Women's health risk grows with waistline

Though the term might sound dated, “middle-age spread” is a greater concern than ever.

As women go through their middle years, their proportion of fat to body weight tends to increase, more than it does in men. Especially at menopause, extra pounds tend to accumulate around the midsection, as the ratio of fat to lean tissue shifts and fat storage begins favoring the upper body over the hips and thighs. Even women who don’t actually gain weight may still gain inches at the waist.

At one time, women might have accepted these changes as an inevitable fact of postmenopausal life. But we’ve now been put on notice that as our waistlines grow, so do our health risks. Abdominal, or visceral, fat is of particular concern because it’s a key player in a variety of health problems, much more so than subcutaneous fat, the kind you can grasp with your hand. Visceral fat, on the other hand, lies out of reach, deep within the abdominal cavity, where it pads the spaces between our abdominal organs.

Visceral fat has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes. In women, it is also associated with breast cancer and the need for gallbladder surgery.

Fat accumulated in the lower body (the pear shape) is subcutaneous, while fat in the abdominal area (the apple shape) is largely visceral. Where a woman’s fat ends up is influenced by several factors. Heredity is one. Hormones are also involved. At menopause, estrogen production decreases and the ratio of androgen (male hormones present in small amounts in women) to estrogen.

The good news is that visceral fat yields fairly easily to exercise and diet, with benefits ranging from lower blood pressure to more favorable cholesterol levels.

Measuring up

Researchers have tried several ways of measuring the links between health risks and body weight or fat distribution:

• Body mass index. A ratio of weight in kilograms to the square of height in meters, BMI helps identify people whose weight increases their risk for several conditions, including heart disease, stroke, and diabetes. People with BMIs of 25–29.9 are considered overweight, and those with BMIs of 30 or over, obese. However, some researchers think BMI isn’t always a valid indication of obesity, because it gives misleading results in people who are very muscular or very tall.

• Waist-to-hip ratio. To find your waist-to-hip ratio, divide your waist measurement at its narrowest point by your hip measurement at its widest point. As a marker of a person’s abdominal fat, this measure outperforms BMI. For women, the risk for heart disease and stroke begins to rise at a ratio of about 0.8.

• Waist circumference. The simplest way to check for abdominal fat is to measure your waist. Run a tape measure around your torso at about the level of your navel. In women with a BMI of 25–34.9, a waist circumference greater than 35 inches is considered high risk, although research suggests there is some extra health risk at any size greater than 33 inches. Since abdominal fat can be a problem despite a normal BMI, health assessments should include both BMI and waist circumference. The relationship between waist circumference and health risk varies by ethnic group. For example, in Asian women, a waist circumference above 31.5 inches is considered a health risk.

The reason cellulite is rarely seen in men (obese and non-obese) is because the epidermis, dermis and uppermost part of the subcutaneous tissue is different in males. Men have thicker epidermis and dermis tissue layers in the thighs and buttocks.

The differences in subcutaneous fat cell structure in men and women occur during the third trimester of fetus development and are manifested at birth. Variations in hormones between genders largely explain this skin structure deviation. It has been shown that men who are born deficient in male hormones will often have a subcutaneous fat appearance similar to females.

Since cellulite is largely due to a structural conformation below the skin, it is often common in very slender women. However, individuals who are over-fat will frequently have a more pronounced cellulite development, while those with less fat and more muscular definition tend to have less visible cellulite.

In women, the dermis reaches its maximal thickness at 30 years of age. Secondly, the dermis area, which is bound together by the connective tissue, starts to get looser, due to the aging process of the collagen and elastic fibers. This allows for more adipose cells to protrude into the dermis area, accentuating the sight of cellulite. In addition, an increased deposition of subcutaneous body fat may often reflect a lifestyle of less exercise and changes in dietary consumption.

It is well-established that women generally have a higher percentage of body fat than men. For instance, a healthy range of body fat for women is 20-25 percent, and a healthy range of body fat for men is 10-15 percent. The thighs and buttocks of women tend to store more of this body fat. (Pear shaped.)

Numerous myths and misconceptions about cellulite have been popularized in print, media and the Internet. Some of the most well-known will now be clarified. First and foremost, cellulite is not a disease. As explained above, it is due to fat-cell chamber structure below the skin dermis. Secondly, although the skin is richly vascular with blood vessels, cellulite is not caused by damaged blood vessels. In addition, cellulite is not due to a weakening of capillaries or a decreased circulation in the subcutaneous area. Some sources have suggested that cellulite is a lymphatic disease or abnormal hormone condition, yet there is no scientific support for this contention.

Since the subcutaneous fat tissue structure is gender-typical to females, the question should actually be is fat deposition hereditary? Although the exact percentage is not fully clarified in the research, there is a meaningful hereditary component to fat deposition.

It appears that cellulite is observable in women of all races. Studies involving women from China, South Africa, Egypt, Brazil, United States, Canada, Mexico, Afghanistan, Russia, Japan, Thailand and Indonesia all report cellulite in women.

There is much variation in anatomy and skin anatomy from person to person. Women have unequal amounts of subcutaneous fat, as well as variable thickness and denseness of the dermis and epidermis skin layers.

The underlying fat-cell chambers do not change with a loss of weight. For optimal skin adaptation to weight loss, it is advisable for weight loss to be progressive and not extreme (such as repeatedly seen with fad diets). Also, skin elasticity is best up to the age of 35 to 40 years. Collagen and elastic fibers can retract best to lesser volumes (from fat loss) before this chronological age.