Health warning: don't let the middle go over a metre (3 feet)

Health warning: don't let

the middle go over a metre (3 feet)

A tape measure could be more important than a set of bathroom scales in helping people protect their health, doctors say.
People with a waist size greater than 39.37 inches (one metre) have a sharply increased risk of heart disease, diabetes and other conditions linked with obesity, according to a study published today in the British Medical Journal.

The one metre cut-off point could become a more important health measure than the existing body mass index (BMI), which defines obesity as a BMI above 30 and is harder to calculate.

In separate research, treatment with the new obesity drug rimonabant helped people lose weight. Patients on a 20mg dose of the drug lost just less than two inches (5cm) from their waist size over a year and their cholesterol and insulin levels improved.

Excess weight around the stomach is more harmful than when deposited in other parts of the body, such as the legs and hips, and putting a simple limit of one metre on waist size could help people maintain a healthy lifestyle. The type of fat and where it accumulates is more important than the amount. Fat deposited under the skin, which wobbles and causes cellulite, is relatively unimportant.

Fat deposited deep inside the abdomen, which is seen in an expanding waist, secretes toxins into the bloodstream, raises cholesterol and increases the body's resistanceto insulin, essential for controlling blood sugar. A rise in insulin resistance means the pancreas has to produce more, which can damage other organs, such as the kidneys.

The problem is greatest in Britain among men. The typical British male has an apple shape, his stomach bulging over his trousers, aided by a diet of beer and chips. Women tend to the traditional pear shape as they age, with weight accumulating on hips and legs.

An apple shape is healthier than a pear shape, but women are increasing their waist sizes and turning from pears to apples, researchers say. The finding that the critical point for waist size is one metre applies equally to the sexes and is the best predictor of insulin resistance - the early warning sign of declining health affecting the heart, liver, kidneys and other vital organs.

No easy test for predicting insulin resistance exists but researchers from the Karolinska University Hospital in Stockholm, Sweden, have set out to devise one.
Guidelines suggest men with a waist size of more than40 inches and women with waists over 35 inches are at higher risk. But the Swedish researchers found a cut off of one metre for both sexes was a better predictor of insulin resistance.

They measured insulin resistance in 2,746 male and female volunteers aged from 18 to 72, with a variety of body shapes, and waist sizes from 26 to 59 inches. The results showed that almost half of those with a waist greater than one metre were insulin-resistant.

David Haslam, the chairman of the National Obesity Forum in the UK, said: "The fat around your middle is the most dangerous ... The good news is that even though it is the intra-abdominal fat that is dangerous, when you lose weight that goes quickest and the benefits are seen in lower blood pressure, blood sugar and cholesterol."

Time to worry?

* The biggest waists are in Scotland and the North-east. But levels of obesity in Scotland are the same as for the rest of the country at 21 per cent - more than 850,000 people.
* 30,000 people die from obesity each year and the death toll will top that from smoking, which kills 100,000 people, in 10 to 15 years.
* Adding extra weight starts early. Children's waist sizes have expanded by two clothing sizes over the past 20 years.
* Three million Britons will suffer from diabetes by 2010, double the number of four years ago.

By Jeremy Laurance, Health Editor,15 April 2005
http://news.independent.co.uk/uk/health_medical/story.jsp?story=629534

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