The distribution of excess adipose tissue

The adverse effects of obesity are due not only to the excessive amount of body fat, but also to its distribution in the body. In most studies of coronary heart disease patients there is a threefold excess of men compared with women, a difference that persists even when the raw data are corrected for such known risk factors as blood pressure, cholesterol in low-density lipoproteins, body mass index, smoking and physical activity. However, as shown in Figure 6.5, if the data are corrected for the ratio of the diameter of the waist to hip, there is now only a 1.4-fold excess of men over women.

The waist—hip ratio provides a convenient way of defining two patterns of adipose tissue distribution:

  • predominantly in the upper body segment (thorax and abdomen) — the classical male pattern of obesity, sometimes called apple-shaped obesity;
  • predominantly in the lower body segment (hips) — the classical female pattern of obesity, sometimes called pear-shaped obesity.

It is the male pattern of upper body segment obesity that is associated with the major health risks, and in a number of studies assessment of the pattern of fat distribution by measurement of either the waist—hip ratio or the subscapular skinfold thickness (section 6.1.2.5) shows a greater correlation with the incidence of hypertension, diabetes and coronary heart disease than does BMI alone.

Abdominal adipose tissue produces less leptin (section 1.3.2) than does subcutaneous adipose tissue, so that abdominal fat will have less effect on long-term regulation of food intake and energy expenditure (section 1.3.2).

Figure 6.5 Body fat distribution and the gender difference in coronary heart disease mortality.

Figure 6.5 Body fat distribution and the gender difference in coronary heart disease mortality.

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