How to lose belly fat

Are you struggling to lose those extra pounds building up around your midsection? You certainly aren’t alone. On any given day, nearly half of American adults are on a diet to lose weight, and only a minority succeed.1

Difficulty with losing weight is troubling, especially concerning belly fat, also known as visceral, abdominal, or truncal fat. Belly fat’s impact is more serious than aesthetics. It’s associated with metabolic disease, type 2 diabetes, and other serious health concerns.2

That may sound depressing, but with the right information, you can choose a diet that specifically targets this problem. This guide will explain all you need to know about belly fat and provide advice to help you get rid of it for good.

 

1. What is belly fat, why does it matter?

Overweight or fat adult man in very tight jeans on a gray background. Healthcare, medicine concept.

People tend to carry fat in two distinct ways: either under the skin (as subcutaneous fat) or in the abdomen and surrounding internal organs (as visceral fat). The latter is what is often referred to as “belly fat”.3

How you carry fat is based on several factors: genetics, age, gender, and lifestyle all play a role.4 But the good news is that you can take control and lose unnecessary belly fat.

How to measure abdominal or visceral fat

A magnetic resonance imaging study (MRI) or CT scan are currently considered the gold standards for measuring visceral and abdominal fat.5 A DEXA scan, which uses a low dose x-ray beam produces similar results and may be more accessible. Other tests like bioimpedance scales are less accurate and provide less information about visceral fat, but are widely available.6

For those who don’t have access to imaging tools, a simple technique is to measure your waist circumference. General recommendations are for men to keep their waist measurement below 40 inches (101 cm) and women to keep their measurement below 35 inches (89 cm). However, some ethnic groups, such as South Asians, have lower cutoffs of 35 inches (89 cm) for men and 31 inches (80 cm) for women.7

However, we suggest aiming for an even smaller waist circumference, such as 35 inches (89 cm) for all men and 31 inches (80 cm) for all women.8 Keeping your waist-to-height ratio below 0.5 may be an even better measurement for predicting a lower risk of health complications.9

Low risk Intermediate risk High risk
Waist-to-height ratio <0.5 0.5-0.6 >0.6
Measuring your waist allows you to keep track of your results and follow your progress. It can help you determine if your eating plan is helping you reduce your risk of chronic disease.

If you’re losing weight but not reducing your waist measurement — or belly fat — you may want to change your weight loss methods.

You can also measure your hips and calculate your waist-to-hip ratio (waist measurement divided by hip measurement). The target for men is 0.9 and for women it’s 0.8.10

Do you want to learn more about how to accurately measure your waist circumference or hip to waist ratio?

Here are some steps to accurately and consistently measure your waist size:

  • Stand straight up; don’t slouch.
  • Wrap a flexible measuring tape around yourself, approximately midway between the bottom of your ribs and the tip of your hip bones. It is usually right around your belly button.
  • Breathe normally, and don’t suck in your belly.
  • Measure after you blow out a normal breath.

For measuring your hips, follow the same advice as above, except you want the tape measure around the widest part of your hips, usually a couple of inches below your hip bones.

It is best to take these measurements without bulky clothes between the tape measure and your skin. Feel free to wear fitted undergarments when measuring yourself.

Why does belly fat matter?

Abdominal fat is associated with an increased risk of several health conditions, including:11

  • metabolic disease12
  • type 2 diabetes13
  • heart disease14
  • inflammation15

Belly fat is even associated with a shorter life.16 Even “normal weight” people, as defined by BMI, with extra belly fat are at increased risk of health complications.17

As we saw in 2020, more visceral fat is associated with a higher risk of severe Covid-19 complications.18

Fortunately, excess belly fat can be reduced. Studies show that reducing it improves metabolic health and is likely to improve overall health.19

But not all weight loss leads to a reduction of abdominal fat. In one study, people who did a 10-day fast lost weight, but they lost mostly lean body mass, not fat. The participants eating a ketogenic diet lost fat mass without losing lean body mass. However, the study didn’t report how much of this fat loss was abdominal or visecral fat.20

Summary

Belly fat, also known as abdominal or visceral fat, is associated with an increased risk of multiple health conditions. Imaging tests, like DEXA scans or MRIs, are most effective for measuring belly fat, but simple techniques like waist circumference or waist to hip ratio are also very useful. Fortunately, lifestyle changes can decrease belly fat and improve overall health.


 

2. Nutrition

Any weight loss method may reduce belly fat to a degree. But what intervention helps reduce abdominal fat the most?

Low-carb nutrition

Low-carb nutrition lowers insulin, improves metabolic syndrome, and can reverse type 2 diabetes. It can also help people lose belly fat.21

In 2019, researchers from Virta health published a two-year study on the keto diet and reported a 15% reduction in abdominal fat.22

Other studies show a low-carb diet leads to greater loss of abdominal fat than a low-fat diet, although since they also lead to greater overall weight loss, it isn’t clear that they specifically targeted abdominal fat.23

In one study, low-carb dieters lost 22.8% of their abdominal fat, compared to only 1% for the low-fat dieters, again with greater overall weight loss.24

And another study reported an 11% reduction for low-carb eaters compared to a 1% reduction for low-fat dieters.25

A low-carb diet for beginners

Calorie restriction

Other methods of weight loss may also help people lose belly fat. One randomized trial reported that 12 weeks of calorie restriction reduced fat mass by 11 pounds (5 kilos) and visceral fat by 16%.26

However, as with most eating plans, other studies question the sustainability of these diets and results. One randomized trial using a low-fat, calorie-restricted diet reported that at eight years, the dieters lost only 4.4 pounds (2 kilos), almost all from lean mass rather than fat mass.27

An interesting randomized trial revealed that after one year, exercise without calorie restriction led to the same reduction in belly fat as a diet with 20% fewer calories.28

Vegan diets

In a recent 16-week trial, 122 overweight adults who ate a low-fat vegan diet lost an average of nearly 14 pounds (6.4 kilos), reduced their body fat by 10%, and became more insulin sensitive. The control group continued their standard diet and did not see any significant changes.29

Another 16-week trial reported those following a vegan diet lost 9.5 pounds (4.3 kilos) of fat mass, some of it from visceral fat, whereas those on the control diet did not lose any.30

Vegan diets do not provide all the essential nutrients that humans need, therefore they require ongoing supplementation. The needed supplements are usually widely available making supplementation a fairly easy process for most.31

Some may also find it challenging to meet adequate protein needs on a vegan diet. Protein intake is especially important during weight loss to maximise loss of fat mass and minimize loss of muscle mass.32

Read more about low-carb vegan diets in our evidence-based guide.

Intermittent fasting

Intermittent fasting for beginners
Studies of intermittent fasting, most of them examining alternate-day fasting, show that this strategy can also help people lose abdominal fat.

One study found that six weeks of alternate-day fasting led to a 7% overall weight loss with a visceral fat loss of 5.7%.33

Another randomized trial reported more significant fat mass loss with intermittent fasting than traditional dieting. Although they did not report specific abdominal fat loss.34

But not all studies agree. One trial of alternate-day fasting reported no change in visceral fat.35 This trial had subjects eat 25% of their usual calories one day and 125% the next day. This unusual protocol may have influenced the results.

People can combine intermittent fasting with any diet, so it’s a versatile option available to people with different food preferences.

Summary

Nutrition plays a vital role in reducing abdominal fat. Many diets that promote weight loss can help people lose belly fat. However, low-carb diets may be the most effective method, and studies show they may be more effective than low-fat diets. Intermittent fasting is another promising option.

 
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3. Exercise

Senior Woman in Fitness Class in a Plank Pose Smiling stock photo
One common misconception is that doing stomach strengthening exercises, like crunches or sit-ups, helps people lose belly fat. But studies show that sit-ups alone are not effective at reducing belly fat.36

Other types of exercise, especially when combined with an effective diet, may reduce belly fat. For instance, two trials reported high-resistance training and moderate-cardio programs had a greater impact on belly fat loss than lower-intensity exercise.37

And a study from Spain reported a more significant loss of total fat mass when the investigators added intense exercise to a low-calorie diet.38

Aerobic training alone may also be effective for visceral fat loss, but the key seems to be the intensity. Only studies of moderate and high-intensity aerobic exercise find a meaningful impact on belly fat.39

Summary

To lose unwanted belly fat, exercise can be a helpful addition to nutrition. However, exercise intensity matters, with moderate and high intensity aerobic or resistance exercise showing the best results.


 

4. Supplements

Taking Natural Supplements
If you believe the ads, there are hundreds of “belly busters” or products that will help the fat “melt away from your middle.” While most of these are ineffective, some supplements may help.

Green tea

One randomized trial reported a small benefit in abdominal-fat loss for a group randomized to a green tea extract when compared to a caffeine control group.40 Since the difference was small and this was just one study, you shouldn’t expect green tea to be a magic potion for belly-fat loss. But it may be an added bonus when combined with nutrition, exercise, and other lifestyle improvements.

Probiotics

A randomized study reported that those supplementing with Lactobacillus amylovorus experienced a small decrease in abdominal fat compared to those eating yogurt made with other bacterial strains.41

However, there’s still much to learn about our gut flora’s impact on weight loss and body composition. The evidence is not strong enough to make a general recommendation about using probiotics to lose belly fat. But, if you choose to take probiotics for other reasons, you may want to consider strains with Lactobacillus amylovorus.

Apple cider vinegar

One study in Japanese men reported those who drank 0.5 to 1.0 ounces (15 or 30 ml) of vinegar decreased their waist size by about 0.5 inches in 12-weeks.42

You can read more about the potential health benefits of apple cider vinegar in our evidence-based guide. Again, the evidence isn’t likely to be strong enough to recommend vinegar specifically for belly-fat loss. But if you are taking it for other reasons, you might see a small benefit.

Summary

Marketing for most supplements overstates their potential benefits to help people lose abdominal fat. Although the evidence is limited, some people may see a small effect from green tea, probiotics, or apple cider vinegar.


 

5. Other lifestyle approaches

Single woman sleeping alone in bed at home. Lonely lady missing husband or boyfriend. Hand on pillow. Solitude, infidelity or heartbreak concept. Loneliness and sorrow after break up.

You have likely heard about the importance of getting enough sleep and managing chronic stress. But can these healthy practices also help you lose belly fat? They might.

Elevated levels of cortisol, a hormone that your body produces when under stress, are associated with higher levels of abdominal fat.43

Fortunately, stress management can make a difference. It may help with weight loss and reduce both cortisol and abdominal fat.44

What about sleep?

One randomized trial reported that insufficient sleep reduced fat loss during a weight loss program.45

And another study reported that better sleep correlated with greater fat-mass loss.46 Plus, given all the other health benefits of better sleep, there are plenty of reasons to make it a priority.

Summary

Managing chronic stress and getting adequate sleep are two lifestyle interventions that may improve belly-fat loss. It’s worth prioritizing them for general health.


 

6. The role of hormones in belly fat accumulation

Senior couple dancing tango in the streets of San Telmo.

Despite your best efforts to shed excess abdominal fat, you may find a more significant challenge as you age. When women go through menopause and men experience “andropause,” sex hormones change in ways that can lead to more belly fat.

While menopause refers to a drastic decrease in women’s estrogen levels, andropause refers to a more gradual reduction in testosterone for men.47

Studies show that women experience an increase in abdominal and visceral fat as they transition into menopause.48

This is likely related to the hormonal changes and the resulting decrease in energy expenditure and fat burning.49

However, it’s not clear that hormone replacement by itself is adequate to reduce accumulation of abdominal fat. One randomized trial did not report any benefits in body composition with hormone replacement.50 But other observational trials reported women taking hormone replacement lost more abdominal fat than those not taking hormones, a finding that may be related to “healthy user bias.”51

Studies also suggest that men accumulate proportionally greater amounts of abdominal or visceral fat with decreasing testosterone levels.52 Testosterone replacement therapy, when appropriately given in the setting of testosterone deficiency, appears to improve body composition with decreased fat mass, increased lean body mass, and specifically decreased abdominal fat.53

While we wouldn’t recommend relying solely on hormone replacement for losing belly fat, addressing documented hormone deficiency along with nutrition and exercise may be a particularly effective method for reducing abdominal fat for those who have entered menopause or andropause.54

Read more about our top 8 tips to lose weight during menopause in our evidence-based guide.

Summary

Hormonal changes that come with age can predispose both women and men to excess accumulation of abdominal fat. For some people, hormone therapy may make it easier to lose unwanted belly fat with improved nutrition and exercise.


 

7. Conclusion

Abdominal or visceral fat is associated with significant health risks, including metabolic syndrome, type 2 diabetes, and heart disease.

Fortunately, you can lose stubborn belly fat with targeted lifestyle changes. A combination of low-carb nutrition, moderate to high-intensity exercise, and intermittent fasting can help you reduce the fat around your midsection.

You can learn more about losing weight from our Top 18 tips for weight loss guide. Or try our program Weight Loss for Good. Plus, if you want to set achievable goals, read our guide, Setting realistic expectations for weight loss before you start making changes.

 

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Weight loss video

 

  1. Obesity Reviews 2017: Prevalence of personal weight control attempts in adults: a systematic review and meta‐analysis [systematic review of observational studies; very weak evidence]

    Journal of the American Medical Association 2019: Trends in self-perceived weight status, weight loss attempts, and weight loss strategies among adults in the United States, 1999-2016 [observational study; very weak evidence]

    The following meta-analysis of RCTs suggested only one commercial weight loss program has evidence showing at least a 5% weight loss. The analysis also reported that as many as 67% of participants drop out within the first year.

    Annals of Internal Medicine 2005: Systematic review: an evaluation of major commercial weight loss programs in the United States [systematic review of randomized trials; strong evidence]

  2. Keep reading for more detailed description and references to follow.

  3. In this guide, we will assume the terms belly, abdominal, central, truncal, and visceral fat all refer to fat accumulation around the waist, including fat accumulation around the internal organs. That’s a fair assumption because many research studies use them interchangeably, and they likely all relate similarly to health outcomes.

  4. American Journal of HUman Biology 2000: Major gene effect on subcutaneous fat distribution in a sedentary population and its response to exercise training: The HERITAGE Family Study [observational study, weak evidence]

    European Journal of Clinical Nutrition 2001: Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years [observational study, weak evidence]

    Age and Ageing 2001: Sex differences of body fat distribution and cardiovascular dysmetabolic factors in old age [observational study, weak evidence]

  5. British Journal of Radiology 2012: The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis [overview article; ungraded]

    However, CT and MRI are expensive and not easily available. In addition, a full-body CT scan delivers a large amount of radiation and therefore is not recommended for routine body composition measurement.

  6. While bioimpedance scales are less accurate then CT, MRI, or DEXA, they may still be helpful, especially for following trends over time. Just make sure you are consistent with your hydration status as changes in hydration can dramatically alter the results. It’s usually best to wake up, go to the bathroom, and step on the scale right away for maximum reproducibility.

  7. Diabetes care 2006: Ethnic-specific criteria for the metabolic syndrome: evidence from China [multicenter observational study, weak evidence]

    Indian Journal of Endocrinology and Metabolism 2012: Waist circumference cutoff and its importance for diagnosis of metabolic syndrome in Asian Indians: A preliminary study [observational study, weak evidence]

  8. These measurements have not been validated as cut off points for all ethnicities in controlled studies, but most clinicians agree that “lower is better.” [clinical experience; weak evidence]

  9. Research in Sports Medicine 2020: A new waist-to-height ratio predicts abdominal adiposity in adults [nonrandomized study, weak evidence]

    BMJ Open 2016: Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference [nonrandomized study, weak evidence]

    BMC Medicine 2014: A proposal for a primary screening tool: ‘Keep your waist circumference to less than half your height’ [overview article; ungraded]

    Obesity Reviews 2012: Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis [meta-analysis of non-controlled studies; weak evidence]

  10. Health Promotion Perspective 2020: What are the optimal cut-off points of anthropometric indices for prediction of overweight and obesity? Predictive validity of waist circumference, waist-to-hip and waist-to-height ratios [observational study, weak evidence]

  11. American Journal of Clinical Nutrition 2007: Waist circumference and cardiometabolic risk: a consensus statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association [overview article; ungraded]

  12. Diabetes Care 1991: Metabolic implications of body fat distribution [overview article; ungraded]

    Journal of Clinical Endocrinology and Metabolism 1982: Relation of body fat distribution to metabolic complications of obesity [nonrandomized study, weak evidence]

  13. International Journal of Clinical practice 2008: How strong is the association between abdominal obesity and the incidence of type 2 diabetes? [overview article; ungraded]

  14. Circulation 2007: Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study [observational study, weak evidence]Journal of the American Heart Association 2018: Sex differences in the association between measures of general and central adiposity and the risk of myocardial infarction: Results from the UK biobank [nonrandomized study, weak evidence]

  15. Diabetes, Metabolic Syndrome and Obesity 2019: Abdominal fat is directly associated with inflammation in persons with type-2 diabetes regardless of glycemic control – A Jordanian study [observational study, weak evidence]

    Medicine (Baltimore) 2019: Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults: An observational study [observational study, weak evidence]

  16. Circulation 2008: Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women [observational study, weak evidence]

    Annals of Internal Medicine 2015: Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality [observational study, weak evidence]

  17. European Heart Journal 2019: Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index [observational study, weak evidence]

    BMJ Open 2017: Risk for metabolic diseases in normal weight individuals with visceral fat accumulation: a cross-sectional study in Japan [observational study, weak evidence]

  18. Metabolism 2020: Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19 [nonrandomized study, weak evidence]

    Metabolism 2020: The role of visceral adiposity in the severity of COVID-19: Highlights from a unicenter cross-sectional pilot study in Germany [nonrandomized study, weak evidence]

  19. Diabetes Care 2007: Reduction of visceral fat is associated with decrease in the number of metabolic risk factors in Japanese men [nonrandomized study, weak evidence]

  20. A 10-day fast led to 21 pounds (9.6 kilos) weight loss, but 13.6 pounds (6.2 kilos) of it was lean body mass, and 7.5 pounds (3.4 kilos) was fat mass. On the other hand, a ketogenic diet showed 14 pounds (6.4 kilos) weight loss, with only 0.44 pounds (0.2 kilos) of lean body mass loss.

    Annals of Internal Medicine 1965: Changes in body composition during weight reduction in obesity. Balance studies comparing effects of fasting and a ketogenic diet [nonrandomized study, weak evidence]

  21. Journal of the American College of Nutrition 2013: Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes [uncontrolled study; weak evidence]

    JCI Insight 2019: Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss [randomized trial; moderate evidence]

    Obesity 2015: Weight loss on low-fat vs. low-carb diets by insulin resistance status among overweight adults & adults with obesity: A randomized pilot trial [moderate evidence]

  22. Frontiers in Endocrinology 2019: Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: A 2-Year non-randomized clinical trial [nonrandomized study, weak evidence]

  23. Nutrition and Metabolism (London) 2004: Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women [randomized trial; moderate evidence]

    Journal of Nutrition 2015: A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes [randomized trial; moderate evidence]

  24. Nutrition and Metabolism (London) 2020: Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial [randomized trial; moderate evidence]

  25. Journal of Nutrition 2015: A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes [randomized trial; moderate evidence]

  26. Journal of Obesity 2014: Lifestyle intervention involving calorie restriction with or without aerobic exercise training improves liver fat in adults with visceral adiposity
    [randomized trial; moderate evidence]

  27. Obesity (Silver Spring) 2015 Changes in body composition over 8 years in a randomized trial of a lifestyle intervention: the look AHEAD study
    [randomized trial; moderate evidence]

  28. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2006: One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue [randomized trial; moderate evidence]

  29. JAMA Network Open 2020: Effect of a low-fat vegan diet on body weight, insulin sensitivity, postprandial metabolism, and intramyocellular and hepatocellular lipid levels in overweight adults: a randomized clinical trial [randomized trial; moderate evidence]

  30. Nutrition and Diabetes 2018: A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein
    [randomized trial; moderate evidence]

  31. Journal of the International Society of Sports Nutrition 2017: Vegan diets: practical advice for athletes and exercisers [overview article; ungraded]

    Nutrients: Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet [review article; ungraded]

    American Journal of Clinical Nutrition: Health effects of vegan diets [review article; ungraded]

  32. British Journal of Nutrition 2020: The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: a randomised controlled trial [randomized trial; moderate evidence]

  33. Journal of Diabetes and Metabolic Disorders 2013: The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women [nonrandomized study, weak evidence]

  34. Practicing intermittent energy restriction led to 26.4 pounds (12 kilos) of fat mass loss compared to 17.6 pounds (8 kilos) for chronic calorie restriction.

    International Journal of Obesity (London) 2018: Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study [randomized trial; moderate evidence]

  35. Clinical Nutrition 2018: Effects of alternate-day fasting or daily calorie restriction on body composition, fat distribution, and circulating adipokines: Secondary analysis of a randomized controlled trial [randomized trial; moderate evidence]

  36. Journal of Strength and Conditioning 2011: The effect of abdominal exercise on abdominal fat [randomized trial; moderate evidence]

  37. International Journal of Cardiology 2013: Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE randomized trial [randomized trial; moderate evidence]

    Medicine Science Sports and Exercise 2008: Effect of exercise training intensity on abdominal visceral fat and body composition [randomized trial; moderate evidence]

  38. BMC Womens Health 2019: Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial [moderate evidence]

  39. PLoS One 2013: The effect of exercise on visceral adipose tissue in overweight adults: a systematic review and meta-analysis [systematic review of randomized trials; strong evidence]

    Hepatology 2013: Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 Randomized Trial) [randomized trial; moderate evidence]

  40. Journal of Nutrition 2009: Green tea catechin consumption enhances exercise-induced abdominal fat loss in overweight and obese adults
    [randomized trial; moderate evidence]

  41. Journal of Functional Foods 2013: Lactobacillus fermentum and Lactobacillus amylovorus as probiotics alter body adiposity and gut microflora in healthy persons
    [randomized trial; moderate evidence]

    And another trial showed similar results.

    Microorganisms 2020: Daily Intake of Paraprobiotic Lactobacillus amylovorus CP1563 Improves Pre-Obese Conditions and Affects the Gut Microbial Community in Healthy Pre-Obese Subjects: A Double-Blind, Randomized, Placebo-Controlled Study
    [randomized trial; moderate evidence]

  42. Bioscience, Biotechnology and Biochemistry 2009: Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects [randomized trial; moderate evidence]

  43. Journal of Clinical Endocrinology and Metabolism 1990: Postprandial hypotension: a systematic review [nonrandomized study, weak evidence]

    Obesity (Silver Spring) 2007: Awakening cortisol response in lean, obese, and reduced obese individuals: effect of gender and fat distribution [observational study, weak evidence]

    International Journal of Obesity Related Metabolic Disorders 2004: Central adiposity and cortisol responses to waking in middle-aged men and women [observational study, weak evidence]

    Psycjosomatic Medicine 2000: Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat [observational study, weak evidence]

  44. The following study reported improved weight loss for those following a stress management program, although body composition was not reported.

    Journal of Molecular Biochemistry 2018: Impact of a stress management program on weight loss, mental health and lifestyle in adults with obesity: a randomized controlled trial [moderate evidence]

    The following study reported a reduction in cortisol and abdominal fat with a minfullness interevntion for stress eating

    Journal of Obesity 2011: Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: An exploratory randomized controlled study [randomized trial; moderate evidence]

  45. Annals of Internal Medicine 2010: Insufficient sleep undermines dietary efforts to reduce adiposity [randomized trial; moderate evidence]

  46. Obesity Facts 2012: Sleeping habits predict the magnitude of fat loss in adults exposed to moderate caloric restriction [nonrandomized study, weak evidence]

  47. As the following review notes, males tend to experience a more gradual decrease in testosterone over time, whereas women have a more abrupt change at the time of menopause.

    Reviews in Urology 2004: Testosterone replacement in men with andropause: an overview [overview article; ungraded]

  48. American Journal of Obstetrics and Gynecology 2019: Fat mass changes during menopause: a metaanalysis
    [meta-analysis of observational studies, weak evidence]

    Climacteric 2012: Understanding weight gain at menopause [review of observational studied, weak evidence]

  49. International Journal of Obesity (London) 2008: Increased visceral fat and decreased energy expenditure during the menopausal transition [observational study, weak evidence]

  50. Journal of Clinical Endocrinology and Metabolism 2005: The effect of hormone replacement therapy on body composition, body fat distribution, and insulin sensitivity in menopausal women: a randomized, double-blind, placebo-controlled trial [randomized trial; moderate evidence]

  51. Journal of Clinical Endocrinology and Metabolism 2018: Menopausal hormone therapy is associated with reduced total and visceral adiposity: The OsteoLaus Cohort [nonrandomized study, weak evidence]

    The following study in Japanese women reported benefits from hormone replacement for those with the “android” body type, but not for those with the “gyenoid” body type.

    Internationa Journal of Obesity Related Metabolic Disorders 2003: Effects of hormone replacement therapy on weight, abdominal fat distribution, and lipid levels in Japanese postmenopausal women [nonrandomized study, weak evidence]

  52. International Journal of Obesity and Related Metabolic Disorders 2000: Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men [observational study, weak evidence]

    Journal of Clinical Endocrinology and Metabolism 1998: Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength, and adiposity [observational study, weak evidence]

    Metabolism 1990: Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels [observational study, weak evidence]

  53. International Journal of Obesity and Related Metabolic Disorders 1992: The effects of testosterone treatment on body composition and metabolism in middle-aged obese men [nonrandomized study, weak evidence]

    International Journal of Obesity 1991: Effect of testosterone on abdominal adipose tissue in men [nonrandomized study, weak evidence]

  54. BMC Medicine 2016: Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial [moderate evidence]