A hot topic in health literature concerns pears verses apples. I am referring, not to fruit, but rather to body shape. Are you a pear or an apple? How does your body accumulate fat? How does this affect your long-term health? Let's explore this together.These two basic body shapes differ in the way they distribute fat. The apple-shaped person carries most of their excess fat around their abdomen, in the middle portion of the body. This type of fat is known as visceral or intra-abdominal fat, and it surrounds the organs, which can contribute to inflammation. The pear-shaped person carries most of their excess body fat lower than that, on their hips, buttocks, and thighs. Their fat is called subcutaneous fat. What determines body shape? Genetics get most of the blame, but your age and gender also play an important role. Women typically collect fat on their hips and buttocks, resulting in a pear shape, while men generally collect weight around the belly, giving them an apple shape. After menopause, as women's estrogen levels drop, they start storing fat around the abdomen as men do, and become more apple-shaped. Those who are apple-shaped are more likely to develop health problems related to obesity. The shape is closely associated with type 2 diabetes and heart disease, as well as to sleep apnea, anxiety, and depression. In women, there is an increased risk of hormonal cancers such as breast, ovary and uterine cancer, menstrual irregularities and fertility problems. Clearly, those with apple shapes need to pay extra attention to their weight. Pear-shaped women have their own set of health issues, such as osteoporosis due to a lower level of androgen (a male hormone), varicose veins due to fat compressing their veins at the thighs, and cellulite (a cosmetic problem). How do you know whether you are an apple or a pear? To find out, all you need is a tape measure. Calculate your waist to hip ratio by dividing your waist measurement by your hip measurement. If you are a woman and your waist to hip ratio (waist inches divided by hip inches) is more than 0.8, or if you are a man and it is greater than 1.0, then you are considered an apple, and are at increased risk for the associated health complications. Another way to check is to simply measure your waist. If you are a woman with a waist greater than 35 inches, or a man with a waist greater than 40 inches, you can likely be considered an apple. While any overweight person should lose weight regardless of their body shape, here are some specific tips to follow depending on body type: Apples • Get regular exercise in order to maintain body weight and improve insulin resistance • Due to a tendency toward diabetes, eat whole grain foods with a low glycemic index and avoid simple sugars and starches with a high glycemic index • Monitor your blood sugar and fat levels with assistance from your doctor • If you are a woman, have regular gynecologic exams which address issues of breast, uterine and ovarian cancer • Be cognizant of sleep problems and daytime fatigue: they may be signs of sleep apnea Pears • Because you are more prone to osteoporosis, be tested with a bone density scan • If your bone density is poor (osteopenia or osteoporosis), do resistance training, take calcium and vitamin D, and talk to your doctor about possible prescription medication • Because pear-zone fat can accumulate easily, maintain a low-fat diet Regardless of whether you are a pear or an apple, if you are overweight, follow the guidelines I've outlined in prior columns for diet and exercise. As always, contact your doctor for guidance, questions, or concerns. Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240. ********** Published: February 27, 2009 - Volume 7 - Issue 45