For older women, shape matters more than size

It’s been my experience that women tend to care more about their weight than men. But this trend is shifting, as the conversation around obesity is changing—with more of a focus on health rather than cultural expectations.

Still, I always take the opportunity to remind women in particular that there’s more to a healthy body than fitting into a certain dress size. And while obesity isn’t good for anyone—you already know my opinions about the modern “fat but fit” myth—a normal body mass index (BMI) isn’t always identical to a clean bill of health, either.

And as it turns out, this is one case where shape matters just as much as size—for women, at least.

A poison apple

Postmenopausal women who are “apple-shaped”—that is, who have a large waist, regardless of their BMI—face an increased risk of heart-related death, cancer death, and all-cause mortality than their obese, large-waisted peers.

And that bears repeating: We’re talking about women in a normal weight range according to BMI (which doesn’t factor in central obesity). In other words, women who would otherwise be considered perfectly healthy, according to current guidelines.

But clearly, such guidelines are misleading—which is one reason I’ve never fully subscribed to BMI as an accurate tool for health assessment. (Unlike the conventional medical community, who hang on to scientifically disproven rules, instead of admitting their mistakes and finding better ways of doing things.)

But I digress… Let’s take a closer look at these numbers, shall we?

Compared to normal weight women without central obesity, normal weight women with central obesity faced a 30 percent higher risk of all-cause mortality. (Ultimately, the same elevations in risk that came with obesity.)

Unsurprisingly, in people with normal BMI and a large waist circumference, the main causes of death were heart disease and obesity-related cancer.

And here’s something worth noting: Overweight women with trim waistlines benefited from lower mortality rates, by about five to seven percent—whereas overweight women with central obesity faced a 16 percent higher risk of death.

Quality vs. quantity

This isn’t the first time we’re hearing about the health risks of being an “apple” versus a “pear”—that is, a thinner waistline that tapers out into wider hips. But this latest research shines a light on some of the long-term dangers.

The real question here is why an apple shape might shorten a woman’s life. Although the answer seems obvious, when you think about it.

For one thing, there’s visceral fat—which accumulates in your midsection and surrounds your internal organs. It’s more inflammatory and metabolically active, making it a bigger risk factor for other chronic diseases than its subcutaneous counterpart… even among people who aren’t technically obese.

Then there’s the fact that gluteofemoral fat—the kind that accumulates on your hips, thighs, and backside—may actually be metabolically protective. (And at the very least, less harmful than belly fat.)

Whatever the case, this study makes it clear that body fat distribution matters to your health. Which means it’s important to know your waist size, no matter what you weigh.

In this case, researchers defined central obesity as a waist circumference over 34.6 inches. So needless to say, older women everywhere need to be paying more attention to that number, and less attention to numbers like BMI (which, at the end of the day, don’t really tell you what you need to know).

Whether or not you can ultimately change your body type is debatable. But you can eat right, exercise regularly, and increase your lean muscle mass. And yes, you can melt away belly fat specifically, with a few targeted changes.

In fact, I detailed a step-by-step strategy to do exactly that back in the October 2017 issue of my monthly newsletter, Logical Health Alternatives (“The deadly ‘hidden fat’ even thin people need to worry about”). So if you’re not yet a subscriber, consider signing up today.

Because when I tell you this information is life-saving, I mean it.


Shape Matters: Apples, Olives With Normal BMI Fare Worse Than Pears.” Medscape Medical News, 07/24/2019. (