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Apples and Pears: The Body Shape Solution for Weight Loss and Wellness

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Overview

A revolutionary approach to the challenges of body shape, apples & pears presents weight loss and wellness solutions that are practical...and, above all, possible.
  • Understand what body shape means, how it is formed, how it changes, and how it relates to your health.
  • Learn why all fat is not created equal.
  • Discover the Elite foods that help protect against disease, ...
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Overview

A revolutionary approach to the challenges of body shape, apples & pears presents weight loss and wellness solutions that are practical...and, above all, possible.
  • Understand what body shape means, how it is formed, how it changes, and how it relates to your health.
  • Learn why all fat is not created equal.
  • Discover the Elite foods that help protect against disease, promote general wellness, and improve your odds of shedding fat.
  • Find out why the human body is not designed to give up weight easily -- and learn what you can do to lose more weight with less effort.
  • Change the way you relate to your body forever.
  • Acquire the tools you need to make conscious, informed, healthy choices about food while still living in the real world.
  • Throw away your scale and get out of the cycle of diet failure. No more fads. No more confusion.

When it comes to your health, body shape really does matter!

Chances are you already know if you're an apple or a pear. If you tend to gain weight in your belly and back, you're an apple. If your thighs and derriere are the canvas on which your snack food sins are written, then you're a pear. But what does it matter? Gut or butt, too much is too much, right? Wrong!

Whether you are an apple-shaped or pear-shaped woman determines far more than whether you select a swimsuit with a waist-whittling pattern or a thigh-hiding skirt. According to medical pioneer Marie Savard, M.D., your body shape is the single most powerful predictor of future health. It is connected to differences in your physical chemistry, hormone production, and metabo-lism and directly affects your likelihood for obesity, heart disease, osteoporosis, the metabolic syndrome, diabetes, stroke, varicose veins, and certain cancers.

Your body shape may be putting your health in danger through no fault of your own. But there is good news: There are things you can do to prevent or even reverse the risks of body shape. Apples & Pears: The Body Shape Solution for Weight Loss and Wellness offers women of all shapes and sizes specific nutritional and exercise recommendations based on body type. So much more than just another diet book, Apples & Pears teaches you exactly what you need to do to sidestep the physical and emotional pitfalls of body shape in order to live longer, lose weight, and feel healthier.

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Editorial Reviews

Library Journal
Women's health expert Savard explains how the fat distribution makes apple-shaped bodies more susceptible to disease than "pears." Weight that is carried above the waist tends to be deposited inside the body, rather than just under the skin as it is below the waist. Visceral fat (within the torso) affects the functioning of heart, lungs, liver, and pancreas, leading to insulin-resistance (type 2) diabetes, osteoporosis, and heart disease. The bad news is that pear-shaped women can become apples after menopause. The good news is that it is easier to shed pounds from the midsection than from the hips and thighs. Sensible nutrition is vital, and Savard presents diet programs specially tailored to each shape. Copyright 2005 Reed Business Information.
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Product Details

  • ISBN-13: 9780743497138
  • Publisher: Atria Books
  • Publication date: 1/4/2005
  • Pages: 400
  • Product dimensions: 6.30 (w) x 9.44 (h) x 1.31 (d)

Meet the Author

Marie Savard

Marie Savard, M.D., is a nationally known internist, women's health expert, and advocate for patients' rights. She is the author of the highly acclaimed How to Save Your Own Life and the creator of The Savard Health Record. She lives in Philadelphia.


Carol Svec is a seasoned health writer and the author of three books. She lives in North Carolina.

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Read an Excerpt

Introduction

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 of apple-shaped women. You can be born with a genetic predisposition to be apple-shaped, as Millie was (my father's side has a history of diabetes and I suspect they were apple-shaped); or you can gradually become apple-shaped after menopause, as my mother did.

My passion to write this book comes from these family stories and the stories of countless other women I have cared for and treated over the years. It is with the clarity of hindsight that I see that I could have made an even bigger difference in my patients' health if only I had recognized sooner the diagnostic importance of body shape. But back then, I didn't have the language of body shape to begin the conversation. It is difficult to take the first step to speak up and interfere with someone else's health choices; talking about body shape would have provided an easy transition into a discussion of weight, lifestyle, and disease risk. I could have told them that, through no fault of their own, body shape had put their health in danger. The good news is that we know now. And there are things we can do to prevent or even reverse the disease process set in motion by "appleness."

Pear-shaped women have their own set of problems. In our image-conscious society, fat thighs and large buttocks are mocked. Even gorgeous, pear-shaped Jennifer Lopez has had to endure years of negative commentary about her figure. There's the joke that may or may not have originated on Late Night with Conan O'Brien, but which has circulated on the internet: When Jennifer Lopez got a massage, Sean Puffy Combs came in with her and told the massage therapist not to touch her rear end. The massage therapist said he wouldn't have been able to massage Jennifer Lopez's rear end anyway because she only booked a half day. Frances O'Toole of the British online newspaper, The Observer, contributed her own take on J-Lo's figure: "This isn't a catwalk bottom — it may be firm, but it's covered in fat." These are the messages that contribute to women being unable to accept themselves. Pear-shaped women who internalize the rail-thin ideal of fashion models end up struggling with body image problems throughout their lives. It's no wonder that they suffer from eating disorders more often than apple-shaped women do. What they don't know is that losing weight will not change the overall shape of their bodies — it will only make them smaller pears. After menopause, pear-shaped women are more likely than apple-shaped women to develop osteoporosis. And like my mother, pear-shaped women can become apple-shaped, increasing their risk for disease while adding inches to their waists. For these women, this book outlines how to sidestep the physical and emotional pitfalls of being a pear, and what can be done to avoid turning into an apple.

The overall purpose of this book is to change the way women and their physicians perceive their bodies and understand their disease risk. I have made it my life's mission to empower every woman to take charge of her health. When the woman is my patient, I can sit her down, explain the importance of body shape in the context of her family history, current medical conditions, and lifestyle and warn her of her specific disease risks. Then, with medical recommendations customized by body shape, I can tell her exactly what she needs to do in order to live longer, lose weight, and feel healthier. For the millions of other women in the world, the ones I can't treat personally, I am putting that same power in their hands with Apples & Pears.

This book is divided into three parts. Part 1 discusses body shape in general — the differences between body shapes, how to determine your shape, the different kinds of fat and its distribution patterns, and how different life stages can affect weight and shape. These chapters provide the framework for understanding and interpreting the information in the rest of the book.

Part 2 provides in-depth information about medical issues, including the body shape connection to the metabolic syndrome, type 2 diabetes, inflammation, heart disease, cancer, osteoporosis, varicose veins, stress, and depression. The chapter on hormones provides answers about birth control pills and hormone therapy — who might benefit, and who should avoid them entirely.

Part 3 provides customized diet recommendations for apple-shaped women and pear-shaped women, as well as the most effective ways to lose weight and the most promising exercises. Plus, I provide a Body Shape Health Log blank for you to copy and use to track your health and weight loss progress.

By the end of this book, you will understand the health risks faced by women with your body shape. You'll be able to identify your particular weak points, and you'll know how to make them stronger. You'll be able to talk with your doctor about how to incorporate body shape into your wellness plan, and you'll be more confident in the health decisions you make. In addition, you will have a whole new way to think about your body — not as an enemy to be punished and hated, but as a dynamic reflection of your genetic and personal history. I've been told by women time and again that once they understood the concepts in this book, they were finally able to feel happy in their own skin. That's how powerful the concept of body shape is; it can affect both our health and our happiness. The mission of this book is to help you learn to harness that power for yourself.

Copyright © 2005 by Marie Savard, M.D.

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First Chapter

Introduction

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 feetwould 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 of apple-shaped women. You can be born with a genetic predisposition to be apple-shaped, as Millie was (my father's side has a history of diabetes and I suspect they were apple-shaped); or you can gradually become apple-shaped after menopause, as my mother did.

My passion to write this book comes from these family stories and the stories of countless other women I have cared for and treated over the years. It is with the clarity of hindsight that I see that I could have made an even bigger difference in my patients' health if only I had recognized sooner the diagnostic importance of body shape. But back then, I didn't have the language of body shape to begin the conversation. It is difficult to take the first step to speak up and interfere with someone else's health choices; talking about body shape would have provided an easy transition into a discussion of weight, lifestyle, and disease risk. I could have told them that, through no fault of their own, body shape had put their health in danger. The good news is that we know now. And there are things we can do to prevent or even reverse the disease process set in motion by "appleness."

Pear-shaped women have their own set of problems. In our image-conscious society, fat thighs and large buttocks are mocked. Even gorgeous, pear-shaped Jennifer Lopez has had to endure years of negative commentary about her figure. There's the joke that may or may not have originated on Late Night with Conan O'Brien, but which has circulated on the internet: When Jennifer Lopez got a massage, Sean Puffy Combs came in with her and told the massage therapist not to touch her rear end. The massage therapist said he wouldn't have been able to massage Jennifer Lopez's rear end anyway because she only booked a half day. Frances O'Toole of the British online newspaper, The Observer, contributed her own take on J-Lo's figure: "This isn't a catwalk bottom -- it may be firm, but it's covered in fat." These are the messages that contribute to women being unable to accept themselves. Pear-shaped women who internalize the rail-thin ideal of fashion models end up struggling with body image problems throughout their lives. It's no wonder that they suffer from eating disorders more often than apple-shaped women do. What they don't know is that losing weight will not change the overall shape of their bodies -- it will only make them smaller pears. After menopause, pear-shaped women are more likely than apple-shaped women to develop osteoporosis. And like my mother, pear-shaped women can become apple-shaped, increasing their risk for disease while adding inches to their waists. For these women, this book outlines how to sidestep the physical and emotional pitfalls of being a pear, and what can be done to avoid turning into an apple.

The overall purpose of this book is to change the way women and their physicians perceive their bodies and understand their disease risk. I have made it my life's mission to empower every woman to take charge of her health. When the woman is my patient, I can sit her down, explain the importance of body shape in the context of her family history, current medical conditions, and lifestyle and warn her of her specific disease risks. Then, with medical recommendations customized by body shape, I can tell her exactly what she needs to do in order to live longer, lose weight, and feel healthier. For the millions of other women in the world, the ones I can't treat personally, I am putting that same power in their hands with Apples & Pears.

This book is divided into three parts. Part 1 discusses body shape in general -- the differences between body shapes, how to determine your shape, the different kinds of fat and its distribution patterns, and how different life stages can affect weight and shape. These chapters provide the framework for understanding and interpreting the information in the rest of the book.

Part 2 provides in-depth information about medical issues, including the body shape connection to the metabolic syndrome, type 2 diabetes, inflammation, heart disease, cancer, osteoporosis, varicose veins, stress, and depression. The chapter on hormones provides answers about birth control pills and hormone therapy -- who might benefit, and who should avoid them entirely.

Part 3 provides customized diet recommendations for apple-shaped women and pear-shaped women, as well as the most effective ways to lose weight and the most promising exercises. Plus, I provide a Body Shape Health Log blank for you to copy and use to track your health and weight loss progress.

By the end of this book, you will understand the health risks faced by women with your body shape. You'll be able to identify your particular weak points, and you'll know how to make them stronger. You'll be able to talk with your doctor about how to incorporate body shape into your wellness plan, and you'll be more confident in the health decisions you make. In addition, you will have a whole new way to think about your body -- not as an enemy to be punished and hated, but as a dynamic reflection of your genetic and personal history. I've been told by women time and again that once they understood the concepts in this book, they were finally able to feel happy in their own skin. That's how powerful the concept of body shape is; it can affect both our health and our happiness. The mission of this book is to help you learn to harness that power for yourself.

Copyright © 2005 by Marie Savard, M.D.

Chapter 1: Apples and Pears

Body shape is the closest thing we have to a medical crystal ball. This one simple piece of information is more important than weight for predicting your risk of heart disease or stroke. It can foretell your likelihood of developing type 2 diabetes 10 to 20 years before blood tests show a problem with blood sugar, and it is as powerful as family history for revealing a tendency toward breast cancer, endometrial cancer, or osteoporosis. The good news is that this crystal ball only shows what is likely to happen; our health destiny is not written in stone. We have the power to improve the course of our lives in spite of our shapes...if we are willing to take action.

But body shape tells us much more than our risk of future disease. Want to understand the reasons for your cellulite, bloated belly, depression, low self-esteem, menopausal hot flashes, gestational diabetes, or varicose veins? In many cases, everything you need to know can be found in the measurements of your waist, hips, and buttocks. Ever wonder why exercise never slims your "thunder thighs," or why you gain weight when you're under stress, or why diets never seem to work for you? Again, body shape reveals all.

Once you understand what body shape means, how it is formed, how it changes, and how it relates to your health, the effect is like ripping off a blindfold. Finally your stomach and thighs make sense. Finally you know what you have to do to lose weight more easily. Finally you can put medical problems in context and really know what to do to improve them. Finally you can appreciate and understand your body as it is, while still nurturing it to become stronger and healthier than ever before. That's the power of body shape, and it's as easy as knowing the difference between apples and pears.

Body Shape Variations

As much as we would like to believe that we are all unique physical specimens, women's bodies are divided into two main groups: apple-shaped and pear-shaped. The classic apple-shaped woman has slender and shapely legs, narrow hips, large breasts, and a relatively large waist. If you look at an apple, you'll notice that the fruit is widest in the middle. An apple-shaped woman also tends to put on weight around her middle, that is, her waist, or the area where her waist would be if she had one. She probably owns few, if any, belts, but short skirts and men's-fit or slim-leg blue jeans look good on her. The classic pear-shaped woman has a relatively thin upper body, often with small breasts, a well-defined waist, and heavier lower body. If you look at a pear, you'll notice that the fruit is widest at the bottom. Again, a pear-shaped woman also tends to put on weight around her bottom -- hips, thighs, and buttocks. She may feel self-conscious about her "thunder thighs," but she'll have no problem cinching a belt around her narrow waist.

Once you know what to look for, you can often identify which women are apple-shaped and which are pear-shaped just by looking at them. Spend a day people watching in a shopping mall and you'll see many examples of both classic apple shapes and classic pear shapes. You'll also spot a few mixed-type body shapes. For example, some women have more of a banana shape -- a body that is straight up and down, with thin upper and lower extremities, small chest, and no waist. There is also a body shape sometimes called the "inverted pear," characterized by large breasts and thick, wide shoulders tapering down to slender hips, but with no discernible waist. And, of course, there is the famous hourglass figure, defined by large breasts, a narrow waist, and relatively large hips. Banana-shaped and inverted pear-shaped women have, for all medical purposes, variations of an apple shape. Women with an hourglass figure have the equivalent of a pear shape. All women, thin or fat, curvy or flat, can be categorized as either apple-shaped or pear-shaped. The key is the waist-to-hip ratio.

The Tape Measure Test

Figuring out your body shape is easy -- all you need is a flexible tape measure and a calculator. First, measure around your waist. If you have a visible waist, measure around the narrowest part. If you don't have a waist, measure around the widest part of your middle, usually about one inch above your navel. Stand up straight, but relaxed. Don't suck in your gut. Hold the tape measure loosely, without putting pressure on the skin. That number is your waist circumference.

Next, measure around your hips -- not where the bones of your pelvis jut out, but about three to four inches lower. This actually corresponds to the point where the top of your thigh bone -- the femur -- meets the pelvis. You should be measuring around your buttocks, not above or below. If you have any doubt, take the measurement at the widest point of your lower body, which may include your "saddlebags" if you are pear-shaped. Divide your waist measurement by your hip measurement to get your waist-to-hip ratio, or WHR.

If your WHR is 0.80 or lower, your body is classified as pear-shaped. If your WHR is higher than 0.80, your body is classified as apple-shaped. For example, if your waist measurement is 26 and your hip measurement is 37, then the calculation is 26 ÷ 37 = 0.70, which means that you are pear-shaped. If your waist measurement is 35 and your hip measurement is 38, then the calculation is 35 ÷ 38 = 0.92, which means that you are apple-shaped. It's that simple. But embedded in that simplicity is a whole new dimension of women's health.

All Fat Is Not Created Equal

The essential difference between apple and pear shapes is fat -- where it is, what type it is, and how it affects health. It's not just a surface difference, like blond hair versus brown hair. It is a deep, fundamental difference; a genetic code that runs through every cell in our bodies coupled with hormonal variations.

Fat comes in two main varieties: subcutaneous, which means "under the skin," and visceral, which means "pertaining to the soft organs in the abdomen." Subcutaneous fat is the stuff that jiggles, the soft stuff we pinch and poke and generally hate to see on our bodies. Visceral fat, on the other hand, is not always visible from the outside. It packs itself around the inner organs of the abdomen, jamming up against the intestines, kidneys, pancreas, and liver (and sometimes even inside the liver). We all have some visceral fat because it protects our internal organs, acting both as shock absorber in case of trauma, and as insulator to help us conserve body heat. While some visceral fat is necessary, too much can create serious health problems.

Fat comes in two main varieties: subcutaneous, "under the skin," and visceral, "pertaining to the soft organs in the abdomen."

Most people think of fat as inert material, much like the rind of fat surrounding a good steak. If we cut it off (or suck it out, in the case of liposuction), all we're doing is getting rid of that hunk of congealed lard -- right? Wrong. Fat is actually living, breathing, hormone-producing, metabolically active tissue. It is critical for survival, and not just because it provides storage for energy. Fat helps regulate body functions through the give-and-take of chemical communications with the central nervous system. People who have too little body fat are just as unhealthy as people with too much body fat, but in a different way. In fact, try not to think of body fat as fat. It's too easy to visualize a "bucket of lard." Instead, try to think of fat as a gland, as active and important as any other gland in the body. In medicine, we call fat "adipose tissue," which has the benefit of reminding us that we're talking about an integrated part of the body, not simply dead weight.

Adipose tissues make and release a variety of compounds, including enzymes, hormones (such as leptin, which helps regulate appetite), and inflammation-related chemicals called cytokines. These and other factors, many of which have not yet been identified, come together to create your body's internal physiologic state. And what that state means for your health comes down to the type of fat you have. Although visceral fat and subcutaneous fat are in the same general category, they are totally different animals. To lump them together would be like saying that your eyes and your ears are the same because they are both sense organs. True, but the difference is as great as the difference between...well, sight and sound.

Fat helps regulate body functions through the give-and-take of chemical communications with the central nervous system.

Subcutaneous fat may be visible and annoying, but it is relatively harmless. Some of it may, in fact, help protect us from disease. Subcutaneous fat that collects around the pear zone -- hips, thighs, and buttocks -- has been shown to increase levels of high-density lipoprotein (HDL, also known as the "good" cholesterol) and actually helps maintain a steady balance of triglycerides in the blood. Subcutaneous fat in the pear zone is able to trap certain fats from the foods we eat, keeping them from escaping into the blood stream where they can damage our arteries.

Excess visceral fat, on the other hand, can be dangerous. Visceral fat is more metabolically active than subcutaneous fat, and most of what it does is harmful to the body. Visceral fat decreases insulin sensitivity (making diabetes more likely), increases triglycerides, decreases levels of HDL cholesterol, creates more inflammation, and raises blood pressure -- all of which increase the risk of heart disease. While fat in the pear zone traps and stores dietary fat (trapped fatty acids are then stored as triglycerides), visceral fat releases more of its free fatty acids into the blood stream, further increasing the risk of both diabetes and heart disease. The overall effect of excess visceral fat is that it creates a physical environment that is primed for heart disease and stroke, and greatly increases the risk for certain cancers. The more abdominal fat, the greater the waist circumference, and the higher the WHR, the more dangerous the situation becomes.

The Nature of Apples and Pears

The qualities of subcutaneous fat and visceral fat are different. And these fat differences are what make apple-shaped and pear-shaped women so varied in terms of how they look, their risk of disease, and their metabolic activity. In many ways, these two categories of women are as physiologically different from each other as women are from men.

To nature, pear-shaped women are perfect -- ideally designed for fertility, pregnancy, childbirth, and long lives of nurturing. (Nature has a rather limited definition of "perfect.") Their body chemistry is dominated by estrogen, that most female of hormones, which provides lush layers of back-up fuel -- we call it fat -- and protection around their eggs and womb. The pear shape is soft, curvy, and warm, endowing women with distinct waists, hips, buttocks, and thighs. In medical circles, the pear shape is known as "gynoid," which derives from the Greek word for woman, as if all women were meant to be pear-shaped.

The apple shape is medically called "android," which derives from the Greek word for man. In women, this means that their body chemistry is dominated by androgen, the typically male hormone. All women produce androgens in their ovaries and adrenal glands, but apple-shaped women produce more of them. They also produce estrogen, of course, but there is a relative predominance of androgen helping to define how they look and function. The effect is that women with an apple shape have bodies that are shaped more like men's bodies -- less curvy, more angular, and with less fat around the lower body. They often have relatively large breasts, usually because of weight gain above the waist, coupled with the powerful way androgens affect the body.

If thin thighs, large breasts, and a small butt were the only outcomes of an android shape, there wouldn't be a problem. But there are repercussions. Apple-shaped women, with their extra androgens, tend to gain weight in the same way men do -- around the waist, with much of it in the form of visceral fat.

So pear-shaped women and apple-shaped women not only look different, they are different. Apple-shaped women have the type of fat that promotes heart disease, whereas pear-shaped women have the type of fat that protects against heart disease. Apple-shaped women have decreased glucose tolerance, whereas pear-shaped women have steady glucose tolerance. Apple- and pear-shaped women react differently on a number of physiologic (and, as we'll see later, psychological) parameters, leading to varied disease risks. In some cases, apple- and pear-shaped women may respond differently to the same medications. Overall, the disparity between body shapes is so dramatic, it's as though we are looking at two entirely different groups of people.

Body Type in Health Research

The significance of this difference is staggering. When scientists do medical research, they usually lump all women together as a single category. Very few researchers separate women into two groups based on body shape. So when we read about a medical study of, say, heart attack in women, who are the researchers studying? Apple-shaped women? Pear-shaped women? A combination of the two?

The reality is that, in most cases, even the researchers don't realize the tremendous response differences between body shapes, so all women are studied as if they are identical. But as we've learned, apple- and pear-shaped women are not identical. They can even have exactly opposite physiologic responses to the same stimulus. So imagine what happens when a scientist studies a large group of women. The combined results of both body types could cancel each other out! Alternatively, the study may investigate the reactions of only one body type, purely by accident. In that case, results will be announced as pertaining to all women, when really only one type of woman was studied.

The result is that many health "truths" that we take for granted are not necessarily true for all women. For example, we've heard that, statistically, men suffer more heart attacks than women. But a closer examination of the data reveals that apple-shaped women have the same heart attack risk as men when the amount of abdominal fat is taken into account. Pear-shaped women have a much lower risk of heart attack, regardless of their overall weight. In fact, virtually the only time a woman will have a heart attack before menopause is if she is apple-shaped or has diabetes...and 85 percent of women with diabetes are apple-shaped! Study after study has shown that women who are shaped like men -- apple-shaped women -- are more likely to die like men, of the same causes and at the same rates.

Many health truths we take for granted are not necessarily true for all women. Women who are shaped like men -- apple-shaped women -- are more likely to die like men, of the same causes and at the same rates.

We know this because some astute physicians asked the question: Why do my female heart attack patients all seem to have an android fat distribution pattern? (We still didn't have the vocabulary to talk about apple-shaped body type back when these studies were being conducted.) The research provided what was then considered a surprising answer -- that apple-shaped women had more heart attacks than pear-shaped women simply because of their body shape, and more specifically, because of the visceral fat that created that shape. Since then, most researchers have understood the importance of measuring waist circumference and (sometimes) waist-to-hip ratio in studies of women and heart attacks.

Although heart researchers may understand the importance of body shape, what about all the other women's health researchers? How confident can we be, then, with the universality of women's health research? When a particular study reveals, for example, that hormone therapy increases risk of heart attack in women (even when most doctors will tell you that their experience and years of observational studies tell them the opposite), how do we know which women were studied? Do the results pertain to all women, or just one category of women? Right now, we just don't know because the vast majority of research does not separate women by body shape.

The few intrepid researchers who have taken these differences between apple- and pear-shaped women into account are expanding the breadth of knowledge about women's health. The hope is that someday all women's health research will include the variable of body shape (through measurement of WHR and waist circumference) so that we have even more definitive prescriptive and preventive information. For now, we use what we have. And even though the research has really just begun, we already know enough about the differences between women with apple or pear shapes to make specific and customized health recommendations based on body shape, personal medical history, and family history.

Not All Fruit Shapes Look Alike

Although the extremes of body shape are easy to identify, there are many different varieties of apple shapes and pear shapes in the world. Total weight, in fact, has very little to do with it. Body shape is strictly defined by the waist-to-hip ratio. Notice the variety of apple and pear shapes in these photographs. Beneath each woman's picture are her shape category, WHR, and BMI (Body Mass Index).

Which Is Better, Apple or Pear?

Women seem to have preconceived notions of which body type is "better," apple-shaped or pear-shaped. Each woman tends to think that whichever type she isn't is the more desirable. Pear-shaped women often silently curse their hips and thighs, dread bathing-suit season, and can be embarrassed by their very womanly, Rubenesque figures. They have to fight the impression that they are wide at the bottom simply because they sit around all day -- "secretary spread" is a pejorative for ample buttocks on a woman with a desk job. Apple-shaped women are often uncomfortable with their bellies. They become geniuses at dressing to camouflage their lack of a waist and are often frustrated to tears at the inability of sit-ups or crunches to slim their middles. They feel shamed into making excuses for their shapes, such as blaming a large tummy on the effects of pregnancy "baby weight" that never went away. (As you'll see in chapter 3, that's actually partly true.)

In reality, neither body shape is better than the other. It may sound as though science is picking on apple-shaped women, but apple-shaped women can be just as healthy as pear-shaped women. Everything depends on the amount of visceral fat they have. Shape, through waist circumference and WHR, is just a convenient way to measure that adipose tissue. So apple-shaped women can really consider themselves lucky to have such a good advance warning system for disease! Pear-shaped women may have less immediate disease risk, but they can become apple-shaped after menopause. And in old age, they face the quiet devastation of osteoporosis. There is no "better" or "worse," there is only what you are.

Regardless of whether you are an apple or a pear, fat or thin, it is important that you understand that your body shape is not your fault. And it is certainly nothing to be ashamed of. It's all part of the specific set of genes and environmental factors that make you who you are. Although scientists have begun mapping the human genome, it is likely that we'll never know exactly which other traits were inextricably interconnected and expressed to make you a unique individual. Are you creative, musical, funny, responsible, intuitive? Are you a great cook, a loving mother, a reliable friend? Are you happy, serious, playful, philosophical, strong? There's a good chance that the factors that went into making you those things are somehow linked to the factors that made you apple- or pear-shaped. You can't change it.

There is no "better" or "worse," there is only what you are. And your body shape is not your fault.

What you can do, however, is make yourself as healthy as possible. This includes identifying your body shape, recognizing the interrelatedness of body shape and certain diseases, and then doing what you can to rid yourself of excess visceral adipose tissue. Visceral fat is the enemy, not your waist, hips, thighs, or butt. This book is full of ways to get rid of visceral fat, prevent the additional accumulation of fat, and counter some of the other disease risks associated with your body shape. Just take one step at a time. If you adopt even a few of the program recommendations, you won't need a crystal ball to tell your health future -- you'll see it in the mirror, and you'll feel it in your heart.

Action Items for Chapter 1: Apples and Pears

· Measure your waist circumference (WC) and your hip circumference, then calculate your waist-to-hip ratio (WHR) to determine whether you are currently apple-shaped or pear-shaped.

· Find the Body Shape Health Log for your shape, beginning on page 328, and write in your current measurements. It is going to be important for your health records to keep track of both your WC and your WHR. As you move forward with the diet and exercise program customized for your body shape in Part 3 of this book, you'll want to monitor your progress by updating these numbers periodically. The logs have spaces to track other health numbers, which I'll explain as we go along.

Take to Heart...

· Being apple-shaped is not inherently good or bad. Being pear-shaped is not inherently good or bad. Is it better to be a beagle or a cocker spaniel? A rose or an orchid? If you understand and accept your body type, you gain the freedom to be happy in your own skin.

Copyright © 2005 by Marie Savard, M.D.

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  • Anonymous

    Posted January 13, 2005

    great book, no matter your 'fruit'

    From its opening sentence--'Body shape is the cloest thing we have to a medical crystal ball'--you will get the clearest look into the future of your health with this remarkable book. I couldn't put it down! Packed with credible scientific fact and written in an easy-to-understand style, Savard and Svec fully explain how and why body type can affect health...and more importantly, what to do about it. A definite read for anyone!

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  • Anonymous

    Posted January 5, 2005

    I'm proud to be a pear!!

    Until Apples & Pears, no one ever classified women by body shape which is critical and makes all the difference in the years to come! I am the perfect pear, all my inches accumulate below the belt mainly the thighs, with a very narrow top. After reading the book, I found out that being pear-shaped, I'm protected from cardiovascular disease because of subcutaneous fat, or what the book terms pear-zoned fat. I learned pears have a greater risk of cellulite/varicose veins, heavy legs and osteoporosis as well as we make less potent estrogen after menopause meaning we are usually candiates, depending on our family history, for hormone replacement. The information gathered in this book is pulled from medical research along with Dr. Savard's expertise/background in women's health making this book #1 and a first of it's kind. I highly suggest everyone reading this review to visit www.applesandpears.org to find out more about body shapes, find out your waist hip ratio, a calculator provided on the site, as well as downloading the health logs which are also printed in the book. To quote Dr. Savard, 'Body shape is the closet thing we have to a medical crystal ball'. To understand what the meaning behind this statement is..you'll have to read the book.

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