There are many nicknames for female fat. We downplay it by using cute or nonoffensive labels such as saddlebags, chunky body, looking healthy, or dimples in the hips and thighs. Or we try to tame it, cover it up, or hold it in using a whole range of garments from girdles to control-top panty hose to baggy clothing. Entire cosmetic industries have arisen to help women get rid of unsightly cellulite and stretch marks, while attractive women's fashions in large sizes are making their mark in stores and in fashion magazines designed for those with a "generous" figure. Most women wage a lifetime battle with fat, as can be seen by the hundreds of diet books for women that fill bookstore shelves. In fact, at any given time, three out of four women are either trying to lose weight or keep it off.
While I would agree with the self-help authors who tell female readers that the key to self-esteem is to love your body, I believe that a woman should find a balance between accepting her body just as it is and paying serious attention to the significant health risks of being overfat. There is nothing life-affirming about having type 2 diabetes, painful and over-stressed joints, and an increased risk of heart disease after menopause. As we have seen, being overfat also increases the risk of certain types of cancers. For example, a recent report published by the National Cancer Institute showed that women with a Body Mass Index (BMI) of 30 or greater were twice as likely to develop cervical cancer. Women with the lowest waist-to-hip ratio, indicating a significant accumulation of abdominal fat, were eight times more likely to develop this disease than women with a normal waist-to-hip ratio.
To better understand how a woman's body fat can become a risk for her, let's take a look at the physiological and hormonal processes involved in female fat storage.
Even though most women equate being overfat with how many pounds they weigh, the scale does not tell the whole story. While scale weight is certainly an important factor and will give you some information about your general health, it is even more important for you to determine your body composition—that is, how many pounds of fat you carry in relationship to how many pounds of lean muscle. The following table categorizes body fat percentages for women:
If you compare these figures with the body fat percentages of men, you will see that healthy women tend to carry approximately 10 percent more body fat. This is nature's way of giving women a small and much-needed fuel surplus for pregnancy, breast-feeding, and child rearing.
Most women believe that it is inevitable that their body fat-to-lean muscle ratio will rise as they age and experience the hormonal changes associated with menopause. In fact, the tables you see in some health books, on the Internet, or in your doctor's office will reflect this belief, allowing for a higher "healthy" percentage of body fat in older people. But women do not have to settle for a higher fat percentage as they reach midlife and their later years. The amount of body fat is directly related to diet, exercise, lifestyle, and hormonal balance.
While it's unlikely that a seventy-year-old woman is going to have 14 percent body fat, she shouldn't be content to settle for an unhealthy amount of fat. It is never too late to improve your body composition through a good nutritional and exercise program. And, I might add, it's never too early. In recent years in my Fat-Burning Metabolic Fitness Plan, I have been seeing women in their twenties and thirties with a high percentage of body fat. One thirty-eight-year-old female client who is 5 feet 8 inches and weighed 158 pounds didn't really consider herself to have a weight problem until we tested her and she saw that her body fat was 34.5 percent, which made her technically obese.
In contrast, since I work with many world-class female athletes, I often see clients whose larger, more muscular bodies cause them to weigh more than the average woman of their height and frame size. In their case, however, they have a very low percentage of body fat and a higher-than-average percentage of lean muscle. A good example would be a female body builder or a competitor in any type of sport where strength is required.
Chapter 4 has a simple at-home test to measure your body fat-to-lean muscle ratio.
By now it should be clear that the most important issue is not just how fat you are but if your level of body fat is within the healthy range. Where do you carry your fat and when does fat become a problem?
The classic female body type is the gynoid shape—that is, fat storage below the waist in the hip and buttocks areas, causing a pear-shaped silhouette. Since weight below the waist presents less of a health risk than abdominal fat, an overweight woman actually has a lower risk than an overweight man for certain illnesses such as heart disease. An article in the British Medical Journal states, "Recent studies have also shown that a preferential accumulation of body fat in the glutofemoral region [hips and thighs], commonly found in premenopausal women and initially described by Vague [a French physician] under the term 'gynoid obesity' is not a major threat to cardiovascular health."
All bets are off, however, when a woman begins to develop what I have described as a reverse fat pattern—that is, fat in the abdominal region. Although many people think of cardiovascular disease as a man's disease, it kills more than half a million women per year. It just affects women ten to fifteen years later than the average high-risk male. A woman's risk for heart attack gradually increases following menopause precisely because that is the time when she is most likely to be storing excess fat in the abdominal region. One of the reasons is that her body is producing less of the hormone estrogen, which has a positive effect on fat mobilization.
Even though women have their first heart attacks later than men, they are more likely to die from them. Within one year of having an attack, 25 percent of men die, but 38 percent of women die. According to a recent article in Health Day News, women are also more likely than men to be physically disabled by a stroke and/or to have speech difficulties, visual impairment, and difficulty chewing and swallowing. On average, women's hospital stays were longer by three days. These are all good motivations to lose that excess abdominal fat.
Women are also less likely to experience the traditional chest pains that warn of heart problems in men. Instead they will complain of abdominal discomfort, nausea, vomiting, fatigue, and shortness of breath. The American Heart Association warns that even though heart attacks are more likely to kill women after they turn sixty-five because they have lost much of the protective value of estrogen and other hormones, coronary events kill 20,000 younger women each year because they do not recognize the gender-specific symptoms of heart problems. Of course, the more obese a younger woman is and the more weight she carries in her abdominal area, the more at risk she will be.
A woman with a reverse fat pattern, whatever her age might be, is also at greater risk for developing type 2 diabetes; certain types of cancer; problems with weight-supporting joints in her hips, knees, and ankles; and foot problems because of the greater constrictive design of women's footwear.
In my Fat-Burning Metabolic Fitness Plan, I work with many women who have a reverse fat pattern caused by being overfat. Many of them suffer from significant hormonal imbalances. The primary hormones affected are estrogen, testosterone, progesterone, and human growth hormone (HGH). A significant number of these morbidly obese women also experience the symptoms of hypothyroidism.
In rare cases the appearance of the reverse fat pattern in women can be caused by Cushing's syndrome. Dr. Richard Milani, the vice chairperson of the Department of Cardiology at the Ochsner Heart and Vascular Institute, New Orleans, Louisiana, says that Cushing's syndrome is a relatively rare hormonal disorder caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal gland. It usually results in abdominal obesity with sparing (thin or slender) of the arms and legs. There is often rounding of the face and thickening of the fat pads around the neck. Additionally, there are pronounced pink-purple stretch marks as well as thin and fragile skin. Women usually have excess hair growth on their face, chest, abdomen, and thighs. Irritability, anxiety, and depression are common. There are various causes of excess cortisol production including tumors that secrete or stimulate cortisol production. Cushing's syndrome can also be caused by prolonged use of high doses of pred-nisone. This condition can be evaluated by blood tests, and treatment is based on the cause in a given individual.
Further Dangers of Abdominal Fat: Metabolic Syndrome X
Overfat women often exhibit one or more of a whole cluster of symptoms that doctors call Metabolic Syndrome X. These include a waist circumference of 35 inches or more, triglycerides greater than 150 mg/dl, HDL (good cholesterol) less than 50 mg/dl, a fasting glucose greater than 110 mg/dl, and blood pressure greater than 135/85 mm/Hg. Anyone who has three or more of these symptoms is diagnosed with metabolic syndrome X. In chapter 4, I include a questionnaire to help you determine whether you have this syndrome. It is important because this combination of symptoms can be a strong indicator that you are at risk within the next ten years for a major cardiovascular event such as heart disease.
Since women naturally store excess fat in the hips and thighs, traditionally one of the best indicators of whether you are overfat is your waist-to-hip ratio. In chapter 4, I show you how to accurately measure your waist-to-hip ratio. I have found, however, that when a woman begins to exhibit a reverse fat pattern with abdominal fat, this measurement can often become inaccurate.
In a recent article published in the British Medical Journal, Dr. JeanPierre Despres of the Quebec Heart Institute pointed out the weakness of the waist-to hip ratio as a reliable indicator of risk for disease in women who have adopted a male fat pattern. Such individuals tend to keep gaining fat equally in the waist and the hips while their ratio remains within the "safe" range. His conclusions were based on a twenty-year study that found that once a woman begins gaining weight above the waist, her waist-
to-hip ratio is no longer an accurate determination of how much body fat she is carrying: "Simultaneous increase in waist and hip measurements means ratio is stable over time despite considerable accumulation of visceral adipose tissue Thus, waist circumference provides crude index of absolute amount of abdominal adipose tissue whereas waist:hip ratio provides index of relative accumulation of abdominal fat."
For this reason, even though the waist circumference has been considered the gold standard for predicting obesity in men and the waist-to-hip ratio the gold standard for women, the waist circumference is a vitally important evaluation tool for both genders. A waist circumference of 35 inches or more spells trouble for women.
The British Medical Journal article also points out that when a woman experiences the reverse fat pattern, especially before menopause, it can indicate that she is a candidate for hypertriglyceridemia, which indicates an increase in the level of triglycerides in the blood, again increasing her risk for cardiovascular disease.
A cell receptor can be thought of as the parking space in which a hormone sits and does its work of turning cell function off and on. The two main types of cell receptors where epinephrine, a fat-mobilizing hormone, can "park" and act on the cell are called alpha receptors, which inhibit the breakdown of triglycerides (a.k.a. the storing of fat), and beta receptors, which stimulate the burning of fat.
Research has shown that both men and women have more beta receptors in the abdominal area, meaning that fat is easier to lose in that part of the body. But women have more alpha receptors in the hip and thigh areas than men, which explains why they tend to store more fat in those areas and why it is harder for them to lose fat.
Another factor contributing to gender differences in fat storage may be the concentration of lipoprotein lipase (LPL) in various tissues. LPL, which also regulates the mobilization of free fatty acids, is located in the walls of blood vessels throughout the body. Women have a greater concentration of LPL in the hips and thighs and a smaller concentration in the abdominal area than men.
The female hormone estrogen may have a positive effect on fat mobilization because it inhibits the fat-storing action of LPL, enhances the production of the fat-mobilizing hormone epinephrine, and stimulates the production of human growth hormone (HGH), which inhibits the storage of excess glucose by the body's tissues and increases the mobilization of free fatty acids from adipose tissue.
Kim Cummins: Watching the Inches Melt Off
I was scheduled to do three makeovers for an article in Let's Live magazine and was looking for people willing to undergo my twelve-week Fat-Burning Metabolic Fitness Plan. One day at lunch while I was watching my executive assistant, Kim Cummins, having a margarita, fried soft-shell crabs, and ice cream, I was suddenly hit with the inspiration that she would be the perfect candidate. When Kim had come to work for me five years earlier, she weighed 140 pounds, but since then she had gained 36 pounds, mostly because of lifestyle choices such as eating a lot of fried foods and fast foods. The joke when we went out for a meal together with clients or athletes was always "Don't eat the way Kim does; eat the way Mackie does," and "See, Kim's eating the disaster meal, but I want you to eat the Mackie Meal."
Kim would always laugh at me because she was young (she had just turned thirty) and felt that she could get away with anything without it adversely affecting her health. Kim ate whatever she pleased and never exercised. I remember a couple of years ago when we both had our resting metabolism tested. Kim teased me because hers was greater than mine: "See, my metabolism is a better fat burner than yours." I said, "But Kim, my body fat is 6 percent. You can joke around now, but someday in the future your lifestyle is going to come back to haunt you."
Sure enough, when my doctor gave her a health evaluation at the start of my Fat-Burning Metabolic Fitness Plan, she had some unpleasant surprises. Her body fat was 35.1 percent, her LDL (bad cholesterol) was high at 154.2 (ideally it should be between 100 and 129), and her waistline was 36 inches (remember, anything above 35 represents significant health risks). Kim knew that abdominal fat was a big strike against her. Most alarming was her C-reactive protein, which was 6.56 (the normal range is between 0 and 0.3). C-reactive protein at this level is an indicator of inflammation, which points toward a greater risk of heart attack. "My blood work was my wake-up call," she told me. "I was only thinking of doing the program before this. I thought it would be fun to work with a trainer and look good in my swimsuit when I went to Miami for my vacation. But the results of the blood work really decided me."
Kim never ate breakfast but ate a large lunch and dinner. It was a bit of a challenge for my nutritionist to get her on the Fat-Burning Metabolic Fit ness Nutritional Plan with enough fiber because she did not like vegetables and hated breakfast foods. Kim said, "If you can make spinach taste like ice cream, I'll eat it. Otherwise, forget it." I told her that if she would learn to eat fiber-rich vegetables, she would see a rapid decrease in her body fat. She even agreed to go to a hypnotist to see if she could overcome her aversion to vegetables, but to no avail.
In spite of this obstacle, we managed to find a food plan with which Kim felt comfortable, and she began eating three large meals and two snacks a day. At first it was a challenge for her to eat all that food, but she was so determined to follow the plan that she actually set an alarm clock to remind her to stop work and grab a snack. She knew it was important for her to eat at least every four hours to boost and stabilize her metabolism.
Within a very short time, Kim noticed a dramatic change in her energy. She told me, "My energy increased unbelievably. Food had never been an obsession with me. My problem was that I didn't eat often enough. Come afternoon, I'd be so tired that one time I actually fell asleep at the wheel of my car at a red light. It was only for a second, but it totally freaked me out. I knew if I'd taken my foot off my brake I would have hit the person in front of me." But now she never feels that afternoon slump. Her sleep has also become more restful. Even though she'd always been a heavy sleeper who had trouble getting out of bed in the morning, Kim told me that she was waking up filled with energy before her alarm clock went off.
We took photos at the beginning of the Fat-Burning Metabolic Fitness Plan, then at one-month intervals. A second turning point came for Kim when she compared her before picture with her after picture at one month. Kim told me that she really wasn't expecting much after only thirty days. She'd noticed that her muscles were getting harder, especially her legs, which had never been muscular before, and that she was losing inches, but she'd only lost 5 pounds of scale weight. I told her not to worry because I could see that she was losing fat and gaining lean muscle.
When Kim actually compared the two pictures, she burst into tears. "I didn't realize how fat my face had become. You always lose weight in the last place you put it on. My face had gone from being round and fat to real slender and skinny. I just couldn't believe how big it had been and how much of a difference there was now. I was only expecting small changes in the second photo. When I saw the results, I realized that I had been expecting that much change at the end of three months. It was a dramatic difference after only one month. I was in shock."
At the end of three months, Kim was feeling great. Her statistics demonstrate the changes her body went through:
Measure Waistline Hip BMI
32.75 in. (a loss of 3.25 in.) 41 in. (a loss of 2 in.) 24.11 (a drop of 1.35 points
C-reactive protein Total cholesterol LDL HDL
6.56 223 154.2 50
into the lower-risk range) 3.73 (a drop of 2.83 points) 209 (a drop of 14 points) 130 (a drop of 24.2 points) 50 (still within the healthiest
range for women) 11 (a loss of 9 points)
Although she had only lost 10 pounds of scale weight at that point, she had lost much more than that in actual pounds of body fat. I often see this in clients—a kind of conversion process where the fat melts off and they lose inches all over their body as they replace it with lean muscle. When we measured Kim's fat-to-lean muscle ratio, she had 22 pounds of fat and 144 pounds of lean muscle, which made her very happy. She told me that she looked so slimmed down that everyone thought she'd lost about 50 pounds.
Kim is indicative of many young women who fall into the trap of eating poorly, who give up exercise in favor of working long hours at a career they enjoy, and who start experiencing a metabolic slowdown with its accompanying gradual accumulation of body fat at an early age. These lifestyle choices are a one-way ticket to disaster.
To this day, Kim continues to follow the Fat-Burning Metabolic Fitness Plan because it has made such a difference in her life. She feels better than she's felt in years and looks great. Most important, she's stopped a trend in body fat gain that would have greatly lessened the quality of her life as she reached middle age and quite probably might have resulted in serious illness later on and a much shorter life span.
Fat in men has been christened with a variety of names. We call it the beer belly, the spare tire, or simply the gut. We joke about it, calling it Dunlap's disease ("His stomach done lapped over his belt") or give it a playful label such as love handles. But there is nothing humorous about abdominal fat. It is a dangerous health risk that can lead to complications such as cardiovascular disease, some types of cancer, hypertension, type 2 diabetes, and erectile dysfunction.
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