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."
How important is body shape?
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.
No matter which body shape you have, how old you are, or how much you weigh, there are many things you can do to decrease your personal disease risk. Diet and exercise are only part of the equation-medical monitoring is critical, as is a change in mind-set. We need to stop thinking of our weight problems, and learn to accept ourselves as women with figures. Every woman can become stronger, look better, and feel healthier. My top tips for getting started:
For apple-shaped women
- First step: throw away the scale and dig out a tape measure.from now on you should measure your health by inches instead of pounds.
- Long-term goal: lose just two inches of fat from your waist to significantly decrease your risks for the metabolic syndrome, diabetes, and heart disease.
- Diet strategy: Think high complex carbohydrates, moderate fats. Avoid foods made with white flour; eat plenty of fruits, vegetables, and whole grain foods. Choose olive oil instead of butter or margarines. Avoid all products made with partially hydrogenated oils-those are the dangerous trans fats, which increase the risk of heart disease.
- Exercise strategy: walk 30 minutes ever day to burn apple-zone fat.
- Medical monitoring: Get yearly tests for cholesterol, triglycerides, and blood glucose.
- Secret sabotage: STRESS -- it adds inches to your waist!
For pear-shaped women
- First step: understand that pear-zone fat is actually healthy.
- Long-term goal: Avoid weight-gain after menopause, which can turn a pear into an apple.
- Diet strategy: Think low fat, high complex carbohydrates. Avoid fatty foods, especially cheese and butter. Avoid candy, which is associated with a high risk of osteoporosis. Avoid salty foods, which can worsen varicose veins. Eat plenty of fruits, vegetables, and whole grain foods.
- Exercise strategy: resistance training three times per week to build bones.
- Medical monitoring: Get a bone density scan at age 45, and again every year or two after menopause.
- Secret sabotage: poor body image-it can lead to eating disorders.
(For additional information and downloadable forms, see the website at www.applesandpears.org.)
Read an excerpt from Apple and Pear: The Body Shape Solution for Weight Loss and Wellness, by Marie Savard.
Marie Savard, M.D. is a nationally known internist, women's health expert, and advocate for patients' rights. She is author of How to Save Your Own Life and the creator of The Savard Health Record. She lives in Philadelphia.
Copyright © Marie Savard. Permission to republish granted to Pregnancy.org, LLC.