DEAR DR. DONOHUE: In regard to the 83-year-old man who worked out at the gym, walked the golf course, was 5 feet 9 inches and weighed 143 pounds but who saw his waist go from 29 to 35 inches: If he’s walking, he’s exercising his legs. I imagine at the gym, he is doing exercises that do not help his waistline. To attack the belly, you have to concentrate on the belly, and that is not done with arm curls. I would predict that his gym workouts do not include much abdominal work. Being a former wrestler and having had substantial weight swings, I could lose weight without it significantly affecting my waist. It was not until I used regular abdominal workouts that I flattened my stomach. Hope this helps. — T.S.

ANSWER: Thanks so much for your input. I agree with all you say. Abdominal exercises, by strengthening the abdominal muscles, create a girdle that holds the abdominal organs and abdominal fat in. The abdomen stays flat.

Three distinct factors have to be considered to achieve a flat abdomen. The first is calorie intake. No overweight person has a flat abdomen.

The second is posture. Anyone with a large abdomen who lies on his or her back on the floor will see his or her abdomen flatten. What causes that? When lying on an unyielding surface, the inward curve of the lower back flattens, and that flattens the abdominal bulge. The treatment is to flatten that inward curve of the lower back as much as possible when standing, walking and sitting. Once this postural goal is met, the abdomen will not protrude so much.

The third factor is abdominal-muscle exercise. Every trainer and every author on abdominal exercise describes the one perfect exercise and condemns all others. That’s nonsense. Many good exercises will achieve the goal of stronger abs. The standard crunch is a good example. Lying on the back with lower legs resting on a seat or bench, arms behind the head, raise the back off the floor. Some say the most important part of the exercise is simply getting the shoulder blades off the floor. Others insist on a full upright position for the back. And still others tell you to alternate elbow touches to the knees, right elbow to left knee, left elbow to right knee.

If you pay attention to all three factors, a trim abdomen is quite possible.

DEAR DR. DONOHUE: My husband is 61 and seems to be in good health. The problem is he has a basketball belly. He drinks about 40 ounces of beer every day, but he exercises often. What’s the reason for his belly? — G.P.

ANSWER: Your husband will benefit from reading the first letter. I believe one of the reasons for your husband’s basketball belly is his beer consumption. I have a feeling you believe that, too, or you wouldn’t have mentioned it. In addition to all the other calories he’s ingesting in a day, his beer intake is providing around 500 daily calories.

He has to decrease his calorie intake and increase his calorie output through more exercise.

And as T.S, the previous letter writer, says, he has to include abdominal-muscle exercises in his routine. He also has to decrease the inward sway of his lower back.

DEAR DR. DONOHUE: Will you say something about race-walking. I saw a race-walk demonstration on TV, and the spokesperson says it was one of the best ways to get a thorough workout. Is it? It looks kind of funny. — J.T.

ANSWER: It does look funny. As I understand it, to qualify as race-walking, a person must keep one foot always in contact with the ground. The front leg is kept straight when it’s in position to touch the ground. The arms are always bent. When the right leg is in the front position, the left elbow comes forward.

A person weighing 150 pounds burns close to 250 calories in 30 minutes of race-walking, a substantial number of calories.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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