The Curse of the Muffin Top

I heart muffin tops

One of the more regrettable innovations of recent years is the fashion for bare midriffs exposing not just belly button jewelry, which after all is a matter of individual taste, but mountains of puffy flesh. Perhaps even more distressing is the view from the rear, of anything from modest “love handles” to pendulous bulges over the kidneys.

The style seems to advertise and endorse obesity. This look is what popular culture has named the “muffin top,” and while it is basically an issue of personal preference and freedom, it’s not exactly clear why anyone would willingly expose their flabbiness. Perhaps it is a cry for help?

Maybe the teenagers of America are just waiting for someone like Celia Milne to come up to them and say, “Stop it!” Milne explains why the problem of big bottoms must take second place to the threat of muffin tops:

The dangerous fat is visceral fat, which lurks inside us, padding the spaces between our abdominal organs. It’s far more sinister than regular (subcutaneous) fat, which lies between the skin and the abdominal wall — and jiggles when we move.

Internal organs do not thrive when encased in fat, and besides, patients who have it might also have thickened carotid arteries. The jiggliness of visible fat might make it appear to be rather lively, but it is relatively passive and inert.

Visceral fat, however, is active, and gets up to all kinds of mischief, like secreting hormones that increase the level of fat in the blood. Dr. Arya Sharma of the Canadian Obesity Network told the reporter that because of this, visceral fat promotes diabetes and high blood pressure.

Also, work done at Harvard University indicates that visceral fat kicks off an internal chemical reaction that influences “bad” cholesterol, and also it interferes with the portal vein, whose job is to convey blood from the gut to the liver. Milne explains some important concepts:

Interestingly, it is possible to be obese and not have visceral fat, and vice versa. Visceral fat isn’t easy to measure. Measuring BMI (body mass index) tells you whether you are normal, overweight or obese — a BMI more than 25 is considered overweight and more than 30 is considered obese. But it doesn’t indicate how your body stores fat and muscle. Doctors nowadays also measure waist circumference, which reveals whether fat is stored around the belly… A third test — waist-to-hip ratio — is also important.

Speaking of the BMI, everybody has heard of it, but not everyone is certain about what it means or what the implications are, and this matters for parents who are getting notices from their children’s schools. For Salon, Dr. Ayala Laufer-Cahana explains the basics of childhood obesity diagnosis, as practiced by schools, starting with the fact that it’s not an exact science. Although the BMI has been shown to correlate with body fat generally, the test does not measure body fat directly.

The doctor says:

Body Mass Index (BMI) is a number calculated from a child’s weight and height (weight in kilograms divided by height in meters squared)… A BMI of 21 — a healthy weight for an adult — is indicative of obesity in a 6-year-old boy, would categorize a 10-year-old boy as overweight, but would put a 16-year-old well within the range of a healthy weight.

The BMI charts are based on what is actually observed, among a “reference population,” to establish some idea of normalcy. But if everybody has been getting fatter, then what good are the charts? Don’t they just reflect fatness as a new kind of normalcy? Laufer-Cahana has an answer:

In establishing the BMI-for-age charts the reference population is the kids of the past — mostly of the ’60s and ’70s, before the obesity epidemic started. There are several charts used around the world, each developed referencing a different population, but they all carry a historic picture of past generations, when childhood obesity was much less prevalent. When you get your kids’ BMI-for-age he’s not compared to the kids of today, but rather to what experts feel is a ‘normal’ population.

But even with those efforts toward accuracy, growth is not always even, and growth rates vary at different ages, which is why pediatricians use charts that are organized by age. Also, boys are different from girls. It seems that while this is a reliable way to diagnose obesity in adults, children are different, and in their case, just knowing the BMI alone is not very informative.

Your responses and feedback are welcome!

Source: “Not all body fat is created equal, experts say,”, 05/11/10
Source: “Explaining the quirks of childhood BMI,” Salon, 06/18/10
Image by rick, used under its Creative Commons license.

2 Responses

  1. While determining what is/isn’t obese for children is problematic, it shouldn’t stop anyone from recognizing the existence of the problem and taking steps to correct it.

    My wife was commenting on all of the muffin tops last Summer when it was warm. Out of curiosity we looked through some of the old high school yearbooks in the local library. If you pick out clubs that probably attract the same type of kid and look at club photos at 5 year intervals you visually see a big change in kids getting heavier starting in the mid 80s – kids from 1950 to 1980 looked about the same, but then each 5 year period is progressively heavier. This doesn’t hold for the sports teams, which are about the same for similar periods. A really interesting exercise.

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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