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Eschewing the Fat

Dear Dr. Roach: I am an old man (84) with a middle-age paunch (5 feet, 7 inches tall and weigh 200 pounds) who needs to fit into a suit with pants an inch too tight in time for a wedding in a few weeks. About how many pounds do I need to lose to fit into them? Is there any formula for converting waist inches to pounds? And are there exercises or other means to focus the weight loss on belly fat? Anon.

Answer: I am afraid there’s no formula. Further, I have to tell you that weight doesn’t always come off where we want it to, and specific exercises aren’t going to make the fat come off in those locations.

The good news is that for most people, especially men, the first 10 pounds or so to come off usually comes from the middle. The fat in the omentum (an apron-shaped structure inside the abdomen) is metabolically active and often is the first place where fat is gained or lost. Moreover, that fat is the most likely to increase risk of heart disease. So losing weight around your middle is a good way of improving overall health, especially if you have more inches there than you’d like.

I often have seen people start a healthy diet and exercise program and find that the waist size decreases but the weight stays the same. That may be because muscle is much heavier than fat, and the increase in muscle mass makes up for the loss of fat. More muscle is good for you; less body fat is good for you. Weight is an imperfect measure.

Liposuction can remove fat from around your waist, but a healthy diet and regular exercise will make you feel better and quite possibly live longer.

Dear Dr. Roach: I was a smoker for 65 years, and I got tired of my doctor and everyone else telling me the dangers of smoking. I tried e-cigarettes about two months ago, and I am hooked on them. At first I didn’t like the taste, but now I have gotten used to it. There is a large amount of “smoke” from them, and it is darkening the color of my teeth. What’s your take on this new fad? — S.G.

Answer: There is no doubt that tobacco has caused vast amounts of suffering and death. The jury is out on the net effect of e-cigarettes, but here are my thoughts.

Although e-cigarettes are likely to be much less dangerous than regular cigarettes, there is no doubt in my mind that they are at least potentially harmful to health. On the good side, if they help you quit your smoking habit, they may have a benefit to you. You should use them to help you quit smoking, then ideally quit using them as well.

However, there is a bad side, and that is when nonsmokers start using them. Some users don’t think of them as cigarettes at all, calling them “hookah pens,” “vape pens” or other euphemisms. They are simply devices to provide nicotine and flavorings. You used the term “hooked on them,” and they probably do have the potential for addiction.

Many young people have strong negative feelings about cigarettes that don’t transfer to these new nicotine products. My main concern is that they will make using nicotine more socially acceptable.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.