A new imaging study finds that excess belly fat — often called a “beer belly” — is associated with potentially harmful changes in heart structure, with stronger effects observed in men. Using detailed cardiac MRI, researchers report that measures of abdominal obesity, especially a high waist-to-hip ratio, correlate with a pattern of heart remodeling distinct from changes tied to body mass index (BMI) alone. The analysis did not evaluate participants’ alcohol or beer consumption.
The team reviewed cardiac MRI scans from 2,244 adults aged 46 to 78. They observed that higher BMI was generally linked with larger heart chamber sizes in both women and men. By contrast, greater abdominal fat (measured by waist-to-hip ratio) was associated with concentric hypertrophy — thickening of the heart muscle — and reduced chamber volumes. Those concentric changes were more pronounced in men and were particularly notable in the right ventricle, the chamber that pumps blood to the lungs. Investigators suggested this pattern might reflect early cardiac stress related to how abdominal fat impairs breathing mechanics or raises pressures in the lungs.
Lead author Jennifer Erley, MD, a radiology resident at University Medical Center Hamburg-Eppendorf, said a high waist-to-hip ratio appears to drive a different, potentially more pathological type of remodeling than elevated BMI alone. With concentric hypertrophy the heart wall thickens without enlargement of the overall chamber, reducing the volume it can hold and pump. Over time, that process can interfere with the heart’s ability to relax and fill properly and contribute to heart failure. The researchers proposed that the stronger changes in men could reflect earlier or greater accumulation of visceral fat, though they emphasized that more research is needed.
The results were presented at the Radiological Society of North America (RSNA) annual meeting in Chicago (November 29–December 3). The study has not yet been published in a peer-reviewed journal.
Independent clinicians not involved in the work said the findings align with known harms of visceral fat. Mir Ali, MD, medical director at MemorialCare Weight Loss Center, noted that abdominal fat increases systemic inflammation, alters hormones, and promotes insulin resistance — pathways that damage the heart and blood vessels. Kevin Shah, MD, program director at MemorialCare Heart Failure Outreach, highlighted that visceral fat worsens inflammation, insulin resistance, and cholesterol profiles, accelerating cardiovascular disease.
Practical points and implications
– BMI is weight (kg) divided by height (m) squared; a BMI of 30 or higher defines obesity. Waist-to-hip ratio divides waist circumference (narrowest point) by hip circumference (widest point); thresholds of ≥0.90 for men and ≥0.85 for women indicate abdominal obesity and higher cardiovascular risk. Unlike BMI, waist measures reflect fat distribution and better capture visceral fat.
– Experts recommend including waist circumference or waist-to-hip ratio alongside BMI when assessing cardiometabolic risk.
– Reducing visceral fat typically requires overall weight loss through improved nutrition, increased activity, medications, or bariatric surgery. Recommended strategies include regular resistance training (2–3 times per week), adding 20–30 minutes of daily walking, prioritizing protein and whole foods, and cutting refined carbohydrates. Small, sustained lifestyle changes can shrink waist size and improve long-term heart health.
