Is pear-shaped really better than an apple-shaped figure?
The location of your body fat makes a difference to your risk of heart disease. People with excess fat in their belly area (so-called “apple” shape) have a greater risk of developing and dying from heart disease than people who carry their weight in their hips and thighs (pear-shaped).32
To see if your weight puts you at risk for heart disease, you should measure the distance around your waist, at the level of your belly button.28 BMI tells you roughly how much fat you have on your body, but not where that fat is located. In the Nurses' Health Study of more than 44,000 women aged 40 to 65 years, those who had a waist measurement of more than 38 inches were 3 times more likely to die of a heart attack or heart disease than women who had a waistline less than 28 inches.32
A waistline greater than 35 inches for women and 40 inches for men increases the risk for having obesity-related risk factors and heart problems. However, these cutoffs may be too high for very short people (less than 5 feet tall) and people from Asia and East India.1, 14
Another way to measure abdominal obesity is the waist-to-hip ratio, which is the distance around your waist divided by the distance around your hips. But just measuring your waist is a slightly more accurate way to measure abdominal fat. Waist-to-hip ratio is a better measure of risk than BMI for people of all ethnicities. 14, 16, 18, 19, 33
|High Risk||More than 35 inches (88 cm)||More than 40 inches (102 cm)|
|Waist-to-Hip Ratio = Waist ÷ Hip|
|Desirable||0.80 or less for women|
|At-risk||1.0 or more|
I'm overweight, but I'm fit. Do I still need to lose weight?
You may have heard of the “fit versus fat” debate, which argues that it doesn't matter if you are overweight or obese as long as you are fit. Several studies have shown that exercising may reduce the heart disease risks of being overweight or obese even if you don't lose weight.34
However, while being fit may lower your risk, you will still have a higher chance of developing heart disease than someone who isn't overweight. Being fit doesn't cancel out the dangers of being overweight. In one study of more than 116,000 women, those who were obese and inactive were nearly 5 times more likely to die of a heart attack or heart disease than women who were active and trim. Obese women who were active for at least 3½ hours a week had a lower risk of heart attack and heart disease than obese women who were inactive, but still had a 3-fold higher risk than active women of a healthy weight.35
How can I lose weight?
To learn about your options for losing weight and reducing the associated heart risks, see our Weight Loss Guide.
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- Recommendations for estrogen and progestogen use in peri-and postmenopausal women: October 2004 position statement of The North American Menopause Society. Menopause. Nov-Dec 2004;11(6 Pt 1):589-600.
- Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. Nov 5 2005;366(9497):1640-1649.
- Jee SH, Pastor-Barriuso R, Appel LJ, Suh I, Miller ER, 3rd, Guallar E. Body mass index and incident ischemic heart disease in South Korean men and women. Am J Epidemiol. Jul 1 2005;162(1):42-48.
- McTigue KM, Harris R, Hemphill B, et al. Screening and Interventions for Obesity in Adults: Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. December 2, 2003 2003;139(11):933-949.
- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. Jan 10 2004;363(9403):157-163.
- Heiat A, Vaccarino V, Krumholz HM. An Evidence-Based Assessment of Federal Guidelines for Overweight and Obesity as They Apply to Elderly Persons. Arch Intern Med. May 14, 2001 2001;161(9):1194-1203.
- Folsom AR, Kaye SA, Sellers TA, et al. Body fat distribution and 5-year risk of death in older women. Jama. Jan 27 1993;269(4):483-487.
- Mosca L, Grundy SM, Judelson D, et al. Guide to Preventive Cardiology for Women.AHA/ACC Scientific Statement Consensus panel statement. Circulation. May 11 1999;99(18):2480-2484.
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- Ninomiya JK, L'Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the third national health and nutrition examination survey. Circulation. Jan 6 2004;109(1):42-46.
- Kip KE, Marroquin OC, Kelley DE, et al. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women: A report from the Women's Ischemia Syndrome Evaluation (WISE) study. Circulation. 2004;109:706-713.
- Greenfield JR, Samaras K, Jenkins AB, et al. Obesity Is an Important Determinant of Baseline Serum C-Reactive Protein Concentration in Monozygotic Twins, Independent of Genetic Influences. Circulation. June 22, 2004 2004;109(24):3022-3028.
- Ziccardi P, Nappo F, Giugliano G, et al. Reduction of Inflammatory Cytokine Concentrations and Improvement of Endothelial Functions in Obese Women After Weight Loss Over One Year. Circulation. February 19, 2002 2002;105(7):804-809.
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. Sep 1998;6 Suppl 2:51S-209S.
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- Folsom AR, Kushi LH, Anderson KE, et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med. Jul 24 2000;160(14):2117-2128.
- Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as Compared with Physical Activity in Predicting Mortality among Women. New England Journal of Medicine. December 23, 2004 2004;351(26):2694-2703.
- Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. Nov 2 2004;110(18):2952-2967.