Pear Shape Power: What Midlife Women Should Know About Body Fat

"This belly fat," I hear women say all the time when I ask if they have any issues or concerns.

Sometimes they've gone through menopause, others are in their 30s or 40s.

Yes, this differs between men and women.

You may even feel like your figure now looks like "dad bod".

I recently went to a DexaFit facility to have my bone and body composition scan as well as my VO2 max testing for personalized health metrics and actionable results.

Before we discuss my results, let's discuss body composition in general.

What are the differences between men and women?

Muscle: At the same height and weight, men have more lean mass (muscle mass) than women.

Fat: Men also distribute fat differently than women, typically around the abdomen ("dad bod") whereas women store fat around the hips and thighs ("pear shape")

Why is our pear shape awesome?

Our pear shape is protective.

The distribution of fat can change our risk of cardiovascular disease and metabolic disease.

Specifically, abdominal fat can be:

• Subcutaneous (the fat under your skin) or

• Visceral (the fat around your organs)

Visceral fat in particular is a risk for cardiovascular disease (heart disease, type 2 diabetes).

This holds true for women in addition to men.

What happens to our composition in midlife?

It's hard to study hormonal changes separate from chronological aging but it's of increasing interest, so more studies seem to be popping up on this.

Even before menopause occurs, fat mass starts to increase. The somewhat good thing is that muscle mass can also increase before menopause, but it's outpaced by the fat gain, meaning fat is gained quicker than muscle.

With the onset of menopause, there is a statistically significant change in fat mass and lean mass, though not with BMI overall.

That means there may not be a significant change in weight but there is a significant change in what the weight is made of.

Why does this change happen?

• Estrogen: estrogen makes us more insulin-sensitive, whereas progesterone is more insulin-resistant. Insulin sensitive means our body is able to utilize the hormone insulin and pull glucose (sugars from the breakdown of our food) from our bloodstream into our cells for use. If this process can't occur, then glucose gets stored (as fat). The loss of estrogen then leads to more insulin resistance.

  
  

• FSH: It's an oversimplification to solely blame estrogen deficiency of menopause for the body composition changes though it certainly plays a role. FSH is the hormone from our brain that tells our ovaries to produce hormones. With menopause as the ovaries slow their hormone production, FSH rises. The brain is still trying to get the ovaries to produce hormones. It's interesting that FSH plays a role in fat mass and the type of fat we have, namely brown fat which is more metabolically active and helpful (it produces heat).

  
  

• Leptin, Ghrelin: these are the hormones that tell us to eat (ghrelin) or feel full (leptin). Leptin signals the brain to stop eating and also regulates ghrelin. Obesity actually leads to a resistance to leptin, an inability to receive and respond to the signal to stop eating.

  
  

• Sleep: less sleep leads to more weight gain. Sleep is a difficult thing for many midlife women as I often hear.

  
  

• Environment: pesticides like atrazine and DDE, some pharmacological treatments like Avandia, dietary substances like MSG, and endocrine-disruptors like Bisphenol A (BPA) found in plastics, "forever chemicals" like perflurooctanoic acid (PFOA) found in non-stick cookware have been linked to obesity

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What risks occur with a change in shape?

This isn't a discussion of cosmetics, though the appearance and ill-fitting clothes are often bothersome to women. In fact these may be more bothersome to a lot of women I work with than anything else.

But we are here to discuss this for its metabolic effects.

In a study using data from the Nurses Health Study (data collected from women every 2 years), waist circumference and waist-to-hip ratio are very important parameters for us. In this study, they looked specifically at heart attacks and deaths from heart attack.

• Waist circumference: when measuring 38 inches compared to 28 inches, women with the larger waist circumference had a 3-fold increase in heart disease. The significant increase started at 30 inches.

  (Waist circumference over 35 inches is also a criteria for metabolic syndrome)

  
  

• Waist-to-hip ratio: women with a waist-to-hip ratio of 0.88 or higher had a 5-fold higher risk of heart disease, women at 0.76 had a 2-fold higher risk compared to women who were less than 0.72. The risk increases as the ratio increases.

Wow

This doesn't mean that obesity doesn't matter. Obesity is associated heart disease which was also demonstrated in the above study. It does mean that two women with the same BMI could still have very different risk depending on how their body fat is distributed. The higher the waist circumference and waist-to-hip ratio, the higher the risk, regardless of BMI.

This means these are all independent variables for heart risk.

What were my body composition results?

I am so happy to know with data that I have next to zero visceral fat.

I am also happy to know with data that I have a pear shape. It was also really cool to see this as my body was outlined on the screen during my scan.

I have room for improvement with bone density in certain areas and definitely with muscle mass. I knew as much about muscle mass and I'm using this data as a baseline measurement so I can see how I progress. I'm certainly using it as motivation.

Resources:

Some of the information contained in this article is the result of my training, medical knowledge,

and personal experience without a specific source to be cited.

Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your

doctor.

1. Bredella, M. A. (2017). Sex Differences in Body Composition. Springer, Cham. https://doi.org/10.1007/978-3-319-70178-3_2

2. Bredella M. A., Utz A. L., Torriani M., Thomas B., Schoenfeld D. A., & Miller K. K. (2008). Anthropometry, CT, and DXA as predictors of GH deficiency in premenopausal women: ROC curve analysis. National Library of Medicine: National Center for Biotechnology Information. Retrieved from URL https://pmc.ncbi.nlm.nih.gov/articles/PMC2644238/#r25

3. Fenton, A. (2021). Weight, Shape, and Body Composition Changes at Menopause. Journal of Midlife Health. Retrieved from URL https://journals.lww.com/jomh/pages/articleviewer.aspx?year=2021&issue=12030&article=00002&type=Fulltext&fbclid=lwZXh0bgNhZW0CMTAAAR1e4AfbilUILKWC6_KHLGbE8XchCV6XPw8ZyQt4bxYWtUNw0aAMI52c_aem_Q6TbkFR2CFYYG5EgPpxAhA

4. Greendale, G. A., Sternfeld, B., Huang, M. H., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein J. S., Jiang, S. F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. National Library of Medicine: National Center for Biotechnology Information. Retrieved from URL https://pmc.ncbi.nlm.nih.gov/articles/PMC6483504/

5. Holtcamp, W., (2021). Obesogens: An Environmental Link to Obesity. Environmental Health Perspectives Publishing. Retrieved from URL https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.120-a62

6. Rexrode, K. M., Carey, V. J., Hennekens, C. H., Walters, E. E., Colditz, G. A., Stampfer, M. J., Willett, W. C., & Manson, J. E. (1998). Abdominal adiposity and coronary heart disease in women. JAMA, 280(21), 1843–1848. https://doi.org/10.1001/jama.280.21.1843