Ascites vs belly fat: What is the difference?

Most cases of increased belly size are caused by fat. But medical conditions like ascites can also be culprits.

Avatar illustration of ascite laparocentesis

Key takeaways:

  • Ascites is a medical condition characterized by a build-up of fluid in the abdomen, causing a distended belly, and is different from belly fat which occurs due to the accumulation of fat in the abdominal area.
  • The differences between ascites and belly fat lie in their causes, symptoms, treatment method and even appearance. Also, while ascites is a complication of an underlying health condition, belly fat is not a health condition but can increase the risk of health conditions like heart disease and stroke.
  • Both ascites and belly fat can be treated. However, while ascites often require taking medications, belly fat can often be eliminated using dietary and lifestyle changes.

There are several reasons why a person's abdominal area can appear bulgy. In some cases, it can be due to the accumulation of fat around the abdominal area, while in other cases, it can be caused by health conditions like ascites.

Like belly fat, ascites can cause a larger or more protruding abdomen, so it might be hard to differentiate between them. However, in most cases, people can tell when their increased belly fat is a symptom of an underlying health condition like ascites because other symptoms will most often accompany the bulgy belly.

Ascites is a condition in which fluid builds up in the abdomen and is commonly caused by severe liver disease.

Ascites and belly fat can both cause an increase in abdominal size, but their causes are different. Furthermore, while belly fat is more common and often harmless, ascites is less common and can lead to life-threatening complications, especially if left untreated.

How can you tell the difference between ascites and belly fat?

This article will cover the key differences between ascites and belly fat, their causes, and treatments.

Causes of ascites vs. belly fat

Ascites is a medical condition where fluid builds up in the peritoneal cavity, a space in the abdominal area that contains the stomach, intestines, and liver. The organs in your abdomen, like the stomach, kidney, liver, and bowels, are covered by the peritoneum. The peritoneum is a thin tissue that has two layers. As seen in ascites, a buildup of fluid between the layers can cause a bulgy belly.

On the other hand, belly fat is used to describe the accumulation of fat in the abdominal area, which is usually contributed by a lack of exercise, a poor diet, and stress.

Causes of ascites

Ascites often occur in people with health conditions like cirrhosis of the liver (scarring of the liver due to long-term damage). It is the most common complication associated with liver cirrhosis or chronic liver disease.

Ascites occur in cirrhosis when the blood pressure in the portal vein increases excessively. The portal vein is a blood vessel that delivers blood from the digestive organs to the liver. As the pressure in this blood vessel increases, fluid builds up in it and starts leaking into the peritoneal cavity. This buildup is because liver cirrhosis makes the liver hard and shrunken, thereby resisting blood flow to the liver from the portal vein.

This will cause a large amount of blood to remain in the blood vessels that supply the liver and digestive system.

Increased blood retention in the blood vessels that supply the liver and digestive system means a reduction in the amount of blood circulating to those areas. The kidney will interpret it as a reduced blood volume that needs to be increased, so it will cause the body to start retaining salt and water. The excess fluid retained leaks into the peritoneum, causing a swollen abdomen.

However, while this is the primary cause of ascites, there are other possible causes or risk factors for ascites, such as:

  • Non-alcohol-associated fatty liver disease
  • Hepatitis C
  • Hepatitis B
  • Alcohol use disorder
  • Autoimmune hepatitis
  • Genetic liver diseases (like Wilson disease and alpha-1- antitrypsin deficiency)
  • Congestive heart failure
  • Cancers of the abdominal organs or pelvis
  • Kidney failure
  • Infections

Causes of belly fat

Belly fats are fat deposits around the abdomen. There are two types: subcutaneous and visceral. Visceral fat is deeper in the abdominal cavity and surrounds the organs. Subcutaneous fat is right under the skin. While subcutaneous fat is often not a cause for concern in terms of health, visceral fat has been linked to health conditions such as stroke, heart disease, and diabetes.

According to a recent 2020 study, nearly half of the world's adult population (41.5%) has central obesity—excess visceral fat around the abdominal area.

Different things can cause or contribute to belly fat, including:

  • Excessive intake of alcohol: Excess alcohol consumption can cause people to gain weight around their abdomen. Alcohol consumption can also lead to other health conditions like liver disease and inflammation, which can impact weight and be linked to belly fat.
  • Poor diet: Some diets will increase your chances of getting belly fat. Examples of these diets are foods high in refined carbohydrates, baked foods, sweetened beverages, and other processed foods. Foods high in saturated and trans fat, like food shortenings, fried foods, and frozen dough, are common culprits for belly fat.
  • Stress: The body produces a hormone called cortisol under stress. Cortisol is a steroid hormone that helps control and manage stress. In a stressed condition, we often and sometimes unconsciously reach for food. Excess production of cortisol when stressed can cause the excess calories from those foods to get stored around the belly.
  • Lack of exercise: You will likely gain weight when you don't exercise regularly. When you eat foods without burning up fat, the calories can become excess, leading to increased belly fat.
  • Lack of sleep: When you don't get enough sleep, there are chances that your food intake may increase. Sleep plays a vital role in regulating hormones like ghrelin and leptin, which are integral to appetite and hunger. Lack of sleep can cause reduced leptin and increased ghrelin, leading to increased appetite and hunger. Also, when you don't get enough sleep, you might develop some unhealthy eating behaviors like emotional eating.

Some people have little, or no control over their belly size as some cases of belly fat have genetic predispositions, i.e., they run in the family. Furthermore, for some people, surgical procedures such as a hysterectomy can increase their chances of developing belly fat.

Ascites vs. belly fat: Difference between the two

Differences between ascites and belly fat


Belly fat

Ascites is caused by an accumulation of abdominal fluid.

Belly fat is caused by excess fat around your abdomen.

Ascites are caused by health conditions like liver problems, kidney disease, surgery complications, and infections.

Belly fat is caused by factors like excess calories in your meals, poor lifestyle choices, and too much stress.

A doctor can diagnose ascites with the help of tests like CT scans and ultrasounds. They may notice the presence of a fluid wave in the process.

To diagnose belly fat, skinfold calipers can be used. It will show the amount of fat that is under the skin of the belly.

The symptoms of ascites are a swollen and hard belly, along with increased girth and body weight.

The symptoms of belly fat are a soft belly that often has rolls, an increased girth, and increased body weight.

You can treat ascites by reducing or restricting your intake of sodium. Diuretics can also work to eliminate the excess accumulated fluid.

You can treat your belly fat by making changes to your diet and lifestyle, such as exercising and getting better quality sleep.

Ascites can cause life-threatening complications, like an increased risk of infection of the peritoneum and sometimes fluid buildup in the lungs.

Belly fat has been linked to a higher risk of diseases such as heart disease, type 2 diabetes, high cholesterol, and hypertension.

Symptoms of ascites vs. belly fat

Apart from having a distended and smooth appearance, you can differentiate ascites from belly fat from the symptoms you experience. Besides the accumulation of fat around the belly area, belly fat often doesn't cause unpleasant symptoms. Ascites, on the other hand, have a wide range of symptoms.

Symptoms of ascites

  • Shortness of breath
  • Bloating
  • Nausea
  • Vomiting
  • Swelling in the abdomen
  • Swelling in your lower legs
  • Hemorrhoids
  • Sense of heaviness in your stomach

How to treat ascites

Healthcare professionals are in the best position to diagnose and treat health conditions like ascites. Your doctor can recommend diuretic medications like chlorothiazide, metolazone, indapamide, hydrochlorothiazide, torsemide, bumetanide, and triamterene. These medications, also known as "water pills," can help eliminate salt (sodium) and water from your body.

Your doctor can also remove some of the fluid using a slender needle if the ascites are affecting your breathing. This process is called paracentesis.

Also, dietary and lifestyle changes can help treat your condition, such as:

  • Reducing the amount of fluid you drink
  • Avoiding or limiting alcohol intake
  • Reducing your salt intake.

Speak with your doctor to suggest low-salt foods you can eat. Also, if you have to take salt, don't use salt substitutes that have potassium in them. Some medicines for ascites can cause potassium levels to rise.

How to reduce belly fat

To reduce your belly fat, you have to make some adjustments to your lifestyle and dietary habits.

You can do the following to reduce your belly fat:

  • Eat healthier diets containing vegetables, whole grains, proteins, and low-fat dairy products, and limit unhealthy foods.
  • Reduce your intake of sugary foods, including sweetened beverages. Substitute the beverages with water instead.
  • Eat moderate food portions. It would be best if you didn't eat more than your body requires to avoid storing up calories in your body.
  • Regular exercise is one of the surest ways to lose belly fat. Cardio and resistance training can help you lose excess fat.
  • Eat food rich in fiber. Soluble and viscous fibers are types of dietary fiber that help with weight management and weight loss. You can find soluble fiber in nuts, barley, seeds, oat bran, beans, fruits, and vegetables, and viscous fibers in asparagus, oats, Brussels, sweet potatoes, and beans.
  • Eat healthy dietary fats. Not all fats are harmful to the body. Some dietary fats are healthy for the body, such as those found in foods like avocados and avocado oil, eggs, fatty fish, olives, nuts, and chia seeds.

Wrap up

People with health conditions like liver cirrhosis may experience a buildup of fluid in the abdomen, which would cause an increase in belly size. A person may mistake this for belly fat, but it's not. One feature that can distinguish belly fat from ascites is that in the former, the abdomen doesn't feel soft on touch; rather, it feels stiff and bloated.

Beyond an increase in size, if your belly feels distended or you experience other health symptoms like shortness of breath, swelling of your legs, or a sense of heaviness in your stomach, you should see your doctor.