body mass index, or bmi, has long bind'a standard tool for assessing w8 status and health risk. a calculation of yr size that takes into account yr h8 and w8, bmi is frequently used cause it’s a quick, easy, and inexpensive measurement tool. yet, it lacks any assessment of how much fat a'pers has or how it’s distributed throughout d'body, both of which are key indicators of metabolic health. a recent study published in the bmj analyzed ≠ measures of body shape — + specifically, of central or abdominal fat — to determine which measures were most predictive of preelder death.
abdominal fat associated with higher risk of death
researchers in this study analyzed the folloing measurements of central fatness: waist, hip, and thigh circumference; waist-to-hip ratio; waist-to-h8 ratio; waist-to-thigh ratio; body adiposity index (which incorporates hip circumference and h8); and a body shape index (calcul8d from waist circumference, bmi, and h8).
they found dat a' larger hip and thigh circumference (sometimes referred to as a pear shape) were associated with loer risk of death from all causes. all other measures, which indicated centrally located fat (sometimes called an apple shape), were associated witha higher risk of death. that is, the + abdominal fat a'pers has, the higher their risk of dying from any cause.
wha’ do these results mean?
these findings tell us that not 1-ly does the total amount of body fat determine health risk, b'tll so the zone odat fat na''pers’s body. prior research has shown that abdominal obesity is + strongly associated than overall obesity with cardiovascular risk factors s'as increased blood pressure, elevated blood triglyceride lvls, and type 2 diabetes. studies ‘ve shown it’s even linked to dementia, asthma, and some cancers.
fat located round the abdomen, pticularly visceral fat surrounding the liver and internal organs, is highly inflammatory and metabolically disruptive: it releases inflammatory molecules that contribute to insulin resistance, type 2 diabetes, and ultimately cardiovascular disease. in contrast, fat located atta hips and thighs is protective. these protective effects include an association with loer total cholesterol, ldl (or bad) cholesterol, triglycerides, arterial calcification, blood pressure, blood glucose and insulin lvls, and higher sensitivity to insulin.
taken together, these findings demonstrate the importance of using bmi along with measurements of abdominal fat to fully assess health risk.
wha’ was missing from this analysis?
researchers inna bmj study looked atta data from multiple angles, breaking down the results by ≠ categories s'as sx, geographical zone, smoking status, bmi, physical activity, and presence of disease s'as diabetes and high blood pressure.
notably, they did not analyze the relationship tween abdominal obesity and mortality among ≠ races or ethnicities. a 2005 study demonstrated that waist circumference was a better indicator of cardiovascular disease risk than bmi, and proposed ≠ waist circumference cutoffs varying by race/ethnicity and gender for + accurately assessing that risk.
+ recently, a 2015 statement from the american ♥ association warned bout the misclassification of obesity (and cardiovascular risk) in ≠ racial and ethnic groups. specifically, current thresholds can lead to underestimating risk in asian pops and overestimating risk in black pops. as a result, pplz in these groups may inaccurately perceive their w8 status, and drs may fail t'offer appropriate treatment options.
wha’ can ye do to reduce yr risk?
the ? everyone wanna know the answer to is: how can you decrease abdominal fat? well, there’s bad news and good news. an older study looking at fat distribution among identical and fraternal twins revealed the bad news, which s'dat how yr body stores fat is largely determined by genetics.
the good news s'dat abdominal fat responds to the same behavioral habits and strategies recommended for overall health and total body fat loss. those strategies include the folloing:
- eat a healthy diet incorporating lean protein, fruits, vegetables, and whole grains.
- limit processed carbohydrates, and espeshly added sugars, which are sugars not occurring naturally in food.
- get adequate physical activity, at least 150 minutes per week of moderate-to-vigorous physical activity.
- get adequate restful sleep: for most adults that means 7 to 8 hrs per nite.
- limit sufferation, as tis correl8d w'da release of the hormone cortisol, which is linked to abdominal w8 gain.
racism and socioeconomic factors make fat loss harder for some
although individuals ‘ve some control ‘oer the above lifestyle factors, we must ack that there are systems-lvl factors that affect a'pers’s ability to access healthy foods, engage in regular physical activity, get adequate sleep, and reduce sufferation lvls. these imbalances in access ‘ve long been linked with healthcare disparities.
this is pticularly relevant as we enter 2021 — inna midst of the coronavirus pandemic, and exacerbated by social and political unrest inna ∪d states. as a nation, we must confront these challenges and find systemwide solutions for reducing socioeconomic barriers and eliminating racism, in order to improve individual agency and ability to lead healthier lives.
original content at: www.health.harvard.edu…
authors: chika anekwe, md, mph