The health risks of having an apron belly – and how to get rid of it

"Apron belly" is most commonly seen in women who have carried children or lost a lot of weight, but can also be an issue for men who have lost significant weight. Photo / Getty Images

An overhanging belly isn’t just frustrating, it can also make you prone to infections and postural problems. Here are three ways to shift it

If you’ve lost a lot of weight or had pregnancies that have stretched your stomach, you might have been left with what’s not-so-charmingly referred to as an apron belly and be wondering how to treat it.

Whether yours is large enough to be causing you pain and difficulty dressing and exercising, or more of a cosmetic concern, there are ways to manage and even resolve the condition.

What is an apron belly?

Colloquially called an apron belly, stomach overhang or mother’s apron, this is a medically recognised condition in which excess fat and skin form a flap that hangs from the lower abdomen. It is properly referred to as an abdominal pannus or panniculus.

“Essentially, it’s an overhanging bit of skin at the bottom of the abdomen that has lost its elasticity and cannot shrink back after weight loss,” explains William Van Niekerk, a consultant plastic and reconstructive surgeon at The Private Clinic in Harley St, central London. “Usually there is still some stubborn fat associated with it, but not always.”

It’s most commonly seen in women who have carried children or lost a lot of weight, but can also be an issue for men who have undergone significant weight loss.

The condition can vary in severity from a small sagging overhang of just a few inches of skin to an unmistakable drooping apron of flesh that can cover the pubic area and reach as far as mid-thigh or even to the knees in serious cases.

What causes apron belly?

Extreme weight loss

It is not usually gaining weight that causes an apron belly, but losing it. Typically, an overweight stomach will protrude outwards, not downwards (although in some obesity cases both may occur together). But after a certain degree of weight loss, the overstretched skin begins to sag and cause an apron or draping effect.

“We tend to see it most commonly in people who have lost a great deal of weight,” Van Niekerk says. “Your skin has been expanded by the extra fat but, as you lose it, your skin has to shrink back. Past a certain point of stretching, the skin can be damaged beyond repair. Like an elastic band that has been pulled too far, it can lose its elastic recoil and only shrink back to a limited degree. Thanks to gravity, that skin and whatever residual fat is left in the area is then prone to hang down.”

Although gradual weight loss is safer in general, he says it’s a myth that losing weight very quickly puts you more at risk of an apron developing than losing weight slowly.

An apron belly is medically called an "abdominal pannus" or "panniculus". Photo / 123RF

Carrying a baby

“You can develop this apron-like stomach to some degree just from going through pregnancy,” says Van Niekerk. “Some women experience weight gain along with pregnancy, but just the baby bulge and no other real weight gain can stretch the abdominal skin beyond a certain level of tolerance. Just as if the skin had been stretched by fat, it is stretched by the baby bump and, at some point, it loses the capacity to entirely shrink back and becomes slack.”

Having a caesarean

Caesarean section scars can exacerbate an apron belly or even create an overhang or shelf of skin in this area, depending on their location and how they have healed. “When you have a C-section, the surgeon cuts through seven layers and the scar tissue can tether the skin to the layer(s) beneath. The scar can act like a barrier, a wall between the skin above and below it,” Van Niekerk says. This horizontal wall across the bottom of your abdomen can cause the skin (and any fat) above it to hang over the scar, creating a small apron that would not be there if the scar was not pulling at the skin. “Even if your body otherwise bounces back from pregnancy well, you can end up with a small lip or overhang of flesh, which can be a source of great frustration.”

Caesarean section scars can sometimes contribute to the formation of an apron belly. Photo / 123RF

Excess abdominal fat

Studies have repeatedly shown that more fat around the abdomen increases the risk of Type-2 diabetes, heart disease, cancer and even neurodegenerative diseases such as Alzheimer’s and Parkinson’s, among other issues. Often, the apron belly is more loose skin than fat, but it may also include stubborn abdominal fat that has become difficult to shift.

Risk of infection

A large pannus is likely to cause hygiene issues as it is difficult to keep clean and can be very sweaty and uncomfortable. This can result in intertrigo, a type of inflammatory rash that develops between skin folds, or fungal infections.

Apron bellies can lead to skin infections due to trapped moisture and friction. Photo / 123RF

Postural problems

“The apron can also cause discomfort and difficulty moving or exercising, and affect posture causing back pain,” says Van Niekerk. “People don’t realise how heavy these aprons can be, and they can pull you forward and put a lot of strain on the back.”

How to get rid of an apron belly

Diet and exercise

You can shrink a stomach overhang to some degree by losing weight through diet and exercise, although often an apron belly will remain. In some cases, they can even look worse the more weight you lose, as it is primarily slack skin rather than fat which creates the apron effect.

Nonetheless, losing weight healthily through a low-calorie diet of vegetables, whole grains and protein can reduce both abdominal and overall fat. Improving your posture and fitness through a combination of cardio and resistance exercise will also get your body primed to have other treatments to successfully reduce the area.

Losing weight too quickly doesn’t necessarily increase the risk of an apron belly more than gradual weight loss. Photo / 123RF

Non-invasive aesthetic treatments

These are most effective for very small stomach “pooches” or overhangs which are mostly made up of hard-to-shift fat rather than extreme excess skin. One popular method is CoolSculpting, where fat is frozen, killing the fat cells which are then excreted by the body over the weeks to follow.

“This method can achieve as much as a 27 per cent reduction in fat in the treated area,” says Ria Murch, a senior medical aesthetician at The Cosmetic Skin Clinic. She advises that it can be used to help improve caesarean section overhangs and small aprons caused by stubborn fat pockets, but is unlikely to be suitable for treating a larger pannus or a lot of loose skin.

Surgical removal

Surgical treatments are the only completely effective way to get rid of a true apron belly. These can range from surgical removal of just the excess skin to a full tummy tuck that removes skin and fat and repairs any muscular damage to the abdomen.

Surgical treatments for apron belly

Tummy tuck (abdominoplasty)

“A full tummy tuck or abdominoplasty will completely recontour the abdomen and remove any sign of an apron,” says Van Niekerk. The procedure involves making an incision horizontally along the bikini line, removing any excess skin from above it (as far up the abdomen as necessary) and repositioning the belly button in the new skin. It also repairs any damage to the muscles of the abdominal wall (as many people having this procedure will also have diastasis recti, a separation of the abdominal muscles caused by pregnancy). A similar option is a mini tummy tuck, which involves much the same process and similar scarring, but only removes skin from the area below the belly button.

Brazilian tummy tuck (abdominoplasty with liposuction)

A Brazilian abdominoplasty is similar to a full tummy tuck but “includes liposuction and preserves the blood supply to the area during surgery better”, Van Niekerk says. This is his preferred method of abdominoplasty where possible as, although it is a longer procedure, it is lower risk and patients do not need drains to remove fluid after surgery.

Apronectomy (panniculectomy)

More unusual but more likely to be offered on the NHS than an abdominoplasty is a panniculectomy (also known as an apronectomy). A more basic degree of operation which focuses just on removing the excess flesh of the apron, it is often offered to people who have lost extreme amounts of weight but still have some to lose and need the excess skin removed to reduce discomfort and improve movement, says Van Niekerk.

Apron belly FAQs

Will walking help get rid of an apron belly?

To a degree, yes – in that any form of regular exercise will help you to shed fat all over and to improve muscle tone and posture, which can all lead to an improvement in the appearance of your apron and shrink it somewhat. However, as Van Niekerk notes, the key feature of significant apron bellies is that they are caused more by damage to the skin than stubborn fat, and this stretched skin cannot be shrunk by diet or exercise.

What exercises are best for an apron belly?

Although you cannot spot-reduce fat or shrink sagging skin with exercise, abdominal and core exercises will improve posture and potentially make your apron belly sit better, or help your body prepare for alternative treatments to deal with the area. Try planks and mountain climbers alongside weight training at least twice a week.

Can hormone imbalance cause apron belly?

Apron belly is not caused by a hormone imbalance per se, but can be influenced by hormonal changes such as pregnancy and menopause. Hormone changes at menopause can cause fat to be distributed around the stomach more than it was previously, while the loss of oestrogen affects skin laxity.

Walking and core exercises won’t remove an apron belly but can improve posture and fitness. Photo / 123RF