Are You an Apple or a Pear?

By Marie Savard, M.D., with Carol Svec

"According to recent studies, your body shape is the single most powerful predictor of future health. More important than weight itself, this simple piece of information can determine the best way to tackle weight loss and predict your propensity to develop certain diseases...."

apple and pearShow me a women -- any woman -- and I can forecast her health destiny just by observing her body shape. I know who will probably die of heart disease or breast cancer, who will have a rough transition through menopause, who will likely end up with a broken hip, and who won't live long enough to celebrate her 70th birthday. From my 30 years of clinical research and a review of decades of research, I've discovered that the single most powerful predictor of a woman's future health is the shape of her body.

Body shape is not something we get to choose. As much as we would like to believe that we are all unique physical specimens, women's bodies are divided into two main groups: apple-shaped and pear-shaped. Body shape is related to differences in our physical chemistry, hormone production and sensitivity, metabolism, and possibly even personality.

I have made it my life's mission to empower every woman to take charge of her health. If the woman is my patient, I can sit her down, explain the importance of body shape, and warn her of her specific disease risks. Then with medical recommendations customized by body shape, I can tell her exactlly what she needs to do in order to live longer, look better, and feel healthier. For the millions of other women in the world, the ones I can't treat personally, I am putting that same power in their hands with "Apples & Pears"

Apples, Pears, and Bananas

Body shape is the closest thing we have to a medical crystal ball. This one simple piece of information is more important than weight for predicting your risk of heart disease or stroke...it can foretell your likelihood of developing type 2 diabetes 10 to 20 years before blood tests show a problem with blood sugar...and it is as powerful as family history for revealing a tendency toward breast cancer, ovarian cancer, or osteoporosis. The good news is that this crystal ball only shows what is likely to happen; our health destiny is not written in stone. We have the power to improve the course of lives in spite of our shapes if we are willing to take action.

But body shape tells us much more than our risk of future diseases. Want to understand the reason for your cellulite, bloated belly, depression, low self-esteem, menopausal hot flashes, gestational diabetes, varicose veins or periodontitis? In many cases, everything you need to know can be found in the measurement of your waist, hips, and buttocks. Every wonder why exercise never slims your "thunder thighs," or why you gain weight when you're under stress, or why diets never seem to work for you? Again, body shape reveals all.

Body Shape Variations

As much as we would like to believe that we are all unique physical specimens, women's bodies are divided into two main groups: apple-shaped and pear-shaped. The classic apple-shaped women has slender and shapely legs, narrow hips, large breasts, and a relatively large waist. If you look at an apple, you'll notice that the fruit is widest in the middle, and an apple-shaped women also tends to put on weight around her waist, or the area where her waist would be if she had one. She probably owns few, if any belts (because tucked in shirts just emphasize her lack of a waist), but short skirts and men's-fit or slim-leg jeans look good on her.

The classic pear-shaped women has a relatively thin upper body, often with small breasts, a well-defined waist, and heavier lower body. If you look at a pear, you'll notice that the fruit is widest at the bottom, and a pear shaped woman also tends to put on weight around her hips, thighs, and buttocks. She will often feel self-conscious about her "thunder thighs," but will have no problem cinching a belt around her narrow waist.

Once you know what to look for, you can often identify which women are apple-shaped and which are pear-shaped just by looking at them. Spend a day people-watching in a shopping mall and you'll see many examples of both classic apple shapes and classic pear shapes. You'll also spot a few mixed-type body shapes. For example, some women have more of a banana-shape -- a body that is straight up and down, with thin upper and lower extremities, small chest, and no waist. There is also a body shap sometimes called the "inverted pear," characterized by large breasts and thick, wide shoulders tapering down to slender hips, but with no discernible waist. And, of course, there is the famous hourglass figure, defined by large breasts, a narrow waist, and relatively large hips. Banana-shaped and inverted pear-shaped women have, for all medical purposes, variations of an apple shape. Women with an hourglass figure have the equivalent of a pear shape. All women, thin or fat, curvy or flat, can be categorized as either apple-shaped or pear-shaped. The key is the waist-to-hip ratio.

The Tape Measure Test

Figuring out your body shape is easy -- all you need is a flexible tape measure and a calculator. First, measure around your waist. (If you have a visible waist, measure around the narrowest part. If you don't have a waist, measure around the widest part of your middle, usually about one inch above your navel.) Stand up straight, but relaxed. Don't suck in your gut. Hold the tape measure loosely, without putting pressure on the skin. That number is your waist circumference. Next measure around your hips -- not at the hip bones, but about three to four inches lower. (This actually corresponds to the point where the top of your thigh bone -- the femur -- meets the pelvis. You should be measuring around your buttocks, not above or below. If you have any doubt, take the measurement at the widest point of your lower body.) Divide your waist measurement by your hip measurement to get your waist-to-hip ratio, or WHR.

If your WHR is 0.80 or lower, your body is classified as pear-shaped. if your WHR is higher than 0.80, your body is classified as apple-shaped. For example, if your waist measurement is 26 and your hip measurement is 37, then the calculation is 26 ÷ 37 = 0.70, which means that you are pear-shaped. If your waist measurement is 35 and your hip measurement is 38, then the calculation is 35 ÷ 38 = 0.92, which means that you are apple-shaped. it's that simple. But embedded in that simplicity is a whole new dimension of women's health...

Which is Better -- Apple or Pear?

Women seem to have preconceived notions of which body type is "better," apple-shaped or pear-shaped. Each woman tends to think that whichever type she isn't is the more desirable. Pear-shaped women often silently curse their hips and thighs, they dread bathing suit season, and they can be embarrassed by their very womanly, Rubenesque figures. They have to fight the impression that they are wide at the bottom because they sit around all day -- "secretary spread" is a prejorative for ample buttocks on a woman with a desk job. Apple-shaped women are often uncomfortable with their bellies, they become geniuses at dressing to camouflage their lack of a waist, and they are often frustrated to tears at the inability of sit-ups or crunches to slim their middles. They feel shamed into making excuses for their shapes, such as blaming a large tummy on the effects of pregnancy, "baby weight" that never went away (as you'll see in Chapter 3, that's actually partly true!).

In reality, neither body shape is better than the other. It may sound as though science is picking on apple-shaped women, but apple-shaped women can be just as healthy as pear-shaped women. It's not really about shape -- it's about "visceral fat." Shape, through waist circumference and WHR, is just a convenient way to measure that deep fat tissue. So apple-shaped women can really consider themselves lucky to have such a good advance warning system for disease! Pear-shaped women may have less immediate disease risk, but they can become apple-shaped after menopause. And in old age, they face the quiet devastation of osteoporosis. There is no "better" or "worse," there is only what you are.

Regardless of whether you are an "apple" or a "pear," fat or thin, it is important that you understand that your body shape is not your fault. And it is certainly nothing to be ashamed of. It's all part of the specific set of genes and environmental factors that make you who you are. Although scientists have begun mapping the human genome, it is likely that we'll never know exactly which traits were inextricably interconnected and expressed to make you as you are, a unique individual.

Are you creative, musical, funny, responsible, intuitive? Are you a great cook, a loving mother, a reliable friend? Are you happy, serious, playful, philosophical, strong? There's a good chance that the factors that went into making you those things are somehow linked to the factors that made you apple- or pear-shaped. You can't change it.

What you can do, however, is make yourself as healthy as possible. This includes identifying your body shape, recognizing the interrelatedness of body shape and certain diseases, and then doing what you can to rid yourself of excess visceral adipose tissue. Visceral fat is the enemy, not your waist, hip, thighs, or butt. This book is full of ways to get rid of visceral fat, prevent the additional accumulation of fat, and counter some of the other disease risks associated with your body shape. Just take one step at a time. If you adopt even a few of the program recommendations, you won't need a crystal ball to tell your health future -- you'll see it in the mirror, and you'll feel it in your heart.

Take it to Heart...

It's not inherently good or bad to be apple-shaped. It is not inherently good or bad to be pear-shaped. Is it better to be a beagle or a cocker spaniel? An oak or a maple? A rose or an orchid? If you understand and accept your body type, you gain the freedom to be happy in your own skin.

Related article: Five Tips to Harness the Power of Body Shape, 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. Carol Svec is a seasoned health writer and the author of three books.

Copyright © Marie Savard. Permission to republish granted to Pregnancy.org.