When it comes to your health, body shape really does matter!No matter what your current weight or how well you take care of yourself, whether you're a teenager or postmenopausal, this book will change the way you relate to your body forever. That's the power of body shape -- and it's as easy as knowing the difference between apples and pears!If you tend to gain weight in your belly and back, you're an apple. If your thighs and derriere are where you bear extra baggage, you're a pear. But do you know that your fruit IQ is the single most powerful predictor of future health? Body type directly affects your likelihood for obesity, heart disease, osteoporosis, diabetes, stroke, varicose veins, and certain cancers. But, as medical pioneer and ABC's women's health expert Marie Savard, M.D., explains in this ground-breaking book, there are things you can do to prevent or even reverse the risks of body shape.The Body Shape Solution to Weight Loss and Wellnesscan help you: understand what body shape means, and how it relates to your health learn how to distinguish between subcutaneous and visceral fat -- butt or gut! -- and discover why all fat is not created equal discover theElitefoods that help protect against disease and improve your odds of shedding fat acquire the tools you need to make conscious, informed, healthy choices about food throw away your scale and get out of the cycle of diet failure -- for good!Work with your body -- not against it -- to achieve maximum health and look your best!

Marie Savard, M.D., is a nationally known internist, women's health expert, and advocate for patients' rights. She is the author of the highly acclaimed How to Save Your Own Life and the creator of The Savard Health Record. She lives in Philadelphia.

Carol Svec is a seasoned health writer and the author of three books. She lives in North Carolina.

Introduction

xv

The Body Shape Solution Promise

xxiii

PART ONE: About Body Shape

Apples and Pears

3

(16)

Weight and Body Shape

19

(16)

Shape-Shifting with Life Transitions

35

(14)

PART TWO: Medical Issues

The Hormone Question: From Childbearing Years through Menopause

49

(30)

The Metabolic Syndrome and Type 2 Diabetes

79

(20)

Heart Disease, Stroke, and Inflammation

99

(20)

Breast and Endometrial Cancer

119

(14)

Osteoporosis and Varicose Veins

133

(20)

Stress, Anger, and Depression

153

(26)

PART THREE: Solutions

Eating Well

179

(32)

Apple Shape Diet

211

(42)

Pear Shape Diet

253

(34)

Apples and Pears Exercise Program

287

(34)

The Power of Body Shape

321

(7)

Body Shape Health Log

328

(3)

Selected References

331

(34)

Index

365

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

Introduction

Show me a woman -- any woman -- and I can forecast her health destiny just by observing her body shape. I know who will probably die of heart disease or breast cancer, who will have a rough transition through menopause, who will likely end up with a broken hip, and who may not live long enough to celebrate her 70th birthday. I am rarely wrong. From my 30 years of clinical experience and a review of decades of research, I've discovered thatthe single most powerful predictor of a woman's future health is the shape of her body.

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, like the fruit, 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, like the fruit, they are widest at the bottom. These terms have been around for decades, but they have mainly been used as physical descriptions, much the way we might say that a woman is blonde or brunette. Only now are we realizing the powerful physiologic effects of being either an "apple" or a "pear."

Body shape is not something we get to choose; we have very little control over our basic underlying proportions. Contrary to popular belief, people don't develop a pear shape simply because they sit on their butts most of the time. The human body is not a loose bag of sand where the weight goes to our lowest point. If that were true, our feet would be the size of watermelons. These two shape categories are fundamental, genetically influenced patterns that affect much more than how we look in a bikini. Body shape is related to differences in our physical chemistry, hormone production and sensitivity, metabolism, and possibly even personality. Have you tried the latest fad diet but found you still couldn't lose weight while everyone else managed to drop two pant sizes? Chances are that particular diet wasn't right for your body shape. Ever wonder why some women suffer through intolerable hot flashes during menopause while others sail right through? Or why hormone therapy makes some women feel healthy and happy, while making other women feel bloated and irritable? Again, blame it on body shape. Our shape affects our likelihood of developing heart disease, osteoporosis, the metabolic syndrome, diabetes, stroke, varicose veins, breast cancer, and endometrial cancer. Body shape also gives clues to which adolescent girls are more likely to develop eating disorders, which types of exercise are best, and which emotions can physically change our shape. It even tells us our chances for living to be old enough to have to worry about nursing home care.

Physicians and researchers have been talking about the importance of body shape for years, but this health message has not been fully explained to the people who can use it most -- women in general. The scientific information inApples & Pearshas never before been analyzed and collected in a single consumer publication, so what you are reading now is the cutting edge of women's health information. In the coming chapters, you will learn how and why different body shapes benefit from customized diets, exercise regimens, medications, menopause therapies, psychosocial interventions, and lifestyle changes. Women who follow the action items for better health will be able to transcend their biology to lose weight, increase energy, and decrease their risks for type 2 diabetes, heart disease, breast cancer, and osteoporosis. In short, I'm going to tell you everything I know about how you can look great and feel wonderful, regardless of your current weight or body shape.

Putting all the pieces of the body shape puzzle together was one of those "Aha!" moments for me. It began decades ago when I watched my mother dutifully complete lengthy surveys that were sent to her every few years. She would have to detail her every health move, including what she ate, how much exercise she did, what she weighed, which medical conditions she had, and which medications she was taking. My father remembers searching the house for a flexible tape measure to help my mother record her waist size. (This turned out to be a tough task -- my dad was an engineer and carpenter and only had metal or wooden rulers.) What could they possibly want with that information, he asked himself. Now we know. You see, my mother is part of the now famous Nurses' Health Study, which has been recording the lifestyle choices and medical conditions of more than 120,000 women nurses since 1976. Much of what we know and teach about women's health today comes from this ongoing study, and from subsequent studies of younger nurses and their daughters.

A summary of the learnings from that study was published in 2001 in a wonderful book titledHealthy Women, Healthy Lives,which my mother gave to me as a gift. (She knew that I would be proud of her contribution to this landmark study, especially because I had been a nurse before becoming a physician and had a special interest in women's health.) As I paged through the book, I noticed that the concept of body shape was an ever-present, although not central, observation with regard to disease risk. What kept jumping off the page for me were all the references to apple-shaped women -- and their higher risks of developing heart disease, type 2 diabetes, stroke, and breast cancer.

Aha! I already understood to some degree the importance of body shape in predicting the risk of heart disease. I knew, for example, that men and women who carry most of their body fat around their middles have a much higher risk of having a heart attack than pear-shaped people. But I didn't understand the profound impact that shape could have on risk for a host of conditions -- including cancer, osteoporosis (the bone-thinning disease of old age), varicose veins, and even eating disorders -- until I started looking at the medical literature. Then I found evidence everywhere. It was overwhelming. When it comes to overall health, body shape really does matter!

MY FAMILY'S MIXED BASKET

Of course, I really only needed to look within my own family to see what I had missed all along. I am one of eight children (I have three brothers and four sisters). Most of us girls have subtle variations of the pear shape -- we always tended to have "small tops and big bottoms." For as long as I can remember, whenever I shopped for new clothes, I always tried on the pants portion of a suit first because my bottom was the hardest part to fit. To this day I prefer to wear pants to cover my larger-than-I-like legs, instead of the short skirts that many apple-shaped women (with their typically beautiful legs) can wear.

Three of my four sisters had similar concerns. My fourth sister, Millie, had a much different experience, and a more serious problem. Unlike my other sisters, Millie has an apple-shaped body. True to her type, she has great legs, which always made the rest of us a little envious. But over the years, she has gained weight primarily around her middle. Although she must have had an apple shape her whole life, I didn't really notice until later in life when her midsection became more rounded and she lost whatever waist she had in her youth. Millie now has a number of serious medical conditions, including type 2 diabetes, high blood pressure, abnormally high blood fats in a worrisome pattern, and osteoarthritis of her knees. Her diabetes has led to other complications, including nerve damage (neuropathy) in her feet, causing constant burning and pain. For years Millie had been told about her borderline blood sugar levels, but she was never told how something as innocent-sounding as "blood sugar" could devastate her body. Nor was she ever told that it was within her power to avoid serious disease. In fact, Millie recently requested her old medical records from a previous physician and discovered that she had had borderline blood glucose readings for many, many years, but her doctor never told her. After years of ignorance, she was ultimately diagnosed and treated for diabetes.

Today, Millie manages her blood sugar, blood pressure, and blood fats with a combination of medications and major lifestyle changes. Even the pain of her neuropathy is better now that she is controlling her diabetes. But if only she could turn back the clock, she could have avoided many of the health problems that plague her now. Millie was born to be apple-shaped. Throughout her adolescence, into adulthood, and past menopause, her body followed a pattern that made her more likely to develop particular diseases. If we knew then what we know now, she could have prevented much of the damage that has already been done. That's what this book is all about -- recognizing the risk, then taking action to stop the process of disease and decline.

My mother has a different story. My mother had the classic pear shape, or hourglass shape, that was once revered. After she passed through menopause, however, her body began to change. My mother was too busy raising and worrying about her eight children to take the time to care for herself. She rarely went to the doctor, never monitored her health, and slowly gained weight. Like many pear-shaped women who were used to finding inches added to their hips and thighs, my mother didn't notice the redistribution of fat and creeping weight gain around her waist. Eventually, my mother's shape shifted from pear to apple. At age 65, my mother suffered a massive heart attack. Suddenly her health was in the spotlight for the first time in decades. She learned that the physical changes that occurred with menopause and aging led to a big increase in her blood pressure and blood cholesterol, and she had become a walking time bomb for heart attack.

My sister Millie and my mother represent two ends of the spectrum of apple-shaped women. You can be born with a genetic predisposition to be apple-shaped, as Millie was (my father's side has a history of diabetes and I suspect they were apple-shaped); or you can gradually become apple-shaped after menopause, as my mother did.

My passion to write this book comes from these 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 thelanguage of body shapeto 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. And there are things we can do to prevent or even reverse the disease process set in motion by "appleness."

Pear-shaped women have their own set of problems. 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. There's the joke that may or may not have originated onLate Night with Conan O'Brien,but which has circulated on the internet: When Jennifer Lopez got a massage, Sean Puffy Combs came in with her and told the massage therapist not to touch her rear end. The massage therapist said he wouldn't have been able to massage Jennifer Lopez's rear end anyway because she only booked a half day. Frances O'Toole of the British online newspaper,The Observer,contributed her own take on J-Lo's figure: "This isn't a catwalk bottom -- it may be firm, but it's covered in fat." These are the messages that contribute to women being unable to accept themselves. Pear-shaped women who internalize the rail-thin ideal of fashion models end up struggling with body image problems throughout their lives. It's no wonder that they 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. After menopause, pear-shaped women are more likely than apple-shaped women to develop osteoporosis. And like my mother, pear-shaped women can become apple-shaped, increasing their risk for disease while adding inches to their waists. For these women, this book outlines how to sidestep the physical and emotional pitfalls of being a pear, and what can be done to avoid turning into an apple.

The overall purpose of this book is to change the way women and their physicians perceive their bodies and understand their disease risk. I have made it my life's mission to empower every woman to take charge of her health. When the woman is my patient, I can sit her down, explain the importance of body shape in the context of her family history, current medical conditions, and lifestyle and warn her of her specific disease risks. Then, with medical recommendations customized by body shape, I can tell her exactly what she needs to do in order tolive longer, lose weight, and feel healthier.For the millions of other women in the world, the ones I can't treat personally, I am putting that same power in their hands withApples & Pears.

This book is divided into three parts. Part 1 discusses body shape in general -- the differences between body shapes, how to determine your shape, the different kinds of fat and its distribution patterns, and how different life stages can affect weight and shape. These chapters provide the framework for understanding and interpreting the information in the rest of the book.

Part 2 provides in-depth information about medical issues, including the body shape connection to the metabolic syndrome, type 2 diabetes, inflammation, heart disease, cancer, osteoporosis, varicose veins, stress, and depression. The chapter on hormones provides answers about birth control pills and hormone therapy -- who might benefit, and who should avoid them entirely.

Part 3 provides customized diet recommendations for apple-shaped women and pear-shaped women, as well as the most effective ways to lose weight and the most promising exercises. Plus, I provide a Body Shape Health Log blank for you to copy and use to track your health and weight loss progress.

By the end of this book, you will understand the health risks faced by women with your body shape. You'll be able to identify your particular weak points, and you'll know how to make them stronger. You'll be able to talk with your doctor about how to incorporate body shape into your wellness plan, and you'll be more confident in the health decisions you make. In addition, you will have a whole new way to think about your body -- not as an enemy to be punished and hated, but as a dynamic reflection of your genetic and personal history. I've been told by women time and again that once they understood the concepts in this book, they were finally able to feel happy in their own skin. That's how powerful the concept of body shape is; it can affect both our health and our happiness. The mission of this book is to help you learn to harness that power for yourself.

Excerpted from The Body Shape Solution to Weight Loss and Wellness: The Apples and Pears Approach to Losing Weight, Living Longer, and Feeling Healthier by Marie Savard
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.