How to Lose Weight in Your Stomach

How to lose weight in your stomach is one of the most common health questions in the UK, and the answer is more nuanced than most people expect. Abdominal fat comes in two distinct forms, subcutaneous and visceral, and the latter carries significant health risks. Targeted exercises alone will not shift it; sustained dietary change, regular physical activity and, in some cases, clinically supervised support are what the evidence supports. This article explains why stomach fat accumulates, how it affects your health, and what practical steps are most likely to help.

Why do people carry extra weight around their stomach?

Abdominal fat accumulates due to a combination of genetics, hormones, age and lifestyle; cortisol, oestrogen decline and insulin resistance all influence where the body stores fat, meaning targeted exercises alone are unlikely to resolve it.

People carry extra weight around their stomach due to a combination of genetics, hormones, lifestyle habits and age, and no single factor explains it entirely. Fat accumulates in two distinct layers in the abdominal region: subcutaneous fat, which sits just beneath the skin and can be pinched, and visceral fat, which surrounds the internal organs deeper within the abdominal cavity. The balance between these two types varies considerably between individuals.

Hormones play a role in fat distribution. Cortisol, the body's primary stress hormone, is associated with abdominal fat storage when chronically elevated, though in the general population this relationship is observational rather than firmly causal; markedly elevated cortisol due to a medical condition such as Cushing's syndrome is a distinct and less common cause.^[13][14] Oestrogen decline during the menopause is associated with a shift in fat distribution from the hips and thighs towards the abdomen, which is why many women notice changes in body shape during midlife.^[15][16] Declining testosterone in men with age may have a similar, though less well-characterised, effect on fat distribution. Insulin resistance, which can develop gradually over years, is also linked to greater visceral fat accumulation.

Genetics influence where the body preferentially deposits fat, meaning some people are predisposed to an apple-shaped distribution regardless of their overall weight. Poor sleep, high alcohol intake and a sedentary lifestyle each independently contribute to abdominal fat accumulation. Understanding these overlapping causes is important because it explains why targeted abdominal exercises alone are unlikely to resolve the problem, and why a broader approach to lifestyle is generally needed. Fat distribution is not entirely within personal control, and this should be recognised when setting expectations.

Does belly fat affect your health more than fat elsewhere?

Visceral belly fat is more harmful than fat stored on the hips or thighs because it releases inflammatory proteins and fatty acids directly into the liver, raising cardiovascular and metabolic risk.

Visceral belly fat is metabolically more active and more harmful to health than subcutaneous fat stored in the hips, thighs or buttocks. Unlike subcutaneous fat, visceral fat releases fatty acids, inflammatory proteins and hormones directly into the portal circulation, which drains into the liver. This contributes to raised triglycerides, reduced HDL cholesterol, elevated blood pressure and impaired glucose regulation, all of which are components of metabolic syndrome.

NICE guidance and NHS clinical frameworks use waist circumference as a practical proxy for visceral fat burden. Two risk levels are recognised. An 'increased risk' threshold applies at a waist measurement of 80 cm (31.5 inches) or above in women and 94 cm (37 inches) or above in men. A 'very high risk' threshold applies at 88 cm (35 inches) or above in women and 102 cm (40 inches) or above in men. These thresholds are lower for people of South Asian, Chinese, Japanese and other East Asian backgrounds; for example, a waist of 90 cm or above in men and 80 cm or above in women from these groups is associated with increased risk, reflecting differences in body composition at equivalent BMI values. If you are unsure which thresholds apply to you, your GP or practice nurse can advise.

To measure your waist accurately, find the midpoint between the bottom of your lowest rib and the top of your hip bone (iliac crest), usually around the level of your navel. Wrap a tape measure around this point, keeping it snug against the skin but not compressing it, and measure after a gentle breath out.

Waist-to-height ratio is increasingly used alongside waist circumference and BMI. A ratio below 0.5 (that is, your waist circumference in centimetres is less than half your height in centimetres) is generally considered to indicate lower risk; values at or above 0.5 suggest increased cardiometabolic risk.

It is worth noting that a person can have a normal BMI and still carry a clinically significant amount of visceral fat, a pattern sometimes described as being 'metabolically obese, normal weight'. Conversely, someone with a higher BMI who carries fat predominantly in the lower body may have a more favourable metabolic profile. This is why waist circumference and waist-to-height ratio are increasingly used alongside BMI in clinical assessments, rather than BMI alone.

What actually works for losing stomach fat in the long term?

Sustained overall fat loss through consistent diet and physical activity is the most evidence-based approach; spot reduction is not supported by clinical evidence, and pharmacological options such as semaglutide or tirzepatide may suit eligible adults.

Sustained reduction in overall body fat, achieved through consistent changes to diet and physical activity, is the most evidence-based approach to losing stomach fat in the long term. There is no method that selectively removes fat from the abdomen without reducing fat elsewhere in the body; the concept of 'spot reduction' is not supported by clinical evidence. When the body loses fat, it does so systemically, and the abdomen tends to respond well to overall fat loss, particularly visceral fat, which is more metabolically responsive than subcutaneous fat.

Long-term success depends on changes that are sustainable rather than extreme. Crash diets and very low-calorie regimens can produce rapid initial weight loss, but they are associated with muscle loss, metabolic adaptation and high rates of weight regain. NICE guidance on weight management emphasises behavioural support, realistic goal-setting and addressing the psychological and social factors that influence eating and activity patterns.

For some people, lifestyle changes alone are insufficient, and clinically supervised weight management programmes or pharmacological treatment may be appropriate. Semaglutide (Wegovy, available in doses up to 2.4 mg weekly by subcutaneous injection, with a higher-dose 7.2 mg formulation also MHRA-authorised) and tirzepatide (Mounjaro) are MHRA-authorised for chronic weight management in adults who meet specific clinical criteria.^[2][8] Clinical trial programmes, including the STEP trials for semaglutide and the SURMOUNT trials for tirzepatide, have reported reductions in overall body weight and visceral fat in participants who received these medicines.^[9] Weight-management medicines are not suitable for use during pregnancy or whilst breastfeeding; individual suitability depends on a person's full medical history and should be discussed with a prescriber, in line with the relevant SmPC and NICE technology appraisal criteria.

Bolt Pharmacy is a GPhC-registered UK online pharmacy offering online weight-management consultations, with prescriber review and pharmacist support. Semaglutide (Wegovy) and tirzepatide (Mounjaro) are among the options a prescriber may consider following such a consultation, and are only prescribed where clinically appropriate. Any pharmacological treatment should be used alongside dietary and lifestyle changes, not as a replacement for them.

How does diet affect fat around your middle?

A consistent calorie deficit alongside a diet low in ultra-processed foods and refined carbohydrates reduces abdominal fat; a Mediterranean dietary pattern has the strongest evidence for lowering visceral fat and cardiovascular risk.

Diet has a direct and well-evidenced effect on abdominal fat, primarily through its influence on overall energy balance, insulin levels and systemic inflammation. A consistent calorie deficit, achieved by reducing energy intake relative to expenditure, leads to fat loss across the body, including the abdomen. However, the composition of the diet also matters, not just the total calorie count.

Diets high in ultra-processed foods, refined carbohydrates and added sugars are associated with repeated spikes in blood glucose and insulin, which over time may encourage visceral fat deposition and contribute to insulin resistance. The evidence linking dietary quality to metabolic health is observational in large part, so these associations should be understood as plausible and consistent rather than definitively causal. The NHS Eatwell Guide provides a practical UK framework for a balanced diet, and the Scientific Advisory Committee on Nutrition (SACN) has published reports on carbohydrates and health that underpin UK dietary recommendations. In contrast, diets rich in fibre, lean protein, healthy fats and minimally processed whole foods support more stable blood glucose levels and tend to promote greater satiety, making it easier to maintain a calorie deficit without feeling deprived.

The Mediterranean dietary pattern, which emphasises vegetables, legumes, wholegrains, fish, olive oil and moderate amounts of dairy, has a strong evidence base for reducing cardiovascular risk and has been associated with lower levels of visceral fat in observational and intervention studies, including randomised controlled trials.^[23] Alcohol deserves particular attention: it is calorie-dense, and regular consumption is independently associated with increased abdominal fat accumulation. The UK Chief Medical Officers' low-risk drinking guidelines advise keeping alcohol intake to no more than 14 units per week, spread across several days, with some alcohol-free days each week.^[12]

Practical steps that can support dietary change include:

• Prioritising vegetables, pulses and wholegrains at most meals

• Reducing portion sizes of refined carbohydrates such as white bread, white rice and pastries

• Limiting sugary drinks, including fruit juices

• Eating regular meals to avoid excessive hunger that can lead to overeating

Can exercise help reduce stomach fat, and which types work best?

Aerobic exercise is most effective at reducing visceral fat; combining it with resistance training produces better outcomes than either alone, and abdominal exercises such as sit-ups do not selectively burn overlying fat.

Exercise can meaningfully reduce abdominal fat, particularly visceral fat, even when overall body weight changes only modestly. Research, including systematic reviews and meta-analyses, consistently shows that aerobic exercise is especially effective at reducing visceral fat, with benefits seen even before significant changes in body weight or waist circumference become apparent.^[17][18] This is thought to be because visceral fat is more metabolically active and more sensitive to the fat-mobilising effects of exercise-related hormonal changes.

The UK Chief Medical Officers' Physical Activity Guidelines recommend that adults aim for at least 150 minutes of moderate-intensity aerobic activity per week, or 75 minutes of vigorous-intensity activity, alongside muscle-strengthening activities on two or more days per week. In the context of abdominal fat reduction, activities such as brisk walking, cycling, swimming and jogging are all effective choices for aerobic exercise. Vigorous-intensity exercise, such as running or high-intensity interval training (HIIT), may produce greater reductions in visceral fat per unit of time compared with moderate-intensity activity, though both are beneficial and the choice should be individualised based on fitness level, preferences and any existing health conditions.

Resistance training, which includes weight training and bodyweight exercises, contributes to fat loss by preserving and building muscle mass, which supports a higher resting metabolic rate. Combining aerobic and resistance training appears to produce better outcomes for abdominal fat than either type alone.^[20][21] It is also worth reducing prolonged sitting time throughout the day, as sedentary behaviour is independently associated with poorer metabolic health. People who are deconditioned or who have long-term health conditions should increase activity gradually and seek medical advice before starting a new exercise programme if they have any concerns.

It is worth noting that abdominal exercises such as sit-ups and crunches strengthen the underlying muscles but do not selectively burn the fat overlying them. Consistency over months and years, rather than intensity over short periods, is the most important factor for long-term results.

When should you speak to a GP about your waist size or weight?

See a GP if your waist reaches the increased-risk thresholds (80 cm in women, 94 cm in men), or promptly if abdominal swelling is accompanied by pain, bloating, unexplained weight loss or rapid distension.

You should speak to a GP about your waist size or weight if your waist circumference reaches or exceeds the 'increased risk' thresholds (80 cm in women or 94 cm in men) or the 'very high risk' thresholds (88 cm in women or 102 cm in men), or if you have noticed a significant and unexplained increase in abdominal girth over a short period. Lower thresholds apply for people of South Asian, Chinese, Japanese and other East Asian backgrounds. A GP can assess whether your weight or body composition is contributing to other health conditions and can refer you to appropriate support services.

There are specific circumstances that warrant prompt medical attention rather than a routine appointment. If abdominal swelling is accompanied by pain, bloating that does not resolve, changes in bowel habits, unexplained weight loss or visible distension that has developed rapidly, you should contact your GP promptly. In women, persistent bloating, early satiety or pelvic discomfort are recognised features that NICE guidance (NG12, Suspected cancer: recognition and referral) advises should be assessed without delay, particularly in women aged 50 and over. These symptoms can occasionally indicate conditions unrelated to fat accumulation, such as fluid retention, ovarian pathology or gastrointestinal conditions, and they require clinical assessment. For symptoms that are severe or develop suddenly, contact NHS 111 for urgent advice.

A GP can also assess whether you meet the clinical criteria for structured weight management support, including referral to a tier 3 specialist weight management service or consideration of pharmacological treatment. NICE technology appraisals set out the criteria under which medicines such as semaglutide (Wegovy, available in doses up to 2.4 mg weekly, with a higher-dose 7.2 mg formulation also MHRA-authorised) and tirzepatide (Mounjaro) may be recommended, though local commissioning decisions by Integrated Care Boards determine NHS availability in practice.

If you experience any suspected side effects from a weight-management medicine, these can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk. Your GP remains the most appropriate first point of contact for ongoing weight management concerns.

Scientific References

1. Medicines regulator approves up to 7.2mg dose of semaglutide (Wegovy) for patients with obesity.
2. MHRA authorises diabetes drug Mounjaro (tirzepatide) for weight management and weight loss.
3. Overweight and obesity management (NG246): Identifying and assessing overweight, obesity and central adiposity.
4. Overweight and obesity management (NG246): Appendix A1 – Summary of evidence from surveillance.
5. Suspected cancer: recognition and referral (NG12).
6. Tirzepatide for managing overweight and obesity (TA1026).
7. Wegovy | European Medicines Agency (EMA).
8. Semaglutide | Drugs – BNF – NICE.
9. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). Wilding JPH et al..
10. UK Chief Medical Officers' physical activity guidelines.
11. Physical activity guidelines for adults aged 19 to 64.
12. Alcohol consumption: advice on low risk drinking – UK Chief Medical Officers.
13. Stress-induced cortisol response and fat distribution in women. Moyer AE et al. Obesity Research..
14. Glucocorticoid-induced fingerprints on visceral adipose tissue transcriptome and epigenome. Journal of Clinical Endocrinology and Metabolism..
15. Metabolic and epigenetic regulation by estrogen in adipocytes. Frontiers in Endocrinology..
16. Metabolic syndrome and menopause: pathophysiology, clinical and diagnostic significance. Advances in Clinical Chemistry..
17. A dose-response relation between aerobic exercise and visceral fat reduction. Ohkawara K et al..
18. A systematic review and meta-analysis of the effect of exercise on visceral adipose tissue. Ismail I et al..
19. Aerobic exercise and weight loss in adults: a systematic review. Jayedi A et al. JAMA Network Open..
20. Effects of concurrent training on fat mass and its distribution in individuals with overweight or obesity: a systematic review, meta-analysis, and exploratory regression analysis. BMC Public Health..
21. Exercise modalities for adults with type 2 diabetes mellitus and obesity: comparative effects on visceral fat, metabolism, and inflammatory markers from a network meta-analysis. Frontiers in Immunology..
22. Impact of different exercise modalities on visceral adipose tissue in normal weight and low-overweight individuals: a systematic review and meta-analysis. Biological Research for Nursing..
23. Effect of predominantly plant-based diets on visceral fat: a systematic review and meta-analysis. Journal of Human Nutrition and Dietetics..

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