Obesity - Pear vs. Apple, Fit vs. Fat

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}

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.

For More Information:
NHLBI Obesity Education Initiative
CDC Obesity and Overweight

References

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