science of waist:hip ratio, "apple" shape, TOFI?

This topic contains 15 replies, has 4 voices, and was last updated by franfit 10 years, 5 months ago.

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franfit

1:39 pm
24 Apr 14
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I’m sorry I’ve been away from the forum for a while and neglected some topics; a family crisis kept me away, but I’m glad to be back.

I’m wondering how concerned I need to be about having a large waistline in comparison to the rest of me if I’m fairly thin. My waist has always been large compared to my bust (one size larger) and especially my hips (three sizes larger) in terms of standard clothing sizes, even when I was a thin teenager sewing my own clothes. At this point I’ve lost 38 pounds, my BMI is 20.4, and my waist:hip ratio has dropped from 0.92 to 0.86. So even if I lose 14 more pounds and get back to my baseline weight at a BMI of 18.0, I don’t think my waist:hip ratio will get below 0.8, which is supposedly what you want for diabetes prevention, which is something I’m concerned about because of family history. And since my hips are small compared to the rest of me and American clothing sizes have gotten so much larger than they used to be, I will have to either find size 0 jeans in expensive clothing stores (ouch!) or buy my jeans in the children’s department (the colors in the girls department are hideous; the cut of the boys’ jeans is not very flattering; I’ve checked, I can already fit into the largest children’s sizes). Since I wear jeans 7 days a week and they’re most practical for my work, this is a problem. (Sewing one’s own jeans is *not* practical.) Continuing to lose weight past my baseline, below a BMI of 18.0, seems questionable at best for health purposes. Losing even 3 more pounds at that point would put my BMI at 17.5 and still probably not solve the large waist problem.

Can you still be TOFI at a BMI of 18.0 or 17.5? Is the waist:hip ratio thing somewhat arbitrary? What about a bust:waist ratio? Why hips? Does it not apply at a lower BMI?

My ability to get really fit is limited by CFS/ME, but I am finally at the point where I’m averaging almost 10,000 steps per day of walking. The fat in the middle seems to be more on the inside, although there’s still a bit of excess subcutaneous fat left to lose both there and elsewhere.

Is the waist:hip ratio thing all about the kind of visceral fat that drives metabolic syndrome, insulin resistance, and diabetes? Would it make more sense to get my insulin level checked than to focus on the waist:hip ratio? Is a fasting insulin good enough, or do I need a glucose tolerance test to see if my Islets of Langerhans over-respond to glucose, causing intermittently high insulin levels? If it’s still a problem, can doing 6:1 or a couple of 16-hour fasts a week take care of it?

If anyone knows scientific articles I can access about this, it would be extremely helpful.

nickynackynoo

11:09 pm
24 Apr 14
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I don’t know the medical answer to this, but if you think of it logically, with small hips, the desired ratio is never going to be as easy to hit. It’s a question of maths, and small hips skew the suitability of the equation in your case. These numbers and equations are only meant as a guide, and they need to be applied with a bit reflection. As I would say your bmi is very low, I would not imagine the problem to be viceral fat. With small hips, I would think that your organs are positioned a little higher than average. In a bigger hipped person, the organs would settle lower into the pelvic cavity, and possibly higher into the rib cage too? Organs being pushed into the middle, your waist would be proportionally wider. Does that make sense?

franfit

12:24 pm
26 Apr 14
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Nickynackynoo, thanks for your reply.

I guess my question really boils down to this:

How can you tell when enough of the problem-causing visceral fat is gone?

Just having your BMI in a normal range wouldn’t work for apple-shaped folks.

So, when your waist is less than half your height (a guideline proposed for both men and women)? When your waist:hip ratio is <1.0 for men, <0.8 for women? Or do you need to get your blood work done and see if all of it is normal? If you need blood work, what specific blood work do you need?

Maybe I should put this in a new thread.

nickynackynoo

10:32 pm
27 Apr 14
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Hi franfit,
I am no expert, but at the levels you are talking about, you must have very little body fat. I would guess that if you have a secret supply of dangerous viceral fat, you would be most unlucky!
I can’t remember where I saw this, but I found somewhere an article relating to body shape and fat. It detailed the different shapes, explaining that your shape indicates the positioning of dangerous fat. This is based on one body of research, and there are others that disprove it, but I input the required information, and the result came up that I am a pear, with a waist size (Height 5ft 8in, waist 34inches) that does not put me in an unhealthy zone. I would disagree with that…my bmi is still well in the overweight range and I’m still bigger than I should be, but if one equation marks *me* within a healthy range, then I don’t think you are likely to get a simple answer to your question! No one has done research on which everyone is in agreement.

franfit

1:34 pm
29 Apr 14
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nickynackynoo, thanks for your reply. I still have 14 pounds to go to get to my baseline weight, so I’m not that skinny yet, and I sound to myself like someone who wants an excuse to quit before I get there 😉

I’ve got a tiny little rib cage and a narrow pelvis and was actually quite busty at 105 lbs., wearing a 30D bra size. Even when my weight would dip below 100 lbs., I still had a figure. I agree with you that the range of normal weights is wide, and that just fitting into a chart doesn’t guarantee a healthy weight; I guess it has to feel right for yourself. I worry partly because I have a lot of risk, based on family and personal medical history, for diabetes and atherosclerotic complications and Alzheimer’s disease. But I think you’re right that there’s no definitive answer to my question without an MRI scan to look for visceral fat, which is unlikely to happen; I guess the next best thing is if I can get normal blood work, but even then some of the tests are expensive and not routinely performed.

StraR

1:50 pm
29 Apr 14
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Hi Franfit
I have wondered the same thing – I have always had a big tummy compared to the rest of me, and even with a BMI of 21 – 22 my waist/hip ratio and waist measurement relative to height have always come out as ‘unhealthy’ despite my overall size and weight. Furthermore, all the fat is on the front of my torso, as opposed to spread all the way round, so although I am hourglassish from front and back view from the side I just look pregnant! The bit they tell you to measure around, on me is the biggest part, not my ‘natural’ waist so I’m never sure exactly where to put the tape measure either.
What nickynackynoo says makes a lot of sense. The various ‘normality’ scales should be used as a guide in conjunction with all the other charts and scales. Not many people are ‘normal’ and healthy shapes and sizes vary enormously. If an MRI scan is not possible there are scales you can buy which claim to measure visceral fat. They do look quite expensive compared to normal scales and I have never used any so I don’t know how accurate or reliable they are.

franfit

5:39 pm
29 Apr 14
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Yes, StraR, that’s my shape, too (for a while I wore maternity T-shirts because at least they didn’t ride up in front). A good friend of mine has Type II diabetes, just like her (very skinny) mother and (obese) sister, and, although she has been overweight in recent years, she says that even when she was 89 lbs. (she’s 5’1″ tall) she had a “belly” that stuck out. So I wonder if those of us with this shape are at especially high risk for diabetes, what with what you read about apple shapes and visceral fat, and what we can do about it besides losing weight and IF, or how we can figure out if we need to do anything special.

nickynackynoo

9:01 am
30 Apr 14
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Hi Franfit and StraR,
Yes, I do agree that knowledge is power. It will be possible to pay for a test to tell you whether you are fat on the inside, but as StraR agreed, don’t get stuck on equations. They will not give you a definitive answer.
When you have hit your target weight, if a test came back telling you you are fat on the inside, what would you do? In the long term, what would the result of those viceral pounds be? Would you be able to live with that knowledge?
If not, why not take action anyway?
You are already taking the very best evasive action. You can’t do much more than ensure that you keep your body fit and healthy. Getting down to a healthy bmi will have a huge impact on the cards you have been dealt, and keeping fit is also so important.
Michael Mosley has the same concerns and came up with 5:2 as a tool to help. We have all embraced this, but even so, some experts object. At the end of the day all we can do is stack our cards the best we can. If the key to a long and healthy life was medical tests, the richest layer of the world, would also be the longest living.
Franfit, good luck with your last few pounds, it sounds like you are doing brilliantly already!

nickynackynoo

9:16 am
30 Apr 14
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By the richest layer, I mean the ultra rich! Not the difference between rich and poor societies.

franfit

4:56 pm
6 May 14
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nickynackynoo, thank you, I’m sorry I missed this post of yours! I think I’m finally learning how to track down all the posts I need to reply to, lol. I certainly appreciate the compliments 🙂 I’m afraid my weight loss might slow now, as I sit here at 119 pounds and a BMI of 20.4 and still feeling my (fat) belly sticking out, but I just tell myself that I’m in Mimi (Spencer) territory now, that if she did it, then I can, too!

Elainefriend

3:10 pm
6 Jun 14
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Dear Franfit, So glad to know I’m not the only one wrestling with the waist-hip dilemma. I predominately embarked on this diet to try and get my waist size down. Over 15 weeks I’ve lost 21lbs going from 148 to 129 lbs and my waist has dropped from 35 inches to 29.5 inches however my hips have dropped conversely from 39 to 35 inches so my hip/waist ratio is just sitting on the cusp of normal, depending on what chart I go by! I’m wish to lose another 4lbs but I really don’t think it will change the dreaded hip/waist ratio as I know my hip size will drop also! It’s frustrating to keep reading how body shape puts us at risk of diabetes and heart disease but I guess us apple shapes are giving ourselves a much better fighting chance of staying healthy if we are at least within our ‘normal’ weight and BMI. Anyway, I feel great and have to say the fast diet is the only diet where I’ve manage to get my hip/waist anywhere near normal. I intend to lose 4 more pounds and then change to 6:1 for maintenance. Really hoping I can keep the weight off 🙂

franfit

3:09 pm
7 Jun 14
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Elainefriend, I’m so glad you responded! I was starting to feel like maybe I was some kind of a nut about this. The thing is, even when I was 14 years old and weighed 105 pounds, my waist:hip ratio wasn’t anywhere near 0.80. At my current age and fitness level, my doctor, my son, and myself are all happy to have me maintain at 115-119 pounds. At least my waist is less than half my height, and, if I get more fit, maybe I can figure out a way to whittle the waist a bit more.

One thing is, even though I’m technically apple-shaped by the numbers, it’s really not a beer-belly type shape, where there’s this tight basketball shape sticking out whether I’m standing up or lying down. I don’t think there’s any way short of a CT scan to really know if there’s too much visceral fat lurking in there. I think that, after a few weeks/couple of months on maintenance, I’ll get some blood work done; if fasting blood sugar, hemoglobin A1C, triglycerides, and HDL cholesterol are all good, I won’t have any signs of metabolic syndrome, which is the dreaded consequence of visceral fat, so then I think I should just relax and consider myself slim-hipped rather than thick-waisted.

The FastDiet has been the only thing that allowed me to get my weight down, too; daily calorie restriction left me hungry almost all the time, not a sustainable way to live. Why don’t you join us on a new maintenance thread, started by Auriga, called ‘Thank you Dr M for my success’? You don’t have to be all the way to goal weight to join.

Elainefriend

6:34 pm
7 Jun 14
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Dear Franfit, I so appreciate your replying so quickly. What you have to say is extremely interesting and like you, I guess I’m “technically” an apple shape but to be honest I don’t look it, as I do not have a pot belly either. I actually look quite hour-glass despite the thick waist, and, like you, even when younger and slimmer my waist was never less than 26 inches. Not sure where you are situated and whether you work in metrics or imperial – guess I’m showing my age using imperial measurements! I am currently situated in Greece where I live for part of the year, the rest of the time I spend in my home-town of London. Getting back to the waist-hip conundrum – I have noticed that weight gain, now that I’m a woman of a certain age, is not as firm and I tend to store weight on my back, it does drop a bit and thus i think its this that thickens my waist at the back, rather than it being my stomach that is thickening my waist. I’m pleased to say that I’ve lost most of this fat now. As I said before I will be happy to achieve a maintaince weight of 125lbs (8.13), I’m 5ft 4in and I think this will be a good weight for me my BMI is currently 22.14. I would like to join the maintanence forum as I believe keeping the weight off can be as challenging as achieving goal weight. Thank you for telling me about it. Looking forward to joining in :-))

franfit

10:06 pm
7 Jun 14
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Elainefriend, I’m 5’4″ also, and when I started 5:2 my goal was to get back to my original, baseline young adult weight, before I ever started gaining, which averaged 105-107 (although I could go as low as 97 and as high as 112), “or at least within 5 or 10 pounds of it, depending on how I look and feel when I get there,” as I put it then. But my son was a bit skeptical and my doctor didn’t think I should go below 110. At 107 I would be technically underweight. (I’m in the US, near Philadelphia in Pennsylvania, hence my use of pounds, I have to pull out my calculator every time someone mentions stones or kg., lol!) So, at 117, my ribs started to show when I wear a low-cut top, and that, plus a few other things, convinced me that I’m not supposed to be the same weight at 57 that I was at 17 and 27, even if I would like to take more off my waist, it’s not going to come off only there. Post middle age it’s probably not such a good idea, health-wise, to be extremely lean but not fit; medical problems limit my ability to get fit; so, at this point, better for me to focus on maintaining my weight loss and on gradually increasing fitness. While doing 5:2 I gradually increased my walking from an average of < 4,000 steps/day to an average > 10,000 steps/day; next Thursday I will start seeing a physical therapist about designing a home exercise program that’s appropriate for my limitations. The point I meant to make before I started going off on a tangent was that each person’s goal weight is a very individualized thing and sometimes has to be revised a little depending on how things turn out; everyone has a different frame, some people are more muscular than others, people just look and feel better at different weights, even if they’re the same height, and what worked at one age may not work so well at another. I decided on a maintenance range, so that when I get to the lower end of the range and stay there, I will know I can start fasting a bit less; if I get to the top of the range, I’ll know I need to start fasting a bit more again. Apparently keeping the weight off is even harder than taking it off, and re-gaining more than five pounds is a set-up for trouble ahead, so I don’t want to go anywhere near that. I feel *so* much better now, and this project was *a lot* of work, I’m not going to let it go to waste. Plus I gave away my too-large clothing — I’d have literally nothing to wear!

I think dividing the year between Greece and London sounds heavenly 🙂 even though I like where I live, it’s a small college town where people actually know each other, and my apartment building is across the street from an arboretum, which is a wonderful place to walk 🙂

Elainefriend

9:32 pm
8 Jun 14
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Hi Franfit Wow 5ft 4ins and weighing 97lbs, boy that does sound low but one size doesn’t fit all with weight! I’m very big busted so I often find that I look a lot slimmer than other women who are the same hight and weight as me but are big hipped and small chested. I feel women in the USA tend to op for lower weights than us Europeans. I’m aiming to reach a goal weight of around 125 lbs but I may go a bit lower once there, however, my hubby is already making noises about my “not losing too much weight”! Having said that, I’m not doing this to pleased anybody but myself so I will stop when I feel happy with how I feel. So, Franfit, what did you weigh when you first started the 5:2? It’s fascinating isn’t it to hear everybody’s story and for us all to connect with one another, I’m finding this forum quite inspirational:-)

franfit

7:31 pm
9 Jun 14
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Elainefriend, when I would get down to 97 or 98 pounds I would actively try to gain weight, I really looked too thin. I’m just one of those people who loses their appetite when they’re unhappy, so sometimes my weight would go down.

I started 5:2 last August 17 at 157 pounds and 5’4″ tall, age 57, and lost 40 pounds in 40 weeks with 5:2 plus increasing my walking (over time) to an average of 10,000 steps/day. I did do 4:3 for the last couple of weeks as my weight loss slowed as I got smaller. I suspect that this is fairly rapid weight loss for a woman in the post-menopausal age group. I was quite careful on non-fasting days. I also suspect that my metabolism still manages carbs fairly well as long as I don’t eat them in isolation. I think that, if your body has a lot of trouble handling carbs, weight loss becomes more problematic unless you use a well-formulated low-carb approach.

The highest weight I ever got to was 186, back in 1998, when I first got really sick I blew up by 50 pounds in a few months. Once my medical problems got somewhat sorted, I managed to lose 30 of those pounds just by making sure that I ate 5 servings of veg and 3 of fruit every day, I had less room for more calorific stuff. But then my weight loss stalled in the 150s and stayed there. With daily calorie restriction I could lose about a pound a month but was hungry almost all the time, so as soon as I let up on being hyper-vigilant the amount I lost that way would come right back.

I’m big-busted, too, lol, it does help the waist look a bit smaller than it is. But it feels funny to have my waist still be almost the size of my rib cage.

The way I’m thinking about this problem now is this: the problem an apple shape is supposed to point to is visceral fat, and the problem with visceral fat is metabolic syndrome. So, I should get my hemoglobin A1C, triglycerides, and HDL cholesterol checked, and, if they’re all OK, there’s no real problem there. If they’re out of whack, I could try losing more weight with intermittent fasting or try a low-carb way of eating while trying to maintain my current weight.