From Web Md. Com, 9/27/02

No matter where fat is, it belongs to the entire body.

Question:
How do I get rid of my love handles?

Answer:

Questions about fat burning and spot toning/reducing are our most popular question. The short answer is that you cannot spot reduce, and the way to burn fat is through aerobic exercise, which burns lots of calories; resistance exercise, which builds muscle (muscle is the engine that burns calories and maintains your metabolic rate); and then watch your caloric intake.

1. There is a genetic factor that determines where people accumulate fat. Women tend to accumulate it in their hips, buttocks, and thighs, and men tend to accumulate it in their abdomen. The reasons for the differences between sexes have not been identified. Some people accumulate more fat than others, and the reasons for that have not been fully identified either, although there are theories.

2. The fat that accumulates on the hips, thighs, and buttocks, although perhaps not cosmetically appealing, is not dangerous for your health. In fact, there is some evidence that it is actually good for your health. The opposite is true for abdominal fat. That fat has been implicated in heart disease, diabetes, and other health problems. Men with a large pot belly are therefore at increased health risk, whereas women with large hips or thighs are not necessarily at risk, at least not from the fat on their lower extremities.

3. Fat, no matter where it is on the body, belongs to the entire body, so you can't spot reduce, i.e., you can't do sit-ups and lose abdominal fat, and you can't do leg raises and lose thigh fat.

4. Fat is stored in special fat cells called adipocytes located all over the body. You have anywhere from 25 billion to 275 billion adipocytes. The average individual has around 30-35 billion. These adipocytes store fat and they release fat. When they release fat, the adipocyte gets smaller, and when they store fat, the adipocyte gets larger, just like a balloon that you fill with air or release air from. Contrary to popular belief, adipocytes do not divide when they get too big. Instead, what happens is that as an adipocyte absorbs excess fat and increases in size to approximately 15-20 microns (the diameter of a human hair is 100 microns), it sends a biochemical signal to adjacent adipocyte precursor cells called preadipocytes to absorb fat and grow larger. These preadipocytes then become fully mature adipocytes, and as a result, the individual gets fatter. During childhood and into puberty, both the number of mature adipocytes (hyperplasia) and the size of the adipocyte increases. It is believed by many scientists that the number of adipocytes stays fairy stable after adolescence and instead of an increase in the number of adipocytes during adulthood, the mature adipocytes enlarge to increase body fat. However, there is some recent evidence to suggest that the number of mature adipocytes can also increase during adulthood. In any case, what is certain is that excess caloric intake leads to increases in body fat, either through hyperplasia or through enlargement of the adipocyte.

It should be noted that preadipocytes develop from special cells in the body, and although genes control proteins that control preadipocyte function and development, the process is extremely complex and not well understood, but scientists are busy studying it.

One other point on this subject. Adipocytes do not disappear when they get smaller. They shrink only to a certain size, and then they just hang around as very tiny adipocytes, and they can always get large again. The only way to get rid of them totally is through liposuction.

5. Adipocytes get large by feeding them. If you eat more calories than you burn, some of the excess carbohydrate will be stored as sugar, or glucose, in the muscles (called glycogen), and the rest of the excess will be stored as fat in the fat cells. If you continue to eat more than you burn, you continue to feed the adipocytes with fat and you get fatter.

6. When you exercise, the adipocytes release fat into the blood stream, where it circulates around to the muscles that need it for fuel (a car burns gasoline, our bodies burn fat and glucose). The more you exercise, the more calories you burn. But when you exercise, you cannot choose which adipocytes release fat. It would be nice to say, "release fat from my hips," but that's not how it works. What does happen is that when you exercise, adipocytes get a signal from hormones circulating in the blood stream to release fat (sort of like putting your foot on the gas pedal in your car to get the gasoline flowing to the carburetor), and adipocytes from all over the body get released. During exercise, your muscles may be burning fat released from fat cells in your face, shoulders, arms, abdomen, and other locations. You don't have control over that, and some adipocytes are more sensitive to those hormones and release more fat than other adipocytes. They also tend to release in a consistent pattern that is probably determined by genes. Everyone who has ever lost and regained weight more than once can tell you that the pattern of their weight loss is almost always the same. Many people lose from their face first, but it varies. In most cases, it is the hips, thighs, and buttocks for women that goes last, if it goes at all.

7. Aerobic exercise stimulates the adipocytes to release lots of fat. That fat will be burned by the muscles during exercise, and if not, it returns to the adipocytes for storage.

8. Weightlifting also stimulates the adipocytes to release fat. Another advantage to weightlifting is that it builds muscle. Muscle is the engine that burns calories and sets your metabolic rate. It's a good thing to have lots of muscle, so any weightlifting is beneficial. Not only that, but when you lose weight, you lose some muscle too, which makes it harder to lose more weight (remember that muscle burns the calories), so weightlifting during weight loss helps preserve the muscle, and also enhances your ability to lose and maintain weight.

9. Weightlifting will tone muscles, too. If you do leg exercises like lunges, it will tone the muscle under the fat, and that will improve the contour of the leg, but it will not remove fat. Likewise, abdominal exercises will tone and tighten the abdominal muscles, and your pants may even fit looser even though you don't lose weight.

10. There is evidence that adipocytes in the hips, thighs, and buttocks tend to resist releasing fat into the blood stream. It seems these adipocytes are stubborn, and they don't like to give up fat. This is not good news for people, women especially, who want to lose fat in their thighs, hips, and buttocks, but it does provide some explanation as to why it is difficult for women to lose the fat in their lower extremities. On the other hand, there is evidence that adipocytes in the abdomen do release fat into the blood stream easier than lower extremity fat. That's probably one of the reasons why men can lose their gut faster than women can lose their hips. The adipocytes in the abdomen seem to cooperate more.

11. For women, pregnancy, childbirth, and menopause are also factors in how much weight and body fat you accumulate and lose. Of course, age is a factor, too.

12. Cellulite is caused by irregular patterns of connective tissue beneath the skin, and as the adipose (fatty) tissue, which forms in compartments of little honeycombs, pushes into the skin, it causes the dimpling of cellulite. It has been shown that people who have cellulite have different patterns of connective tissue than people who don't, and men tend to have this pattern much less than women. Cellulite is not directly a function of excess weight, but a genetic difference in the way adipose tissue and connective tissue form. In fact, cellulite affects people whether they are overweight or not. Skin creams sold to reduce cellulite make the skin swell so that the appearance of the cellulite changes, but the effects are transient, don't look that good, and do nothing to change the structure of the connective tissue. Biochemically, cellulite does not behave any differently than other fat and there is no health risk to cellulite. Weight loss and exercise can have some effect on cellulite, but in many of the cases it does not significantly change the appearance.

13. Diet is important. No matter how much exercise you do, if the calories consumed exceed the calories burned, you will not lose weight or fat.

14. People frequently report that they recently started exercising and dieting. Recently could mean a few days to several months. Patience and realistic expectations are important when it comes to weight loss and fitness. You can expect significant improvements in strength in 8-12 weeks, weight loss of 1-2 pounds per week (but often less for many people), some muscle tone in 8-12 weeks, and improvements in mass in 3-12 months. All of these time frames are estimates, and the results depend on how much body fat and muscle you have to start, your fitness level when you start, age, gender, length of time you have been sedentary and overweight, how often and how hard you workout, diet, and perhaps most important, genetics.

15. The bottom line to losing fat in the hips, thighs, buttocks, love handles, or anywhere else is to stimulate the adipocytes through exercise to release fat into the blood stream. You can't spot reduce for the reasons I've mentioned. Fat you burn will come from all over the body. Lunges will not stimulate the leg muscles to lose more fat first, and abdominal exercises will not stimulate fat loss in the abdomen.

16. Finally, there are things we have control over, and things we don't. As much as we exercise, as much as we diet, we may never have the "perfect" body that we desire, and it's not our fault.

Richard Weil, MEd, CDE, is an exercise physiologist and certified diabetes educator. He has published dozens of articles on exercise and health and has appeared on many television programs. He also speaks about health at many national conferences.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have a question about your health, you should consult your personal physician. This event is meant for informational purposes only.

Originally published Aug. 19, 2002.