by Dr. Marie Savard
Are you an apple or a pear? Most women understand intuitively whether their bodies tend to store fat around their waists (forming an apple shape) or lower down around their hips, thighs, and buttocks (forming a pear shape). But few of us understand the dramatic impact body shape has on our current health and risk of future disease. Every aspect of a woman's life is affected by her shape, including her ability to lose weight, her fertility, severity of menopausal symptoms, response to birth control pills and hormone replacement, emotional volatility, body image, and long-term risks of breast cancer, heart disease, diabetes, osteoporosis, and other disorders.
Determining your body shape is easy: First, measure around your waist to get your waist circumference. Next, measure around the widest part of your lower body to get your hip circumference. Divide the first number by the second to get your waist-to-hip ratio (WHR). If your SWHR is 0.80 or less, you are a "pear." If your WHR is greater than 0.80, you are an apple."
Although we've known for decades that these different body shapes existed, only now are their causes and related health risks becoming clear. The startling discovery is that these two categories of women-apple-shaped and pear-shaped-are as physiologically different from each other as women are from men. The reason is fat.
Fat comes in two main varieties: subcutaneous fat, which is located under the skin; and visceral or abdominal fat, which packs itself around the inner organs of the abdomen. Subcutaneous fat, being closer to the surface, is always easy to see. Visceral fat, on the other hand, is not always visible from the outside. It jams up against the intestines, kidneys, pancreas, and liver (and sometimes even inside the liver). We all have some visceral fat because it protects our internal organs, acting both as shock absorber in case of trauma, and as insulator to help us conserve body heat. While some visceral fat is necessary, too much can create serious health problems.
Most people think of fat as inert material, much like the rind of fat surrounding a steak. But fat is actually living, breathing, hormone-producing, metabolically active tissue. Fat is critical for survival because it stores food energy, and because it helps regulate body functions through the give-and-take of chemical communications with the central nervous system.
Subcutaneous fat may be visible and annoying, but it is relatively harmless. In fact, fat in the pear zone-hips, thighs, and buttocks-helps to protect us from disease. Scientists believe that pear zone fat acts like a fat magnet, trapping certain fats from the foods we eat and keeping them from escaping into the blood stream where they can damage our arteries.
Excess visceral fat, on the other hand, can be dangerous. Visceral fat is more metabolically active than subcutaneous fat, and most of what it does is harmful to the body. Visceral fat decreases insulin sensitivity (making diabetes more likely), increases triglycerides, decreases levels of HDL cholesterol (the good one), creates more inflammation, and raises blood pressure-all of which increase the risk of heart disease. Instead of trapping fat, visceral fat releases more of its free fatty acids into the blood stream, further increasing the risk of both diabetes and heart disease. The overall effect of excess visceral fat is that it creates a physical environment that is primed for heart disease and stroke, and greatly increases the risk for certain cancers. This is why apple-shaped women, who carry their weight around their waists, have an increased risk of metabolic and vascular diseases.
Although pear-shaped women are protected from heart disease and diabetes, they have health risks of their own. Because pear-zone fat produces a less potent form of estrogen than apple-zone fat, pear-shaped women are more likely to experience more severe symptoms of menopause, and to develop osteoporosis. Pear-shaped women are also more likely to develop eating disorders, probably because society tends to value the narrow hips and slender legs that are impossible for pear-shaped women to achieve, even with liposuction.