Q: I read your article about how certain foods affect the waistline, and have taken steps to avoid them. I am determined to get better looking abs in the New Year, and wondered, are there other things that I can do?

A: The abdominal area is probably the most stubborn area of the body to firm up. Along with consuming a healthy diet, it is vital to include cardiovascular and strength training exercises as a regular part of your fitness program. By working all of the major muscle groups both aerobically and anaerobically, you can help to optimize body fat burning and keep your metabolism revved.

- Body fat testing. Common methods of determining body fat, such as skin fold calipers, are not true measures of percentage, as they look at only one type of fat. Understanding that there are different types of fat is key. Subcutaneous fat lies just under the skin and covers the muscles. Even with regular exercise, if subcutaneous fat levels are high enough, the body will have a softer look and feel. Examples of abdominal subcutaneous fat are the “muffiSn top” or “love handles.” Visceral fat, on the other hand, cannot be seen. It lies underneath the abdominal muscles, potentially pushing them forward. An example of this would be the potbelly, which is round and hard to the touch. Here, the abdominal muscles are actually being stretched tightly over a lot of deep abdominal fat. Although the focus for most exercisers is on the jiggly stuff, numerous studies have shown that subcutaneous fat presents substantially less health risk than visceral abdominal fat. When visceral fat is released into the blood stream, it often ends up clogging coronary arteries and can lead to problems such as high blood pressure, elevated cholesterol , diabetes and other problems.

- Fiber. Most Americans are not getting enough fiber through diet, primarily due to over-consumption of processed foods and lack of fruits, grains and vegetables. On the other hand, even when diet is very good, consuming too much fiber, or increasing fiber too quickly, can cause digestive problems and bloating around the midsection. The Institute of Medicine recommends consuming 14 grams of fiber for every 1,000 calorie requirement.

- Age-related skin changes can make the abs look less than toned. As time goes by, this is a natural occurrence as elasticity of the skin diminishes. While some age-related changes are to be expected, drinking plenty of water, limiting exposure to the sun and consuming Omega 3 fatty acids and foods rich in antioxidants can help to keep the skin healthy and improve its appearance.

- Genetics and gender can play a role in how and where body fat is distributed. The number and distribution of fat cells is different for everyone, more prevalent in areas such as the waist for some (apple shape), and in the hips and thighs (pear shape) for others. Men tend to carry the majority of fat in the upper body and midsection, while most women carry fat in the lower body, mainly the thighs, hips and buttocks, although can also have trouble losing weight around the middle. Fat cells inflate when we overeat, and deflate when there is a calorie deficit. Interestingly, it was once thought that we were each born with a set number of fat cells, which remained the same throughout our lifespan. We now know that the number of fat cells is also influenced during times of rapid change, such as during puberty, or when a significant amount of weight is gained and therefore, more energy storage is needed.

- Stress studies have looked at the hormone cortisol, released when we are under stress, and its relation to abdominal fat. Cortisol affects distribution of fat by causing more of it to be stored around the organs. While research has looked at the cortisol response in overweight women, Yale researchers found that lean women with abdominal fat also have exaggerated responses. In addition to how we handle stress, lifestyle habits such as smoking or alcohol use, as well as quality and quantity of sleep, play a role in how the body uses and stores fat.

- How can sleep affect weight? Sleep deprivation is associated with the hormones ghrelin and leptin. Ghrelin’s job is to signal you to eat, and it has been shown that those who are sleep-deprived have more of this hormone. Leptin signals the brain to stop eating, and those who are sleep-deprived have less of this hormone. The combination of more ghrelin and less leptin promotes weight gain. Sleep deprivation also increases the urge to grab a sugary treat or extra cup of coffee for a quick energy boost. The effect is short-lived with the inevitable crash soon following, and the extras can add up to hundreds of extra calories, making it even harder to lose weight.

- Eat for the activity. If you are like most people, the majority of your calorie intake occurs at dinner and beyond. Unfortunately, this is also the time of day when we are least active, increasing the likelihood that the extra calories will be stored as fat. Your best bet is to gauge activity levels and consume bigger meals beforehand, allowing time for digestion before leaning up with exercise. The result is a better workout because you are fueled for it, and less chance you will end up overeating once the workout is finished. Remember to replace high calorie drinks with water for greatest health benefit and weight loss.