Marie Savard Celebrity Guru

Dr. Marie Savard is an internationally known internal medicine physician, expert on wellness and champion for patient rights. She is the author of three books: The Body Shape Solution to Weight Loss and Wellness: The Apples & Pears Approach to Losing Weight, Living Longer, and Feeling Healthier, How to Save Your Own Life: The Savard System of Managing – and Controlling – Your Own Health Care and The Savard Health Record. Dr. Savard has been a health columnist for Woman’s Day magazine, technical advisor to the World Health Organization’s Fourth World Conference on Women in Beijing, senior medical consultant to the Lifetime TV series Strong Medicine, consultant to the media on health, wellness and patient empowerment issues, and a practicing physician in Philadelphia. You can learn more about Dr. Savard at: www.DrSavard.com and www.applesandpears.org

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What Does Your Body Shape Mean?

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 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 they are widest at the bottom.

The classic apple-shaped woman has slender and shapely legs, narrow hips, large breasts, and a relatively large waist. 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. A pear-shaped woman tends to put on weight around her bottom—hips, thighs, and buttocks.

How Do You Determine Your Shape?

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. 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.

Body shape matters to men too. A man whose WHR is over 0.9 is considered apple-shaped and therefore has greater health concerns.

What Factors Determine Body Shape?

Body shape is not something we get to choose; we have very little control over our basic underlying proportions. Body shape is in large part genetic and is related to differences in our physical chemistry, hormone production and sensitivity, metabolism, and possibly even personality and mood.

What Motivated You to Write This Book?

My passion to write this book comes from my 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.

What are the Different Kinds of Fats?

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 stuff we 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 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.

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. Try to think of fat as a gland, as active and important as any other gland in the body.

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. Although visceral fat and subcutaneous fat are in the same general category, they are totally different.

What Diseases are Associated With the Apple-shape?

Apple-shaped women have more visceral fat, which 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. 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 such as breast and endometrial cancer. The more abdominal fat, the greater the waist circumference, and the higher the WHR, the more dangerous the situation becomes.

What Diseases are Associated With the Pear-shape?

Fat in the pear zone is subcutaneous fat which traps and stores dietary fat (trapped fatty acids are then stored as triglycerides). 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. Young pear-shaped women who internalize the rail-thin ideal of fashion models end up struggling with body image problems and 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. Many of the health problems caused by obesity is because excess visceral fat is the problem, not pear-zone fat.

After menopause, pear-shaped women of all sizes lose their estrogen advantage, and can therefore start to experience many of the same health problems as apple-shaped women—especially increased risks of heart disease and diabetes.

Pear-shaped women are also more susceptible to osteoporosis, cellulite and varicose veins.

Do Different Ethnic Groups Have Different Body Shapes?

Different ethnic groups have different body shapes and different health risks that require different waist circumference guidelines. For all ethnic and racial groups, the higher the waist circumference, the higher the disease risks. What we know so far is:

Chinese and Asian Indian women develop metabolic problems and heart disease at lower waist circumferences than do Caucasian women, so the guidelines for their optimal waist size are smaller. How much smaller is not yet known, but a cut-off of 32 inches has been suggested, with a possible optimal measurement of 28 inches.

Hispanic and Mexican women experience greater risk of diabetes and hypertension at lower waist circumferences than Caucasian women, and therefore need a lower cut-off. More research needs to be done before appropriate guidelines can be offered.

African-American women have about twice the rate of obesity compared with Caucasian women and studies have shown that African-American women tend to have less visceral fat and more subcutaneous fat compared with Caucasian women at the same total body weight. It has been suggested that African-American women might have a greater sensitivity to the effects of visceral fat compared with Caucasian women, so that even lesser amounts of visceral fat equate to worse risk outcomes for African-American women. Still, it is clear that visceral fat is harmful to the health of African-American women, and they should be encouraged to reduce waist size.

What Are the Hormone Differences Detween Apple-shaped and Pear-shaped women?

Pear-shaped women have a body chemistry that is dominated by estrogen. 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 but there is a predominance of androgen. 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.

What Happens to our Body Shape as we Age?

All children start out apple-shaped, and boys stay apple-shaped. But once the hormones of adolescence hit, girls can either remain apple-shaped or become pear-shaped. Studies have shown that women who have never been pregnant have lower waist-to-hip ratios (making them more pear-shaped) than women who have had one or more children. And when researchers looked at individual women, taking their measurements before and after pregnancy, they found that weight gained or retained after pregnancy seems to be mainly visceral fat. Menopause seems to want to make "apples" of us all, mainly because of our plunging estrogen levels.