Tum or Bum? Apple or Pear? According to women's health expert Dr Marie Savard, body shape is the closest thing we have to a medical crystal ball. More important than our weight itself, this one simple piece of information can help determine our propensity to develop certain diseases as well as guide us towards the best way of tackling weight loss. Apples and Pears will help women assess their own body shape, alert them to the potential health risks associated with each one such as heart disease, osteoporosis and breast cancer and offer them vital dietary advice on how to manage their shape and stave off weight gain. Detailed dietary plans provide simple, long-term weight loss solutions based on medical assessments of the characteristics of apple and pear-shaped women. Whether your hips are that inch too wide or your stomach sticks out that bit too far will determine far more than which swimsuit design is most flattering for your body. Apples and Pears is a highly accessible, practical guide to finding out why.
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Dr Marie Savard is a pioneer in the field of women's health. She appears regularly on television and is the women's health expert for ABC. She has been interviewed in the Wall Street Journal and quoted in numerous American health magazines. Her website is: www.drsavard.comExcerpt. © Reprinted by permission. All rights reserved.:
Show me a woman -- any woman -- and I can forecast her health destiny just by observing her body shape. I know who will probably die of heart disease or breast cancer, who will have a rough transition through menopause, who will likely end up with a broken hip, and who may not live long enough to celebrate her 70th birthday. I am rarely wrong. From my 30 years of clinical experience and a review of decades of research, I've discovered that the single most powerful predictor of a woman's future health is the shape of her body.
All women's bodies can be categorized as either "apple-shaped" or "pear-shaped," depending on where they are most likely to put on fat, even if they aren't currently overweight. Women who tend to gain weight around their waists are said to have apple-shaped bodies because, like the fruit, their weight collects around their middles. Women who tend to add extra pounds around their hips, buttocks, and thighs are said to have pear-shaped bodies because, like the fruit, they are widest at the bottom. These terms have been around for decades, but they have mainly been used as physical descriptions, much the way we might say that a woman is blonde or brunette. Only now are we realizing the powerful physiologic effects of being either an "apple" or a "pear."
Body shape is not something we get to choose; we have very little control over our basic underlying proportions. Contrary to popular belief, people don't develop a pear shape simply because they sit on their butts most of the time. The human body is not a loose bag of sand where the weight goes to our lowest point. If that were true, our feet would be the size of watermelons. These two shape categories are fundamental, genetically influenced patterns that affect much more than how we look in a bikini. Body shape is related to differences in our physical chemistry, hormone production and sensitivity, metabolism, and possibly even personality. Have you tried the latest fad diet but found you still couldn't lose weight while everyone else managed to drop two pant sizes? Chances are that particular diet wasn't right for your body shape. Ever wonder why some women suffer through intolerable hot flashes during menopause while others sail right through? Or why hormone therapy makes some women feel healthy and happy, while making other women feel bloated and irritable? Again, blame it on body shape. Our shape affects our likelihood of developing heart disease, osteoporosis, the metabolic syndrome, diabetes, stroke, varicose veins, breast cancer, and endometrial cancer. Body shape also gives clues to which adolescent girls are more likely to develop eating disorders, which types of exercise are best, and which emotions can physically change our shape. It even tells us our chances for living to be old enough to have to worry about nursing home care.
Physicians and researchers have been talking about the importance of body shape for years, but this health message has not been fully explained to the people who can use it most -- women in general. The scientific information in Apples & Pears has never before been analyzed and collected in a single consumer publication, so what you are reading now is the cutting edge of women's health information. In the coming chapters, you will learn how and why different body shapes benefit from customized diets, exercise regimens, medications, menopause therapies, psychosocial interventions, and lifestyle changes. Women who follow the action items for better health will be able to transcend their biology to lose weight, increase energy, and decrease their risks for type 2 diabetes, heart disease, breast cancer, and osteoporosis. In short, I'm going to tell you everything I know about how you can look great and feel wonderful, regardless of your current weight or body shape.
Putting all the pieces of the body shape puzzle together was one of those "Aha!" moments for me. It began decades ago when I watched my mother dutifully complete lengthy surveys that were sent to her every few years. She would have to detail her every health move, including what she ate, how much exercise she did, what she weighed, which medical conditions she had, and which medications she was taking. My father remembers searching the house for a flexible tape measure to help my mother record her waist size. (This turned out to be a tough task -- my dad was an engineer and carpenter and only had metal or wooden rulers.) What could they possibly want with that information, he asked himself. Now we know. You see, my mother is part of the now famous Nurses' Health Study, which has been recording the lifestyle choices and medical conditions of more than 120,000 women nurses since 1976. Much of what we know and teach about women's health today comes from this ongoing study, and from subsequent studies of younger nurses and their daughters.
A summary of the learnings from that study was published in 2001 in a wonderful book titled Healthy Women, Healthy Lives, which my mother gave to me as a gift. (She knew that I would be proud of her contribution to this landmark study, especially because I had been a nurse before becoming a physician and had a special interest in women's health.) As I paged through the book, I noticed that the concept of body shape was an ever-present, although not central, observation with regard to disease risk. What kept jumping off the page for me were all the references to apple-shaped women -- and their higher risks of developing heart disease, type 2 diabetes, stroke, and breast cancer.
Aha! I already understood to some degree the importance of body shape in predicting the risk of heart disease. I knew, for example, that men and women who carry most of their body fat around their middles have a much higher risk of having a heart attack than pear-shaped people. But I didn't understand the profound impact that shape could have on risk for a host of conditions -- including cancer, osteoporosis (the bone-thinning disease of old age), varicose veins, and even eating disorders -- until I started looking at the medical literature. Then I found evidence everywhere. It was overwhelming. When it comes to overall health, body shape really does matter!
MY FAMILY'S MIXED BASKET
Of course, I really only needed to look within my own family to see what I had missed all along. I am one of eight children (I have three brothers and four sisters). Most of us girls have subtle variations of the pear shape -- we always tended to have "small tops and big bottoms." For as long as I can remember, whenever I shopped for new clothes, I always tried on the pants portion of a suit first because my bottom was the hardest part to fit. To this day I prefer to wear pants to cover my larger-than-I-like legs, instead of the short skirts that many apple-shaped women (with their typically beautiful legs) can wear.
Three of my four sisters had similar concerns. My fourth sister, Millie, had a much different experience, and a more serious problem. Unlike my other sisters, Millie has an apple-shaped body. True to her type, she has great legs, which always made the rest of us a little envious. But over the years, she has gained weight primarily around her middle. Although she must have had an apple shape her whole life, I didn't really notice until later in life when her midsection became more rounded and she lost whatever waist she had in her youth. Millie now has a number of serious medical conditions, including type 2 diabetes, high blood pressure, abnormally high blood fats in a worrisome pattern, and osteoarthritis of her knees. Her diabetes has led to other complications, including nerve damage (neuropathy) in her feet, causing constant burning and pain. For years Millie had been told about her borderline blood sugar levels, but she was never told how something as innocent-sounding as "blood sugar" could devastate her body. Nor was she ever told that it was within her power to avoid serious disease. In fact, Millie recently requested her old medical records from a previous physician and discovered that she had had borderline blood glucose readings for many, many years, but her doctor never told her. After years of ignorance, she was ultimately diagnosed and treated for diabetes.
Today, Millie manages her blood sugar, blood pressure, and blood fats with a combination of medications and major lifestyle changes. Even the pain of her neuropathy is better now that she is controlling her diabetes. But if only she could turn back the clock, she could have avoided many of the health problems that plague her now. Millie was born to be apple-shaped. Throughout her adolescence, into adulthood, and past menopause, her body followed a pattern that made her more likely to develop particular diseases. If we knew then what we know now, she could have prevented much of the damage that has already been done. That's what this book is all about -- recognizing the risk, then taking action to stop the process of disease and decline.
My mother has a different story. My mother had the classic pear shape, or hourglass shape, that was once revered. After she passed through menopause, however, her body began to change. My mother was too busy raising and worrying about her eight children to take the time to care for herself. She rarely went to the doctor, never monitored her health, and slowly gained weight. Like many pear-shaped women who were used to finding inches added to their hips and thighs, my mother didn't notice the redistribution of fat and creeping weight gain around her waist. Eventually, my mother's shape shifted from pear to apple. At age 65, my mother suffered a massive heart attack. Suddenly her health was in the spotlight for the first time in decades. She learned that the physical changes that occurred with menopause and aging led to a big increase in her blood pressure and blood cholesterol, and she had become a walking time bomb for heart attack.
My sister Millie and my mother represent two ends of the spectrum ...
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