Apples and Pears – Size, Shape, and Adiposity

We all love to beat up on BMI. That measure may be good for epidemiologists who need a way to define obesity in a population. But it’s not so good for defining obesity in an individual. For that matter, it’s not the definition for obesity itself. Obesity is excess adiposity that harms health. And a new study in JAMA Open Networks tells us that central adiposity – the “apple” body shape – can be a marker for the health risks of obesity. Even in a person with a “normal” BMI.

The Elevated Risks of Central Adiposity

Yangbo Sun and colleagues studied 156,624 women. They analyzed the relationships among BMI, waist circumference, and mortality. They used waist circumference as a marker for central adiposity. Thus they found that even women with a normal BMI and central adiposity had higher risks for death. In fact, their risks were similar to the risks of women with a both a high BMI and central adiposity.

In other words, the health risks of obesity seem to come from storing excess fat around your central organs. It’s what defines the classical apple body shape, versus a pear shape with more fat around the hips.

Reinforcing an Established Idea

In an invited commentary, Lilian Golzarri-Arroyo, Luis Mestre and David B. Allison pointed out that this finding, though important, is not entirely new:

Waist circumference is certainly a notable factor when studying obesity; however, this is not a new finding. As far back as 1947, French physician Jean Vague suggested that obesity in the upper half of the body was associated with cardiovascular disease and diabetes, an association he did not find in individuals with more fat in the lower half of the body.

Central obesity has repeatedly been proven as a strong factor for the higher risk of
morbidity and mortality associated with obesity.

This is the first study to show that central adiposity in people with a normal weight can predict cancer mortality. Even more than that, this study underscores what obesity is and what it isn’t. Obesity is not BMI. Obesity is a disease of excess adiposity that harms health.

Shape and size and BMI are just markers. The disease is all about unhealthy adiposity. When a body starts storing excess fat around vital central organs, that’s when obesity begins. Plain and simple.

Click here for the study, here for the commentary, and here for further reporting.

Still Life Apples and Pears, painting by Paul Cezanne / WikiArt

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July 28, 2019