Monday, September 19, 2011

Middle-Aged Spreads: The Shape of Things Come

Enjoy a leisurely cup of coffee at an outdoor café, and watch the world and his wife waddle by, and you'll see that the shape of the human race is changing. Pot bellies are now the norm rather than the exception. These unsightly bulges have become so commonplace that we're now treating them as figures of fun, referring to them as balconies, bay windows or bread baskets. But these jokey euphemisms shouldn't be allowed to conceal the fact that these anatomical aberrations are not just cosmetic disasters. Today they're a major health hazard, in the over-developed world, predisposing to cardiovascular disease, high blood pressure, asthma, and Type-2 diabetes.

It's unfortunate that evolutionary forces caused our primeval ancestors to carry the bulk of their excess fat stores around their waists. This development, which has been passed on to us, is in accord with sound ergonomic principles. The closer weights are carried to the spine, and the nearer to the body's centre of gravity, which is roughly the level of the navel, the easier they are to bear. This was shown some years ago, when two Indian researchers set a small group of volunteers the task of carrying 70lb of granite chips in a variety of different ways. Sometimes the load was carried in their hands, at other times on their head, or in a rucksack. The results revealed that the effort was least when the load was symmetrically balanced and carried as close as possible to the spine. This was best achieved by using a double pack harness, of the sort developed for use by commandos during WWII, which places the load on the abdomen and buttocks. This is exactly what happens when obese people carry their load of excess flab on their bellies and butts. Unfortunately, while this mode of transport is mechanically highly efficient, it's also carries a serious health risk. This is one time when what looks attractive to others, is equally good for us. Women must strive to regain their hour glass figures, which men have always found alluring. One of my overweight lady patients told me that she had retained her hour glass figure - it was just that the sand had dropped. Her measurements were still 38-24-35, but not necessarily in that order!

In the old days 'apples and pears' were cockney rhyming slang for 'stairs'. Now they're used to describe the shapes of people who carry their weight around their bellies (the 'apples'), and those who carry it primarily around their buttocks and thighs (the 'pears') Tests show that the apples are at greater risk of heart disease than the pears, or those whose fat is spread more evenly around the body. For this reason it's thought that measuring the waist-to-hip ratio is a more accurate health indicator than checking the overall body weight. To make this assessment, the hip circumference should be measured in inches at its widest point, and this figure then divided by the waist measurement taken in inches at the same level as the belly button. Men with a ratio greater than 1.0, and women with a ratio of 0.8 or more, have the greatest risk of heart disease. Research carried out at the University of Texas has also shown that people with the largest waist-to-hip ratios are twice as likely to have calcium deposits in their arteries, which predisposes them to arteriosclerosis and coronary disease. Having a pot belly can also increase the risk of asthma, even among people who would not otherwise be classified as overweight. This was revealed at the Northern California Cancer Centre, when a study was carried out of 130,000 women of varying shapes and sizes. This showed once again that the significant factor is not the overall body weight, but more particularly the place where the fat is stored. Even women whose weight was judged to be within normal limits were found to have a 37 per cent increased chance of developing asthma if their waistlines spanned more than 35 inches. In the same way a study carried out at Birmingham University showed that men with waists in excess of forty inches, and women with midriffs greater than thirty-five inches, have a two, to four-fold risk of developing Type-2 diabetes. All of which suggests that a camera, tape measure or full-length bathroom mirror is a better tool for assessing the health risks of obesity than a weighing machine.


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