I remember one day in the clinic when a patient of mine asked, “I hear people constantly talking about how women store fat in the lower body, and men store fat in their stomach. But I don’t store fat like the typical woman. My main issue is belly fat. I have a leaner lower body compared to my middle. I am an apple shape. What does this mean? Why do I store fat this way?”

I’ve been asked a variation of this exact question at almost every talk or lecture I give on female fat loss. But what’s interesting about this patient is that she is not fat by anyone’s standard. And if it were not for the fact that I knew her measurements, I probably would’ve dismissed her observation as another example of poor body image.

(Please note: Discussing “fat loss” often gets misinterpreted as if we are saying women “should” look a certain way. Nothing could be further from the truth. Excess fat, especially around the belly, has health implications, and losing it is beneficial. We need to talk about this more in health and fitness because sometimes I think we are making people neurotic when talking about body change.)

Female belly fat and hormones

There are a few hormones we need to talk about in regards to belly fat in women. And before the calorie zealots get in an uproar, I am not saying calories don’t matter. What I am saying is that it is the hormonal situation that determines where fat is stored, and belly fat is no different.

To lose fat, you need both a caloric deficit and hormonal balance. To lose stubborn fat, particularly stubborn belly fat, you need to understand the hormones involved.

In women, those hormones are insulin, cortisol, estrogen, progesterone, and testosterone. And, of course, the major fat-burning hormones, the catecholamines.

When you think of hormones, realize they never work in isolation. In other words, it’s wrong to think about the action of a single hormone because hormones behave differently depending on the “hormonal social environment” they find themselves in. 

For example, insulin and cortisol “socializing with” high testosterone and low estrogen and/or progesterone have a unique outcome that makes women more likely to store belly fat. 

Here are how these hormones work in bullets to make it easier:

• Estrogen is insulin-sensitizing, making it less likely excess calories are stored as belly fat, and more likely, a calorie deficit results in fat loss rather than muscle loss.
• Estrogen and progesterone both oppose the fat-storing action cortisol has on the belly.
• Cortisol is associated with stress, and more stress reactive women release more cortisol and have higher amounts of belly fat whether they are thin or overweight.
• Catecholamines (adrenaline and noradrenaline) are released during intense exercise and have a strong fat burning impact on visceral belly fat (deep stomach fat), and a weaker fat burning impact on subcutaneous belly fat (this is because sub Q belly fat has more ANTI-fat burning alpha adrenergic receptors while visceral fat has more fat burning beta receptors).
• Testosterone is tricky because men with low testosterone have larger bellies, but just as estrogen is responsible for giving women smaller waists, testosterone may be why men have bigger waistlines. This testosterone to estrogen ratio is critical for women. Women with higher testosterone levels, like those with PCOS, have thicker waists.

The Female Belly Fat Formula

The female formula for belly fat looks something like this: [(Insulin + Cortisol) x Testosterone] – Estrogen= belly fat

This means insulin & cortisol combined along with excess testosterone & low estrogen = belly fat

And we could even take it a step further to (F + SS) X ST = Belly Fat. 

Where F= fat, SS= sugar/starch, ST= stress.

The most significant impact on the hormone insulin is excess calories in the context of starch/sugar. Foods that combine fat and sugar have the greatest number of calories and the most negative impact on fat-storing hormones.

Add stress, and you have cortisol added to the mix. Cortisol added to insulin is a bad combination and is the most problematic hormonal combination for belly fat. But when stress becomes chronic or extreme in a female, the hypothalamus & pituitary (the command and control center of your hormones) becomes “irritated” (for lack of a better word), and you get downstream effects on the thyroid, adrenal, and ovarian hormone production. Chronic stress in women leads to increased testosterone and lower estrogen and progesterone.

The other aspects of stress are more hidden. Not only does stress raise testosterone, lower estrogen, and negatively impact insulin in women, it also causes increased hunger, constant cravings, and a physiology that is more likely to lose muscle.

This drives home the point that belly fat is not a simple matter of gaining or losing fat. Calories matter, but hormones matter more when it comes to where we store fat and how to attack stubborn areas of body fat unique to us.

If you’re a woman who is doing everything right and still struggling with belly fat, the primary issue is stress management. It’s not too many calories or carbs, and it doesn’t have to do with exercise; it’s stress.

In fact, the dieter mentality (eat less and exercise more) is the exact wrong approach to take to attack stubborn belly fat. This makes physiological stress more significant, and there is much evidence that suggests dieting may actually be making your fat parts (i.e., your belly) fatter.

It’s important to note that when I refer to “stress” I am not just referring to emotional distress. 

Let’s take a mother who just gave birth to her first child. She is happy, elated, and in awe. This may be one of the happiest and most incredible moments of her life. Is she stressed? Probably more than anyone else on the planet! She is sleep-deprived (stress). She is nutritionally depleted from growing a baby and supplying the baby with milk (stress). She has a whole new life impossible to be prepared for (stress). This shows you can be as happy as ever but still stressed to the max.

Over-exercising, chronic and extreme dieting, worries of body image, work worries, relationship tension, sleep deprivation, etc. are all forms of stress. 

And what we know conclusively from women suffering from stubborn belly fat is that they are more stress reactive and less able to adapt to stress than women without. In other words, female belly fat is an issue of stress above all else. For women suffering from stubborn belly fat she can’t get rid of, another hour in bed may be a better strategy than another hour on the treadmill. 

Final Thoughts

At this point, you’re probably wondering what to do. Here are your action steps:

• Remember that female fat belly formula? (Fat + Sugar/Starch) X Stress= fat belly. The stress is the most important part. So prioritize rest and recovery activities.
• Follow a 3:2:1 exercise program to keep from over-stressing through exercise. 3 R&R actvities per week (these lower cortisol and will help re-balance estrogen and testosterone). 2 Traditional weight training workouts per week (these help use testosterone for muscle building, not belly-fat-storing). 1 hour of leisure walking (not power walking) on all or most days. Leisure walking is the best exercise for those with stubborn female belly fat.
• What are R&R activities? They should last about an hour and include a massage, spa time, sauna therapy, hot baths, sex/physical affection, time with pets, leisure walking (not power walking), restorative yoga (not power yoga), tai chi, naps, meditation, etc. Anything that relaxes you both physically and emotionally 
• What is leisure walking? A slow walk (about 3.0 or less on a treadmill) that should feel relaxing and give you time to take in the scenery, which lowers cortisol further.
• Don’t go too low calorie, too low carb, or too low fat. Any type of short, extreme, or continuous chronic dieting is a stress. Find balance in your nutrition.
• Prioritize sleep. You will have to make a choice whether your late-night TV habit is more important than a flat tummy because sleep deprivation is a massive issue for belly fat. If you can’t sleep, then nap. If you can’t nap, then meditate. If you can’t do any of that, then simplify your life so you can. Stress management has to be made a priority.
• Don’t eat less and exercise more. A better approach is to either eat less and exercise less, OR eat more and exercise more (both can also create the environment for fat loss: a caloric deficit and hormonal balance). You will likely find the best results with an eat-less, exercise-less approach.
• Stress is a very tricky thing that can be wreaking havoc on your metabolism without you knowing it. A few supplements have been shown to help the hypothalamus/pituitary control center resist stress. These include curcumin, fish oil (preferably krill oil since it contains phospholipids), and Rhodiola.