Wellness & Prevention

Figuring out your figure

For us women, the bathroom scale is often what we use to determine how healthy and fit we are. But recent studies indicate that we may better serve our waistlines and health outlooks by trading our scales for tape measures.

Monitoring day-to-day weight changes can tell you just that - that your weight has fluctuated. A tape measure, however, tells you about your body's proportions, and therefore your shape. This is important, because each body shape has been found to correlate with risks for specific diseases or conditions.

For example, a woman who naturally has a large waist in proportion to her body is at higher risk for heart disease and diabetes than a woman who has large hips and a smaller waist. However, the woman with larger hips is naturally more susceptible to osteoporosis. 

"If you know your body shape and can determine your risk factors early, then you can take action before you ever experience those conditions for which you are at risk," said Dr. Ronnie Mandal, an internal medicine physician at Swedish Covenant Hospital.

To determine your shape, your first step should be to identify the primary body types which most closely resemble your own.

Knowing your shape
Medically speaking, body shape is determined by a combination of your bone structure, lean muscle mass and how and where you tend to gain weight in your body.

Although there are many theories about the number and variety of different female body types, most women fall under two basic shapes: apple and pear. An apple-shaped woman tends to have broad shoulders, a larger bust and belly, and narrow hips. Pear-shaped women often have wider hips than busts and tend to collect fat around their hips, butts and thighs.

It may seem obvious into what group you fall, or you may feel that you do not fit into either group. But looks can be deceiving. Even slim women who show no outward sign of fat buildup could be genetically inclined to be an apple, for example, and therefore harbor all of the same risk factors as someone who is overweight. 

The best way to determine your shape is to measure the difference in the circumference of your waist and your hips (Find out how below). This measurement is your waist-to-hip ratio (WHR). Women with a WHR of 0.8 or greater are considered apple-shaped. A WHR of 0.8 or less likely means a pear shape.

Knowing this number, and therefore your body shape, can help you and your doctor determine which health risk factors you need to be concerned about now and in the future.

Understanding your shape
"When you talk about body fat and where it ends up, there are two types. One is the fat under your skin, which apple-shaped women will see on their upper bodies and pear-shaped women will see around their lower bodies," Mandal said. "The second type of fat is much more concerning. It is called visceral fat and builds up internally, usually around your organs."

Pear-shaped women tend to gain subcutaneous (skin-level) fat fairly easily, and many have a harder time losing it. They are also susceptible to varicose veins, poor leg circulation and negative body image. Despite these risks and the fact that it is easier to see subcutaneous fat on the outside of the body, overall it is less dangerous to your body's functions and leads to fewer serious health risks.

Conversely, apple-shaped women easily gain visceral fat. Although some visceral fat is necessary to act as a shock absorber for your organs, it can build up and affect how you absorb insulin, process cholesterol and raise blood pressure. Mandal explained that an apple shape, combined with poor diet and exercise habits, can lead to a condition called metabolic syndrome, which in turn can result in Type 2 diabetes, stroke and heart disease.

Taking Action
Regardless of your age, genetics, shape and weight, there are ways to reduce your health risks.

Any health regimen that you and your doctor choose to suit your shape should emphasize exercise, diet, hormone replacement therapy when appropriate, medical monitoring and screenings, as well as a positive attitude.

The first step in any plan is to stop thinking about your body weight and work on keeping yourself strong and healthy, so you can be even more comfortable in your skin.

A good second step, particularly if you are currently overweight or if you are approaching menopause or post-menopause, is to consult a doctor for advice about your risk factors.

"If you have concerns about your genetic shape or your risks for metabolic syndrome, go see your primary care doctor," Mandal said. "The solution could just be a matter of learning how and what to eat from a registered dietitian, or it could be a condition that requires a visit to a specialist."

From there, you can develop a plan that is tailored to your shape. For example:

Apple-shaped: In general, apple-shaped women should focus on:
-  A diet high in fiber and fresh produce to naturally regulate sugar intake
-  Cardiovascular exercise
-  Regular blood sugar tests to help prevent diabetes
-  Regular tests for blood pressure, cholesterol, and tri—glycerides
-  If using hormone replacement therapy during and after menopause, apple-shaped women should consider low doses of progesterone and should avoid testosterone.

Pear-shaped: In general, apple-shaped women should focus on:
-    A low-fat, high-calcium diet
-    Exercises that emphasize strength training and cardiovascular health
-    Regular bone density scans
-    Moderate levels of estrogen-rich hormones during menopause.

"Many people are at risk because of their natural shape, and although it does not seem fair, they can't change that," Mandal said. "What they can do is talk to their doctor, identify their risk factors and adjust their diet and exercise habits well before  body fat, and all the issues that come with it, become a problem."

Determine your Waist-to-hip ratio at home
All you need is a tape measure, a pencil and a little math and you can determine your waist-to-hip ratio (WHR), the primary indicator of body shape. The sooner you know your shape, the quicker you can develop a health fitness plan. Simply follow these three steps:

• Use the tape measure to measure around your waist and determine its circumference. Your waist is typically the smallest part of your abdomen, however, if you do not have an obvious waist, measure about one inch above your navel and measure there. 
• Measure around the widest part of your hips to get your hip circumference.
• Divide the waist number by the hip number to get your WHR.

For women, if your WHR is greater than 0.8, you are apple-shaped. If your WHR is 0.8 or less, you are pear-shaped.

Although height and bone structure are factors, in general, women with a waist circumference size of less than 31 inches (80 cm) typically have fewer health risks, while a measurement of 35 inches (90 cm) or more indicates greater health risks. For men, a waist size of more than 40 inches is considered risky.

According to The Interheart Study, one of the largest studies on heart risk factors, a person's WHR was three times more powerful as a predictor of heart disease risk than body mass index. And heart disease is just one of many risk factors.

This article was originally printed in Well magazine, the precursor to this site, in November 2009. Written and edited by the editorial staff of Well magazine and Well Community.

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