The Belly Burden
Forget the scale. New research points to waistline size as a better predictor of health
Does your belt need a new hole--or three? Has that "spare tire" made it hard to tie your shoes? And what's happened to clothing sizes? Why has everything become just too darn tight around the waist? If you find yourself asking these questions while you lie down on the bed, hold your breath, and try to get that zipper all the way up, join the club. Americans' collective waistline is expanding--a lot. And medical researchers are beginning to understand the complex physiology behind a simple truth women have believed for centuries: the smaller the waist, the better the life.
Over the past 10 years, a raft of new studies have shown that predicting a person's long-term health may be as simple as taking a waist measurement. Fat around the waist has been linked to a greater risk of heart disease, diabetes, stroke, hypertension, breathing problems, disability, some cancers, and higher mortality rates. The medical community once believed that it was weight itself or the body mass index that led to serious illness and earlier death, not where fat is located on the body. But recent research on the wonders of the fat cell has shown that not all fat is alike. Fat around the middle is largely visceral fat, a type of deep fat that packs itself around internal organs and secretes powerful body chemicals. It's this type of fat that sets off reactions in the body that lead to changes in arteries, organs, and cells that result in heart disease, diabetes, and probably some cancers. The more abdominal fat, the greater the risk of developing these conditions earlier. "It's becoming clearer and clearer that body fat distribution is a critically important variable," says JoAnn Manson, chief of preventive medicine at Harvard University's Brigham and Women's Hospital. "And abdominal obesity is the key culprit."
Ideal look. To some extent, folk wisdom and popular culture have reflected this for centuries. A willowy waistline was an ideal for both men and women in colonial and frontier America and easier to attain when food was scarce and a great deal of physical activity was required to hunt, gather, and cook it. The Victorian period ushered in the era of the "hourglass figure," which remained the ideal female form for more than 120 years, until it was supplanted by the "Twiggy" look of the 1960s. Boys, of course, want thin waists, too. Many a late-night infomercial sells the dream of "six-pack abs" or a "washboard stomach" to men.
One thing is certain: The average American waistline is expanding. In fact, it has never been bigger. Federal health surveys show that over the past four decades, the mean waist size for men has grown from 35 inches to 39 inches; for women, from 30 inches to 37 inches. The National Institutes of Health recommends that men with waists measuring 37 inches or greater and women with waists larger than 31.5 inches modify their lifestyles to reduce their waists and resulting health risks. Nearly 39 percent of men and 60 percent of women are carrying too much belly fat.
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