CHARLESTON, W.Va. -- Dear Cindy,

I don't seem to be able to flatten my belly. I have lost about 20 pounds (still have 15 to go), but my belly is the same. In fact, it almost looks worse because I'm losing everywhere but my belly. I've read about cortisol and somehow it is supposed make us have big bellies if we have too much of it. Can you explain how this works? Also, how can I lose this fat around my middle? Thank you. -- Colleen

Dear Colleen,

Just know you are not alone in this battle of the bulge. These days, belly fat captures so much attention that it's plastered on the covers of most health and fitness magazines. It has also spawned new names such as muffin top, which is what belly fat morphs into once it's squished inside low-rise pants. Make no mistake, belly fat is one hot topic now that it has been linked to the hormone cortisol.

However, I find it kind of crazy that some would like us to believe cortisol and only cortisol is behind every morsel of belly fat hanging onto America's middle. While there is a distinct connection between cortisol levels and belly fat, it shouldn't be demonized and expected to shoulder all the blame for belly fat.

Face it: Poor diets, too many calories and too little exercise are the real reasons behind belly fat. Furthermore, physical activity and weight management go a long way toward decreasing determined belly fat.

Still, understanding the role cortisol plays in fat accumulation and distribution is important and actually pretty interesting.

What's up with cortisol?

Cortisol is classified a corticosteroid hormone, which our bodies naturally produce and release especially when we are under duress. Cortisol levels are believed to be the highest in the morning hours, peaking at 7 a.m. and then decreasing as the day progresses. It is responsible for fuel regulation and based on need or situation is released at various times of the day when we are exercising, eating, awakening or under stress.

Stress! Psychologist Richard Lazarus describes stress as "any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual, social system, or tissue system." By definition, I suppose we'd have to agree we all live with stress and, therefore, all get daily doses of cortisol.

This raises the question, "Since we all experience stress in our lives, are we all powerless in the battle of the bulge?"

In fact, we are not. Information is power and we should use it to direct and to manage our health. Stress and cortisol are not all bad. They will always be necessary to provide challenge to our physiological and psychological development. Clearly, it is a natural response and some is needed, but too much cortisol negatively affects our appetite and the way we store fat.

An excessive amount of cortisol is associated with high caloric, fat and sugar cravings, overeating and storing fat in the abdominal area. Fat in the abdominal area -- visceral fat -- is a greater health hazard than subcutaneous fat. Left to accumulate year after year, visceral fat dramatically increases health risks such as cardiovascular disease, type II diabetes, hypertension, and cerebrovascular disease.

Can we curb the cortisol?

Exercise, diet and stress management are three ways to prevent and or to reduce stress-induced obesity. Here are some helpful tips:

• Don't skip meals. This is probably the most important advice I can offer. By eating five to six mini meals a day, including breakfast, you'll lower cortisol production and decrease the chance you'll overeat.
• Try substituting higher-intensity exercise for moderate to low intensity if you are capable. Work harder instead of longer to burn more fat.
• Watch the alcohol. It is empty calories and causes spikes and dips in your blood sugar, which releases cortisol and causes your body to store fat in the belly. If you want to lose belly fat, no more than one or two drinks one or two times a week.
• Keep the starchy carbs to a minimum. Skip the muffins if you want to lose the muffin top.
• Fiber is your friend. Along with lean protein, be diligent about getting enough fibrous veggies in your day. Fiber helps regulate your blood sugar and makes you feel full and satisfied.
• Get a full eight hours of sleep. This is essential to control cortisol and high-carb food cravings.
• Manage chronic stress. Eating right, sleeping enough and exercising will help alleviate stress and enable your body to cope in a healthful way. Movement such as yoga and tai chi are exceptional ways to actively control stress levels. Spending time in meditation, deep breathing and relaxing are equally valuable strategies.

• Finally, don't stress. Losing fat around your middle is accomplished by losing bodyweight all over. A healthy diet and plenty of exercise, including weight training, will give you the body you desire.

Cindy Boggs, fitness presenter, author and Activate America director, has been an ACE-certified coordinator/instructor since 1989. Send your questions about fitness, training or health to YMCA of Kanawha Valley, 100 YMCA Drive, Charleston, WV 25311, or e-mail cindys...@aol.com. Look for Cindy's award-winning fitness advice book, "CindySays ... You Can Find Health in Your Hectic World" on her Web site, www.cindysays.com, or contact the YMCA at 340-3527.