Drug Medical Information

WEIGHT CONTROL: EXCESS FAT ON HIPS

"What goes past my lips settles on my hips" is an oft-repeated lament that is literally true for many women and some men. When these "hippy" types become obese, their excess body fat clings to their thighs and rumps, giving them pear-shaped proportions.

On the other hand, most men and some women who become obese take on rotundity - a tire of fat wraps itself around their middles, causing their figures to resemble apples on legs.

Dr. Ahmed Kissebeh, of the Medical College of Wisconsin at Milwaukee, says that 25 percent of obese men and women are apples, and 25 percent are pears. The remainder, he says, combine aspects of both.

However much the pears lament about their hips, they may have a good-health edge. Science is discovering that apples die at two to three times the rate of pears their own age. The apples fall prey more often to heart disease, high blood pressure, diabetes, gallbladder disease, gout, stroke, and-perhaps most frightening of all-cancer. Pears generally stay relatively healthy for years longer.

When women enter menopause and their hormone levels change, sometimes the fat shifts from below to above their waists, turning them from pears into apples with the same risks for the diseases that plague male apples. It's not only how much fat your body carries that affects your health-where it's draped counts, too.

"We are just learning how dangerous fat above the hipline can be," says Dr. Marvin Kirschner, who runs an obesity clinic at Beth Israel Hospital in Newark, New Jersey. "It's not as dangerous to be a pear." And the doctors are learning about visceral fat, which apples accumulate inside the abdomen. It clings to the intestines. If you have a lot of visceral fat, you're a major target for the diseases that strike apples. And because visceral fat lies deep in your body, you may not know it's there.

Besides its ill effects on the circulatory system, belly fat also may raise the risk of breast cancer in older women. Dr. Aaron R. Folsom and his colleagues at the University of Minnesota School of Public Health in Minneapolis studied 40,000 postmenopausal women. The obese apple-shaped women had twice the rate of breast cancer as women of average build. Dr. Folsom says that changes in female hormones caused by extra fat may set off the cancer. Studies suggest a similar tie-in with colon cancer in both men and women.

Seymour Abend, of Manhattan, knows just how unhealthy appleness can be. He had survived a heart attack.

At a height of 6 feet and a weight of 280 pounds, Mr. Abend then weighed 80 pounds more than the height/weight tables advised. Most of that extra poundage had settled in his trunk. He measured 53 inches around the waist. Unknown to him, pounds of visceral fat also clung to his intestines.

After his heart attack, Mr. Abend lost 13 pounds and lowered his cholesterol readings from 240 to 200. He takes medicine to control his high blood pressure and has reduced his risk of a second heart attack. He says he plans to join the Weight Watchers program.

Dr. George Blackburn directs the Center for the Study of Nutrition and Medicine at New England Deaconess Hospital in Boston. "We need to get to the apples more than the pears between the ages of 19 and 34," he says. "Fifty percent of all people, who diet, don't need to. Eighty percent of the people who need to diet-the apples-are not doing it."

*20/266/5*