Apple or Pear? It Doesn’t Seem to Matter Any More

Being overweight has been linked with cardiovascular ill-health for many years.  But the way of measuring ‘overweight’ has changed over the recent decades.  At one time, it was enough to step on the scale.  Then height was incorporated, so that the body mass index (BMI) could be calculated.  (A BMI over 25 is overweight, over 30 is obese, over 35 very obese, and over 40 morbidly obese.)  More recently, we’ve been urged to pay attention to waist circumference; the healthy ‘upper limit’ is 37 inches for men, and 31.5 inches for women.  And with the measuring tape out, a trip round the hips allows you to calculate your waist-hip ratio.

The waist-hip ratio (WHR) was considered to be a better indicator of whether your body weight is ideal or not. Those with large WHRs, called ‘apples’, were thought to have higher health risks than those with low WHRs, or ‘pears’, because of the accumulation of abdominal/intra-abdominal fat in the ‘apples’. Now this has been thrown into question by a meta-analysis done by University of Cambridge (UK) researchers, and published in the Lancet. 

The 58 studies covered data from more than 220,000 people in 17 different countries with an average age of 58.  During the follow-up period over 14,000 of them suffered a heart attack or stroke.  ‘Adiposity measures’ as well as full physical exam and lab results were available for almost all the subjects.  The predictive values of these various cardiovascular risk factors were calculated.

The bottom line was that BMI, waist circumference, and WHR didn’t improve cardiovascular disease risk prediction when information was available for systolic blood pressure, history of diabetes, and lipid levels.  As one of the researchers stated: “Whatever your shape is doesn’t really matter” (i.e. compared with your blood pressure and lab findings).  I suppose we should be pleased.  I was an apple, but age has moved my fat to make me a pear.  And now it doesn’t matter – except that ‘adiposity’ is still a risk factor, per se.