Waist-to-Hip Ratio: The Overlooked Measure of Women’s Metabolic Health

Introduction to Waist-to-Hip Ratio 0:00

A fair number of women, especially postmenopausally, as their estrogen drops and their body fat migrates upward from their previous apple shape to more of a pear shape, they may be metabolically unhealthy even though they are in a normal weight range. This is where the waist to hip ratio can come in and tell us what's going on with our internal obesity. This is Doctor Talks. Hello and welcome. Today I'd like to talk about something that may seem like a bit of an arcane subject, which is the waist to hip ratio measurement.

And I kind of poo-pooed this for a long time until I kind of had some of my own recent experience that made me think this was more significant than I previously had.

Why BMI Can Miss Metabolic Risk 0:53

I lost a few pounds and I was happy with my BMI, got my hemoglobin A1C checked and it went up a little bit and I'm like, ugh. And then I started paying more attention to metabolic syndrome in general and insulin and things like that. rediscovered the idea of the waist to hip ratio. So what am I talking about? Well, body mass index or BMI is a conventional measurement of obesity, whether one is normal weight, underweight even, normal weight, overweight or obese. And that's what's been measured in doctor's offices for, I don't know, 30 years, maybe 40 years.

And we were all kind of patting ourselves on the back if our BMI was okay. but it's more complicated than that. A fair number of women, especially postmenopausally, as their estrogen drops and their body fat migrates upward from their previous apple shape to more of a pear shape, they may be metabolically unhealthy even though they are in a normal weight range. This is where the waist to hip ratio can come in and tell us what's going on with our internal obesity, what we call visceral adipose tissue.

So there's various types of fat in the body, but the ones that we're most familiar with are the subcutaneous fat, the stuff you can pinch.

Visceral Fat and Health Effects 2:23

And the part we're talking about today is what's inside and is surrounding our abdominal organs, our kidneys, our bowel, the inside lining of our abdomen. This tissue drains its blood supply directly into the liver and it has a whole set of different metabolic effects than the adipose tissue that we can pinch in our outside part of our body, our subcutaneous fat. In fact, we used to think that adipose tissue was just kind of a nice way of keeping our energy metabolism level since we don't eat continuously or we try not to eat continuously.

But in the last decades, we have been finding out that our adipose tissue does a lot more than that. It's hormonally active. That means it has impact on organs downstream, certainly organs such as our blood vessels and our heart. It also is implicated in our glucose metabolism, our risk of diabetes, and so on. It's also very pro-inflammatory. So generalized obesity, you are in a basically pro-inflammatory state, which is negative regarding a bunch of medical diagnoses. You don't want to be in a pro-inflammatory state all the time.

Another condition that's probably related to intra-abdominal visceral obesity is liver fat or adipose tissue that lives in the liver and causes non-alcoholic fatty liver syndrome. In the current era, one of the major causes for liver transplant with our current lifestyle of minimal activity and maximal eating and carbohydrates in particular.

How to Measure Waist-to-Hip Ratio 4:20

It's an epidemic condition, fatty liver disease basically. So how to do this measurement? Well, it's done standing and in a relaxed state. You're not trying to pump up any body parts here. Just take a tape measure or a piece of string if you don't have a tape measure handy and a yardstick to finalize the measurement. Start around your waist and then around your hip at the widest part. I'm going to put more specific details in the show notes. The measurement that we're trying not to exceed for our waist is 35 inches and the waist to hip ratio should be less than 0.85 for women.

and our waist to height ratio should be less than 0.5. In other words, you should be twice as tall in inches as your waist is in inches or centimeters. You can do it either way as long as you're using consistent measurements. If we're over these measurements, We have a bunch of risk factors for the disorders that I've mentioned already, heart disease, diabetes, even cancer, and other types of disorders that are less common. But these are certainly the big metabolic issues in our country currently.

What causes visceral obesity? It's kind of our usual suspects here, inactivity, poor diet, especially high carbs apparently, stress, sleep issues, alcohol intake.

Reducing Visceral Obesity 6:05

There may be others, but those are the ones that we're familiar with now. Reverse of that is what can we do to reduce our visceral obesity if we, let's say, do have an elevated waist to hip ratio? We can go on a low carbohydrate, high protein diet, reduce our alcohol intake, increase our activity, try to work on our sleep. The main thing, of course, if you're nominally overweight is to lose some weight. And that is a whole other subject that we're not going to talk about today. If you're on the fence, let's say your doc is saying, well, your cholesterol, I'm not loving it, or you're fasting glucose, maybe you should change your diet, try to lose a little weight, get more active.

And you find that your waist to hip ratio or your abdominal circumference is too high, then this would mean to me that you should really jump on it. And that's what I've been doing. I've gone on a low carb diet and I'm not trying to lose weight. I'm just trying to improve my nutrition and move the needle a little bit. if you do have an elevated waist to hip ratio and your doc has been telling you don't worry your BMI is okay, I would come back and say well let's rethink my cholesterol and my fasting glucose and my family history and so on and get a little bit more active with the situation.

Closing Thoughts and Call to Action 7:40

So I hope I've convinced you to check this out on yourself and put down in the comments below what you found or what was interesting about this. If this is the kind of information that's interesting and valuable to you, please like and subscribe. And I hope to see you back again soon. Thanks so much for being here today. Thank you for tuning into Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health. Each day is a new opportunity to make choices that empower your well-being.

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