Fight Belly Fat
By Jonny Bowden, PhD, CNS
Find out why your waist-to-hip ratio is more important than you think.

If you and I were in the grocery store, and I said the words "apple" and "pear," you'd probably think "fruit." But when it comes to weight loss and health, these words have entirely different meanings.

Apple and pear are now common terms for describing patterns of fat accumulation on the body. The "apple-shaped" person stores their fat around the middle, while the "pear-shaped" person is bottom heavy, storing most of their excess weight around the thighs and butt. While both types of fat distribution might keep you from feeling comfortable in your jeans, the truth is that they are far from equivalent when it comes to your metabolism and health.

Fat that's stored around the middle is known as VAT—visceral abdominal tissue. You and I may affectionately (or not so affectionately) know that fat as a beer belly or love handles, but it's anything but benign. A substantial amount of research has shown that VAT (abdominal fat to the rest of us) significantly increases the risk for all kinds of problems, from high blood pressure to diabetes to metabolic syndrome. A recent study in the New England Journal of Medicine showed that excess abdominal fat almost doubled the risk of death from a host of diseases, including stroke, heart disease, and cancer. Why is belly fat so much more of a problem than regular, garden-variety fat? The answer seems to lie in the difference in how abdominal fat actually functions. According to Harvard endocrinologist JoAnn Manson, MD, abdominal fat cells tend to be more active in producing hormones and chemical messengers that cause inflammation throughout the body.

As with real estate, the most important thing about fat is location, location, location. Subcutaneous fat—the kind that gets stored on the thighs, butt, and upper arms—is the kind you can pinch and is stored right beneath the skin. Unattractive and annoying, but basically harmless. Belly fat—deep inside the abdominal cavity—is near the liver, and the hormones and chemicals produced by abdominal fat go right to the liver. Increased fat in the liver—called fatty liver syndrome—is a risk factor for insulin resistance, which in turn is linked to type 2 diabetes. "Most of the research suggests that abdominal fat at least triples the risk of cardiovascular disease, diabetes, hypertension, and abnormal cholesterol levels," says Manson.

What to Do?
First thing is to measure your waist. The danger point seems to be 35 inches for women, 40 inches for men. If your waist measurement is that high or higher, "you've fallen off the edge of the cliff," says George Blackburn, MD, associate director of the division of nutrition at Harvard Medical School. That's why a metric called waist-to-hip ratio may turn out to be more important than either your weight or your body mass index (BMI), the standard way of calculating if you are overweight. Here's how to do it:

  • Measure the circumference of your waist at its smallest point.
  • Measure the circumference of your hips at their widest point.
  • Divide the waist measurement by the hip measurement.

A waist-to-hip ratio of 0.9 or greater for men and 0.85 for women indicates increased health risks. However, this is an independent risk assessment and is taken into consideration along with many other factors, such as weight and body type. For example, athletic women may have a high waist-to-hip ratio due to narrower hips but have a normal weight. Researchers at the University of Heidelberg in Germany found that waist-to-hip ratio predicted the risk of stroke far better than BMI did. In their research, those with the highest waist-to-hip ratio had nearly eight times the risk of stroke compared to those with the lowest waist-to-hip ratios!

Here's an interesting sideline on waist-to-hip ratio: it correlates strongly with general health (and with fertility). Women within the 0.85 range and men within the 0.9 range seem to be less susceptible to all sorts of major diseases, from diabetes to heart disease to cancer. And if obesity is redefined using waist-to-hip measurement instead of the more common BMI, the proportion of people categorized as "at risk" for a heart attack triples!

So what to do if your waist-to-hip ratio (or your waist measurement alone) puts you in the danger zone? Generally, if you are overweight, lose weight. If you aren't overweight and still have a high waist-to-hip ratio, look at other risk factors with your doctor to see where you might improve your health. In my experience—and the experience of hundreds of other health professionals—a low-carb diet is particularly suited to overweight individuals with apple shapes. An expanded waistline almost always indicates insulin resistance, a condition that responds very well to low-carb diets of moderate calories.




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