Take a good look at yourself in the mirror. Where do you see most of your excess body fat? Is it found around your middle? Or does it lurk in your thighs and rear end? Be honest here, because where you carry your extra pounds could make a big difference to your health.
Apples at Risk
Apple-shaped obesity, also known as abdominal obesity, truncal obesity or central obesity, is one major symptom in the cluster of symptoms known as the metabolic syndrome, or pre-diabetes. If you’re an apple, you’re also very likely to have other metabolic syndrome symptoms, including high blood pressure, insulin resistance and high blood lipids. In other words, you’re at much greater risk of diabetes and heart disease than someone who’s pear-shaped, with excess weight in thighs and buttocks, even if you’re both the same height and weight. (That doesn’t mean, of course, that if you’re pear-shaped you don’t have any health risks, but your chances of eventually developing diabetes and heart disease are lower.)
If you’re not sure whether you’re an apple or a pear, simply measure your waist. If it is more than 35 inches for a woman or 40 inches for a man, you’re an apple. A more revealing method is to find your waist-to-hip ratio (WHR). Measure your waist and hips, then divide the waist number by the hip number to find your WHR. For example, if your waist is 36 inches and your hips are 40 inches, your WHR is 0.9. The higher your WHR, the more apple-shaped you are.1
The Dangers of Abdominal Fat
Why is abdominal fat more dangerous to your health than fat in other parts of your body? That’s a very good question-and it doesn’t have a definite answer yet. Abdominal fat is really made up of two kinds of fat: the type that’s stored right under your skin (subcutaneous fat) and fat that surrounds your vital organs (visceral fat). Researchers believe that visceral fat cells behave differently than fat cells elsewhere in your body. They seem to produce and respond to hormones and other chemical signals in a complex way that in the end produces insulin resistance and high blood lipids.
Abdominal Obesity and Heart Disease and Diabetes
Whatever the reason, abdominal obesity is closely linked to a significantly greater risk of heart disease. In fact, waist-to-hip ratio is a better predictor of heart trouble in your future than just your BMI or waist measurement. Results published in 1998 from the long-running Nurses’ Health Study, for example, show that women with a WHR of 0.88 or higher have roughly three times the risk of developing coronary heart disease compared to women with a WHR of less than 0.72, even when BMI and other factors are taken into account.2 And a recent study of older Danish women showed that the women with the most abdominal fat also had the most insulin resistance and the most hardening of the arteries.3
Men are at risk too, as a long-term study of Finnish men has shown. In that study, the men with a WHR of 0.91 or greater had triple the risk of coronary heart disease compared to men with lower WHRs. And if the high WHR men also smoked, their risk was 5.5 times as great! Here too, even after BMI and other risk factors were taken into account, the waist-to-hip ratio was the most accurate predictor of heart disease.4
The more fat you have around your middle, the greater your odds of developing insulin resistance and diabetes. Evidence from the Nurses’ Health Study, for instance, shows that women with a waist-to-hip ratio of more than 0.86 have more than three times the risk of developing diabetes as women with a WHR of 0.7 or less.5
Paring Down the Apple
It’s clear that your abdominal fat has to go, but how? Losing weight overall will help you lose weight in the abdominal area as well, but unfortunately, you can’t direct weight loss to a particular part of your body. Fortunately, even moderate exercise will help you get rid of that spare tire around your middle. In a recent year-long study of 170 overweight postmenopausal women, half were assigned to do moderate exercise, such as brisk walking, for 45 minutes a day, five days a week, and half were assigned to take an hour-long stretching class once a week. None of the women went on a weight-loss diet. At the end of a year, the exercisers found that their percentage of visceral (body cavity) fat had gone down between 3.4 and 6.9 percent. Overall, the women in the stretching class had a slight increase in visceral fat. What’s important about this study is that even though the women in the exercise group lost an average only a few pounds of body weight, the weight they lost was chiefly visceral fat.6 A more vigorous sustained exercise program could be expected to produce even better results.
If that’s what exercise alone can do, imagine what doing Atkins can do. If you’re apple shaped with symptoms of metabolic syndrome, the controlled carb approach can help lower your blood pressure, improve your cholesterol profile, improve your insulin resistance and lose weight overall. And because exercise is an essential part of doing Atkins, you’ll be attacking that abdominal fat from two directions at once and doubling your chances of success.
Selected References
1. Jannsen, I., Katzmarzyk, P.T., Ross, R., “Body Mass Index, Waist Circumference, and Health Risk: Evidence in Support of Current National Institutes of Health Guidelines,” Archives of Internal Medicine, 162(18), 2002, pages 2074-2079. (Attribute # 8356)
2. Rexrode, K.M., Carey, V.J., Hennekens, C.H., et al., “Abdominal Adiposity and Coronary Heart Disease in Women,” Journal of the American Medical Association, 280(21),1998, pages 1843-1848.
3. Tanko, L.B., Bagger, Y.Z., Alexandersen, P., et al., “Peripheral Adiposity Exhibits an Independent Dominant Antiatherogenic Effect in Elderly Women,” Circulation, 107(12), 2003, pages 1626-1631.
4. Lakka, H.M., Lakka, T.A., Tuomilehto, J., et al., “Abdominal Obesity Is Associated with Increased Risk of Acute Coronary Events in Men,” European Heart Journal, 23(9), 2002, pages 687-689. (Attribute # 8359)
5. Carey, V.J., Walters, E.E., Colditz, G.A., et al., “Body Fat Distribution and Risk of Non-Insulin-Dependent Diabetes Mellitus in Women. The Nurses’ Health Study.” American Journal of Epidemiology, 145(7),1997, pages 614-619.
6. Irwin, M.L., Yasui, Y., Ulrich, C.M., et al., “Effect of Exercise on Total and Intra-Abdominal Body Fat in Postmenopausal Women: A Randomized Controlled Trial,” Journal of the American Medical Association, 289(3), 2003, pages 232-330.
