In the back of the auditorium of Congregation M'kor Shalom in Cherry Hill, N.J., one recent evening, the bold and brave stepped up to the tape measure - yes, the tape measure. Gamely, they allowed their waists and hips to be measured.
The women were participants in a health forum that had as its thesis the notion that what you don't know about your own shape can hurt you … and often does
"I'm here to get enlightenment about being healthy - without being obsessed about weight," said Dr. Bonita Blazer of Moorestown, N.J., an educational consultant who came to the seminar with her sister, Elinor Hecht, also of Moorestown.
"I think women need all the information they can get about their health risks," added Hecht, who, like her sister, felt the need to know more about body shape and its ramifications. So both of them faced the tape measure, and both learned that they are pear-shaped.
Karla Goldstein of Mount Laurel, N.J., herself a registered dietician and lecturer, was willing to meet the tape measure to verify her body shape at the seminar because she, too, was "seeking realistic and attainable health goals."
The keynote speaker at the event was physician/author Dr. Marie Savard, a nationally recognized internist and women's health expert. She has recently co-written a book with author Carol Svec aptly called Apples & Pears: The Body-Shape Solution for Weight Loss and Wellness.
A Job for the Tape Measure
And she minced no words about her mission.
"Stop obsessing about the scale and get out the tape measure, because body shape is the single most powerful predictor of future health," she said. "And like it or not, women's bodies are almost always shaped either like apples or like pears."
Savard, who trained as a nurse at the University of Pennsylvania, then went on to earn her medical degree at the same institution, began noticing the impact of women's body shapes on their health during her years of private practice in the Philadelphia area.
The physician became so intrigued that she went back to the medical literature on the subject and began seeking more information. One of her reference points was the famous Nurse's Health Study, published in 2001, which had studied 120,000 women nurses since 1976.
"What jumped off the page for me were all the references to apple-shaped women and their higher risks of developing heart disease, Type 2 diabetes, stroke and breast cancer," said Savard, who also wrote How to Save Your Own Life and The Savard Health Record.
Current chair of the Pennsylvania Commission on Women and an adviser to Lifetime TV on medical issues, Savard has been a tireless champion and advocate for women's medical enlightenment and empowerment.
And the apple-pear issue, she suggested to her M'Kor Shalom audience, has been under-recognized despite its value as a forecaster of health destiny.
What determines who's an apple and who's a pear?
The answer is where fat is stored. In apples, it's around the middle; in pears, it's in the hips and bottom.
But it's not quite that simple, as Savard explained: "There are actually two kinds fat - visceral and subcutaneous. Apple-shaped women have more visceral fat, which can gather around the internal organs, and is generally more harmful to the body."
Visceral fat actually creates an environment that is primed for heart disease and stroke. It decreases insulin sensitivity (making diabetes more likely), increases triglycerides, decreases levels of HDL cholesterol, creates more inflammation and raises blood pressure - all of which increase the risk of heart disease.
Subcutaneous fat usually appends itself to the buttocks and thighs, and while it may make its bearers - pear-shaped women - self-conscious in bathing suits, it is not as potentially dangerous as the visceral sort.
But pear-shaped women face other issues. Pears, who are at greater risk for osteoporosis, can - and sometimes do - morph into apples after menopause.
And the tape measure?
It delivers the verdict. And in seconds.
The method: First, a measure should be taken around the waist to get its circumference. Next, the widest part of the lower body should be measured to ascertain the hip circumference. The first number divided by the second yields the waist-to-hip ratio (WHR).
If that WHR is 0.80 or less, you're a pear. If it's greater than 0.80, you're an apple.
So what's a woman to do when the tape measure indicates that she may be in trouble? Apples need to concentrate on losing inches, eating foods that reduce their risk of heart disease and stopping fad diets. The good news: Apples can lose weight more quickly and easily than pears.
Pears may be challenged in losing unwanted inches because pound for pound, apple-shaped women burn calories quicker, even when they are sleeping. It's also harder to lose pear-zone fat that to lose it elsewhere in the body, including the stomach area.
But Savard was encouraging about coping mechanisms. She offered numerous pointers at the recent seminar, and they are detailed in her book. The physician, who's been a health columnist for Women's Day Magazine, offers females common-sense approaches to healthy living.
Those with apple shapes receive specific advice, and so do their sisters, the pears. Among Savard's major pointers:
• For Apples: Lose at least 2 inches of fat from the waist, which significantly decreases health risks. Eat high amounts of complex carbohydrates, and moderate fat intake. Avoid food with white flour.
Eat plenty of fruits, vegetables and whole-grain products. Choose olive oil instead of butter or margarine.
Apples are well-advised to walk 30 minutes daily to burn apple-zone fat.
• For Pears: Avoid post-menopausal weight gain; eat a low-fat/high complex carbohydrate diet; and avoid fatty foods, especially cheese and butter, in addition to salty items.
As for exercise, pear-shaped women are encouraged to do resistance training at least three times a week to build bones because of their greater susceptibility to osteoporosis.
And the expert's final advice: "Whatever your shape - apple or pear - make yourself as healthy as possible, and celebrate who you are. If you understand and accept your body type, and learn its implications, you're on your way to personal freedom."