New research points to body shape as an indicator of the likelihood of cardiovascular disease, writes Claire O'Connell
Here's some heartening news for anyone struggling with "thunder thighs": when it comes to cardiovascular health, stubborn saddlebags are less damaging than a generous waistline.
Experts believe that excess weight is a significant contributor to heart problems, but that your risk also depends on where you stash your fat stores.
A growing body of scientific evidence shows that an "apple-shaped" person who accumulates fat deep in the abdomen is more likely to suffer cardiovascular disease (CVD) compared with a "pear" who deposits fat mainly on the backside, hips and thighs.
For example, in a study published last month, scientists in Colorado measured body fat distribution and cardiovascular risk markers in 95 post-menopausal women and found that increased belly fat is associated with a higher risk of CVD. The researchers also suggested that leg fat may have a more favourable effect on heart health.
These results come as no surprise to US physician Dr Marie Savard, author of Apples and Pears, a book that drives home the importance of identifying your body shape and recognising the associated health implications.
"Body shape is a huge window on your risk," says Savard.
"If two women have the same body mass index but their body shapes are different, the apple-shaped woman has up to four times increased risk of heart disease than the pear-shaped woman."
The main culprit is visceral fat stored deep inside the stomach. Visceral fat is protective in one sense - it is designed to cushion our internal organs. But research shows that far from being an inert tissue, this intra-abdominal fat is metabolically active and an excess can contribute to a range of diseases including insulin sensitivity and diabetes, heart disease and possibly cancer.
"It's highly active fat," says Savard, who says doctors are starting to view deep abdominal fat as a gland which pumps out a cocktail of fatty acids and other biochemicals, raising levels of inflammation and heart-unfriendly hormones such as insulin, androgens and cortisol.
On the other hand, the subcutaneous "pinchable" fat we store just under our skin is much less active. Savard says pear-shaped women are protected by the subcutaneous fat they carry on the backside, hip and thighs.
"That fat seems to absorb the bad fats like a magnet," she says. "It's a more passive fat that is strictly nature's way of storing energy for an emergency like famine, childbearing or breastfeeding."
This might all sound like very bad news for apples, who tend to stockpile visceral fat. Nor is it comfortable reading for pears with ample waistlines, who carry dangerous amounts of belly fat. But Savard notes that identifying potential risks means people can take action before it's too late. To reduce visceral fat, she suggests eating fruit, vegetables and grains rich in soluble fibre, avoiding sugar and white flour, taking regular exercise and moderately reducing calorie intake to shrink fat cells slowly.
And there is currently no quick fix on the horizon. Savard notes that surgical removal of subcutaneous tummy blubber has hardly any effect on the risk of heart disease, and little research has been done to date on the effect of sucking out the more challenging visceral fat.
The silver lining is that because visceral fat is so active and willing to give up its energy stores, those are the easiest fat cells to shrink, according to Savard.
"The most amazing thing is exercise," she says. "Many studies have shown that aerobic exercise or even weightlifting preferentially reduces inflammation, reduces waist size and specifically depletes visceral fat."
Savard is excited by the current shift in focus from weight towards body shape and waist circumference, in part because it alerts young women to the possibility that they could be at risk of CVD, that it's not just a disease of men and older women.
"That someone can recognise whether they are even at risk with the tape measure as opposed to the scale is powerful, and I think it's going to help move us along. A few centimetres around your waist may mean the difference between early death and good health."
Apples and Pears by Dr Marie Savard with Carol Svec is published by Vermillion at €13.99.
Changing your shape can change your risk profile
• Every year cardiovascular disease (CVD) claims 17 million lives, according to World Health Organisation estimates.
In Ireland, around 11,000 people died of CVD or related conditions in 2003. More than half of those were sudden deaths, says consultant cardiologist Dr Brian Maurer, medical director of the Irish Heart Foundation.
He says that carrying excess weight is a heart risk factor in itself, and adds that it becomes even more serious when combined with other risk factors such as smoking or hypertension.
Dr Maurer says waist measurement is a fairly accurate indication of visceral fat, the metabolically active fat that contributes to heart disease. He notes that the ideal waist measurements are 37 inches for a man and 32 inches for a woman, and that any reduction toward those levels is beneficial.
"We are talking about relative risk reduction, so in the same way that putting on a bit of weight raises the risk incrementally, losing it will also decrease the risk."
He recommends a sensible diet and exercise regime for those looking to reduce excess weight and lessen their risk of CVD.
q Every year cardiovascular disease (CVD) claims 17 million lives, according to World Health Organisation estimates.
In Ireland, around 11,000 people died of CVD or related conditions in 2003. More than half of those were sudden deaths, says consultant cardiologist Dr Brian Maurer, medical director of the Irish Heart Foundation.
He says that carrying excess weight is a heart risk factor in itself, and adds that it becomes even more serious when combined with other risk factors such as smoking or hypertension.
Dr Maurer says waist measurement is a fairly accurate indication of visceral fat, the metabolically active fat that contributes to heart disease. He notes that the ideal waist measurements are 37 inches for a man and 32 inches for a woman, and that any reduction toward those levels is beneficial.
"We are talking about relative risk reduction, so in the same way that putting on a bit of weight raises the risk incrementally, losing it will also decrease the risk."
He recommends a sensible diet and exercise regime for those looking to reduce excess weight and lessen their risk of CVD.
q The criterion that determines body shape is the waist-to-hip ratio (WHR). To find out your WHR, first measure your waist circumference at the widest part of your tummy, usually one inch above the naval. Then measure the circumference at the widest part of your hips.
Divide your waist measurement by your hip measurement. If it is 0.8 or less, you are a pear. Over 0.8 means you are an apple.
Children and men tend to be apples. At puberty, some women's genetic make-up means they preferentially build fat stores on their lower bodies and assume a pear shape, while others maintain the apple pattern of fat deposition.
After menopause, hormonal changes mean that all bets are off and even pear-shaped women can morph into apples if they put on weight.
q Every year cardiovascular disease (CVD) claims 17 million lives, according to World Health Organisation estimates.
In Ireland, around 11,000 people died of CVD or related conditions in 2003. More than half of those were sudden deaths, says consultant cardiologist Dr Brian Maurer, medical director of the Irish Heart Foundation.
He says that carrying excess weight is a heart risk factor in itself, and adds that it becomes even more serious when combined with other risk factors such as smoking or hypertension.
Dr Maurer says waist measurement is a fairly accurate indication of visceral fat, the metabolically active fat that contributes to heart disease. He notes that the ideal waist measurements are 37 inches for a man and 32 inches for a woman, and that any reduction toward those levels is beneficial.
"We are talking about relative risk reduction, so in the same way that putting on a bit of weight raises the risk incrementally, losing it will also decrease the risk."
He recommends a sensible diet and exercise regime for those looking to reduce excess weight and lessen their risk of CVD.
q The criterion that determines body shape is the waist-to-hip ratio (WHR). To find out your WHR, first measure your waist circumference at the widest part of your tummy, usually one inch above the naval. Then measure the circumference at the widest part of your hips.
Divide your waist measurement by your hip measurement. If it is 0.8 or less, you are a pear. Over 0.8 means you are an apple.
Children and men tend to be apples. At puberty, some women's genetic make-up means they preferentially build fat stores on their lower bodies and assume a pear shape, while others maintain the apple pattern of fat deposition.
After menopause, hormonal changes mean that all bets are off and even pear-shaped women can morph into apples if they put on weight.
• The criterion that determines body shape is the waist-to-hip ratio (WHR). To find out your WHR, first measure your waist circumference at the widest part of your tummy, usually one inch above the naval. Then measure the circumference at the widest part of your hips.
Divide your waist measurement by your hip measurement. If it is 0.8 or less, you are a pear. Over 0.8 means you are an apple.
Children and men tend to be apples. At puberty, some women's genetic make-up means they preferentially build fat stores on their lower bodies and assume a pear shape, while others maintain the apple pattern of fat deposition.
After menopause, hormonal changes mean that all bets are off and even pear-shaped women can morph into apples if they put on weight.