Heart problems? Hips don’t lie

Every morning I see health club faddists carefully checking their weight on a weighing machine, and many lamenting that the weekend’s extravaganza has resulted in a few extra kilos. As a young doctor, I used to look at height versus weight statics on LIC charts, which suggested ideal weight ranges for a given height. It occurred to be then, that weight is combination of bone weight, muscle weight, fat, water and other constituents. If that is so, which real reflection of general health could be made regarding this?

I have never taken my weight except when I was admitted to hospital. In fact, in my college days, I would gauge my girth by feeling how tight my trousers were around my waist. The fear of spending, on new trousers, from my meagre resident’s salary during my first year of posting, scared me into dieting if the pants were tight. I have often felt that we can make India into a healthy country if we all – both men and women – started wearing trousers. The luxury pyjamas, which can adjust to several inches of waist increase, must be dispensed with. Rather, we do not even realise we are putting on weight because the drawstring on pyjamas gives us no indication of it.

As a measure of obesity, medicine changed its norms where instead of weight, now it relies on Body Mass Index, which is weight in kg divided by height in metres squared. BMIs of 25 and above are said to be associated with several health issues. Perhaps this is better than the old height vs ideal weight which takes no notice of girth. It is said that in a man, a waist circumference of more than 40 inches (101 cm) and in women, more than 35 inches (88 cm) is considered detrimental to health.

The waist is measured at the midpoint of the lower rib and the hip bone (iliac crest) using a stretch resistant tape that provides 100 gm of tension. The hip is measured around the widest part of the hip. Many choose the smallest part of the waist, above the navel, for practicality, divided by the largest part of the hip. Abdominal obesity is defined by the waist-hip ratio being more than 0.9 in men and 0.85 in women for those with a BMI above 30. The waist-hip ratio takes into account the difference in body structure. It is, therefore, possible that despite different BMIs, the waist-hip ratio (WHR)may be the same. If we use the WHR instead of BMI, there will be a three-fold increase in the risk of heart disease. Merkedal et al in the European Journal of Epidemiology state that WHR is a better indicator of heart disease than waist circumference or BMI. Other studies in the Canadian Heart Survey by Dobblesteyn state that waist circumference is a better indicator of heart health than waist-hip ratio. Whatever the semantics, the one important factor that emerges is that waist circumference is a very important indicator of health.

The WHR correlates well with not only health, but also fertility and attractiveness. Women with a ratio of 0.7 or less have optimum sex hormones and are less susceptible to diabetes, heart disease and ovarian cancer. A Dutch study of artificial insemination tells us that a 0.1 unit increase in WHR reduces the probability of conception by 30 per cent. Research by Piotr Sorokowski, of the University of Wroclaw in Poland, of 1,000 women, shows a linear relationship between WHR and the number of children. Fertility seemed to be enhanced with a normal WHR. An article in Arch on sexual behaviour addressing WHR by Koskinci measures attractiveness vs WHR and concludes that generally low and average WHR are more often chosen as indices of attractiveness, while other research tells us that a WHR of 0.7 is more attractive in Indo-European cultures.

William Lassek of the University of Pittsburgh and Steven Gaulin of the University of California had worked on children’s cognitive performance compared to the WHR ratio of the mother. They found that children whose mothers have a wide hip and low WHR scored best. They hypothesise that the foetus brain benefits from the polyunsaturated fatty acid stored in the fat of the hip. According to the Journal of Biological Physiology (Rozmus-Wrzesinska), waist size conveys information about health and reproductive status, and hip size, the amount of fat that can be stored as a source of energy. It states that the waist size or girth is a more accurate index of attractiveness. Studies in twins suggest that the waist hip ratio is under genetic control as well, but obviously not entirely.

It is therefore important to try to maintain a low waist-hip ratio. It helps in fertility in both in men and women, and accounts for attractiveness. Diet, exercise and try to achieve this for heart health, diabetes and several other benefits. And wear trousers – they will always tell you when your girth is increasing.

Dr Altaf Patel writes on good medicine and age-old common sense
(Disclaimer: The views expressed here are the author’s own)

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