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Are You an Apple or a Pear?

How Much Does Your Waist Reveal About Your Health?


A person's body type - apple or pear - has long been considered a way to gauge risk of heart disease. But over the past year, several new studies have reported that there might be less difference between these two body shapes than previously thought. Heartmail's research correspondent, Bonnie Prescott, chatted with George Blackburn, MD, PhD, Director of the Center for the Study of Nutrition Medicine and Chief of the Nutrition/Metabolism Laboratory at Beth Israel Deaconess Medical Center, about these new findings and what measures and risk factors people should be aware of when it comes to their weight, body shape, and heart health.

George L. Blackburn, MD, PhD

What, exactly, does it mean to be described as an apple or a pear?

A person's body fat can be distributed in two ways. If fat is distributed primarily in the lower body, so that you have larger hips and thighs, then you are shaped like a pear. If fat is distributed primarily in the upper body, particularly around the mid-section, then you have a large waist circumference and are shaped like an apple.

How is this difference in body shape related to heart health?

What's unique about waist circumference - the apple fat - is that it includes what is known as visceral fat. Visceral fat is not the fat that is directly under the skin, but is fat that surrounds your abdomen and visceral organs, deep within the body. Visceral fat has been linked to chronic diseases, such as atherosclerosis and peripheral vascular disease. Pound for pound, visceral fat has been thought to be more harmful than subcutaneous fat, like that found in pear-shaped people.

But now, some newer research is saying that there really is no difference between the apple and pear - that being overweight is dangerous no matter where fat is accumulated.

I would say that people should look at the whole picture and not rely on a single factor as an indicator of heart health. There are a number of measures you should be aware of if you want to maintain a healthy body weight and reduce cardiac risk factors. Anthropometric measurements, which include height, weight, body mass index (BMI), and waist circumference, are all important and, in fact, BMI is considered a vital sign for health, in the same way that blood pressure is a vital sign. So these types of anthropometric measures are recommended as a starting point for the physician to assess cardiac health.

But in addition, lipid profiles allow for further accuracy in assessing heart health risk. These are the tests that measure overall cholesterol, as well as good (HDL) and bad (LDL) cholesterol. Lipid profiles can also include more specific information, such as triglycerides. Together, the anthropometric and lipid profiles can more precisely determine a person's risk of coronary disease. One of the most frequently used assessments is the Framingham Risk Score (FRS).

Is it fair to say that any type of weight gain, whether in the abdomen or elsewhere on the body, is always bad?

As a matter of fact, no. The Framingham Heart Study teaches us that from age 20 to age 50, it's expected that people will gain about three-quarters of a pound per year and still maintain good health. So that's about 20 pounds over 30 years. But of course, the biggest news today is not about people who gain 20 pounds, but people who gain 40 or 80 or even 120 pounds during that timeframe.

That's one reason why another "measure" that is often used to assess weight and heart health is knowing a person's body weight history: What were your weight, diet and activity measures at age 18? What has been your highest body weight ever? Tracking this longitudinal information can help determine whether you're sustaining healthy habits or losing ground.

What advice would you give readers who want to take care of their weight and their hearts?

Prevention is everything. Thus knowing your various lipid measures, knowing your body size (BMI), knowing your waist circumference, and staying as close as possible to your ideal weight are all key. And remember, when it comes to healthy eating, exercise and good lifestyle habits, we want people to make small changes that they can stick with. Over time, these small steps will become routine habits, but we know from our research that it takes two to four years to develop a new habit. But if you stick with it, you can have your cake and eat it too - as long as it's angel food cake with strawberries.

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2012