly is a strong indicator that you also have fat stored in your liver. Your liver is supposed to prevent blood sugar levels from rising too high. When a healthy person eats, blood sugar rises and the pancreas responds by releasing insulin into the bloodstream. Insulin lowers blood sugar by driving sugar from your bloodstream primarily into your liver. However, if you have a lot of fat stored in your liver, your liver cannot accept the extra sugar, blood sugar levels remain high, and this causes sugar molecules to attach to the outer membranes of cells. Once sugar is stuck on a cell, it can never get off and is converted by a series of chemical reactions from glucose to fructose and eventually to sorbitol that destroys the cell. This process causes all of the horrible side effects of diabetes.

If you can pinch two or more inches of fat beneath the skin next to your belly button, you are likely to have high blood sugar levels. Check with your doctor, who can do tests for the markers of type II diabetes:
• fasting blood sugar >97
• blood sugar >145 mg/dL one hour after eating
• triglycerides >150,
• good HDL cholesterol <40,
• HBA1C (a measure of sugar stuck on cells) >5.5
• a sonogram test showing extra fat in the liver.

Lifestyle Changes Are More Important than Drugs
There are no drugs that will specifically get rid of fat in your liver, but a lifestyle program with diet and exercise can help (Journal of Hepatology 2017;67:829–846).
Lose Excess Weight: If you have any of these risk factors for diabetes, or if you are already diabetic, you should immediately work to lose weight until you are down to one inch or less of fat over your belly. A seven percent reduction in body weight reduces diabetes risk by almost 60 percent (Diabetes Care, Dec 2002;25(12): 2165–2171). I recommend Intermittent Fasting
Avoid Sugar-Added Foods: Sugar-added foods can cause much higher rises in blood sugar than fruits and vegetables, even though these foods contain sugar. Even moderate amounts of sugar added to foods can raise blood pressure and increase risk for diabetes and heart attacks (British Medical Journal, December 10, 2014).
Avoid Drinks with Sugar: Sugared drinks, including fruit juices, cause high rises in blood sugar levels, because they pass directly from the stomach into the intestines where they are absorbed almost immediately. Quench your thirst with water or other non-sweetened beverages.
Eat Lots of Plants: Fruits and vegetables contain antioxidants that help to prevent the inflammation that can cause insulin resistance. See my report on Anti-Inflammatory and Pro-Inflammatory Foods
Try to Exercise Every Day: Any muscle movement, even when muscles are moved passively on a motor-driven stationary bicycle, lowers blood sugar and increases insulin sensitivity (Med Sci Sports Exerc, published online April 6, 2016). Exercise helps to prevent high rises in blood sugar and increases insulin sensitivity, which helps to cure diabetes and to prevent heart attacks. Contracting muscles lower blood sugar by drawing large amounts of sugar from the bloodstream. Exercise empties the liver and muscles of their stored sugar so you have more places to store sugar safely in your body. The increased sensitivity to insulin caused by exercise lasts only about 17 hours, so you need to exercise every day to get the full benefit.

My Recommendations
If you can pinch more than two inches of fat beneath your skin next to your belly button, you have abdominal obesity that is likely to indicate excess fat in your liver, which puts you at increased risk for diabetes, heart attacks, strokes and certain cancers. To prolong your life, you should follow all of these lifestyle rules for getting rid of fat in your liver.