Apple is the most common body shape in the UK today – and also the most deadly, researchers are now warning.
Having previously been connected to a higher risk of cardiovascular disease and type 2 diabetes, being apple-shaped – where people carry more weight around their midsection, creating a round silhouette with an undefined waist – is now being linked to other serious problems, including the skin condition psoriasis, kidney disease, bowel cancer and dementia.
At least 59 per cent of men and 69 per cent of women have an unhealthily large waist circumference – generally, bigger than 80cm (31.5 in) for women and 94cm (37 in) for men – according to the Health Survey for England.
Large-scale studies have consistently linked large waist sizes and excess belly fat with heart disease, diabetes and even early death.
And last year a team of researchers writing in the journal JAMA Network Open went as far as to propose that a ‘body roundness index’ (BRI) – a calculation based on someone’s waist size as well as weight and height – could be a useful new way to monitor people’s health and risk of disease. They said this could potentially be more accurate than BMI (which only uses height and weight).
This conclusion was based on data from 30,000 US adults over 20 years, which showed that the BRI was a good predictor of all causes of death – and those with the roundest bodies had the highest risk of dying from cancer and heart disease.
The thinking behind the body roundness index is that it’s a good proxy measure for someone’s levels of more dangerous types of body fat – the primary culprit being visceral fat, hidden deep in the abdomen, which can increase body-wide inflammation.
Last year a team of researchers went as far as to propose that a ‘body roundness index’ (BRI) could be a useful new way to monitor people’s health and risk of disease
More recently, a little-known type of fat – ectopic fat – that accumulates around and inside organs such as the liver, pancreas and heart, has also been considered responsible.
Ectopic means ‘out of place’ and, like visceral fat, it releases chemicals that cause organ-damaging inflammation and raised blood-sugar levels. What’s more, ectopic fat could be causing you harm even if you’re not overweight.
‘People with a normal weight could still have a high risk of cardiovascular disease because of their body’s fat distribution around their middle,’ a study published in the European Heart Journal in 2019 warned.
And researchers from Johns Hopkins University School of Medicine in the US reported in 2020 that apple-shaped people have a higher risk of insulin resistance (a precursor to type 2 diabetes) compared with people who aren’t apple-shaped, even if they have the same overall levels of body fat.
Your browser does not support iframes.
The potential danger of being apple-shaped now includes a range of other illnesses, according to a swathe of new studies.
In May this year, researchers at King’s College London reported that fat around the abdomen is more strongly linked to the risk of developing psoriasis than total body fat. The chronic inflammatory condition causes itchy, scaly skin and can lead to agonisingly swollen joints and body-wide arthritis.
It was already known that putting on weight can raise the risk of psoriasis. But after analysing data from more than 9,000 people with the disease, researchers found that the risk from abdominal fat remained consistent regardless of genetic predisposition.
This suggests it is an independent risk factor for the condition, as reported in the Journal of Investigative Dermatology.
As Dr Andrew Scott, a senior lecturer in clinical exercise physiology at the University of Portsmouth, who has published research in this area, explains: ‘The fat around the body is generally inert, but fat in the middle region produces significant levels of proteins called cytokines, which trigger chronic inflammation – which in turn may cause conditions such as cardiovascular disease and psoriasis.’
Belly-fat-induced inflammation appears to be a key factor in driving dementia, too, according to a study published in July. The researchers, from Monash University in Australia, found that apple-shaped men are up to 38 per cent more likely to develop dementia than men who were overweight overall but did not have especially fat bellies, reported the journal Alzheimer’s & Dementia.
In particular, belly fat is associated with shrinking of the hippocampus – an area of the brain associated with forming new memories – the study reported.
Inflammation is also a well-accepted cause of cancer – which may explain the findings of a study last year, which concluded that being apple-shaped significantly raises the risk of developing bowel cancer. This is the fourth most common cancer in the UK, accounting for more than one in ten of all new cases, according to Cancer Research UK – and these are rising.
The study, published in the International Journal of Obesity, examined data from more than 500,000 people (aged between 40 and 69) and found that belly fat was a risk no matter how fat or slim the person was otherwise.
Being an apple shape may also seriously harm the kidneys.
A 2013 study by the University Medical Centre Groningen in the Netherlands, involving more than 300 healthy people, found that being apple-shaped is associated with a risk of developing harmful raised blood pressure within the kidneys. This can put strain on their small blood vessels and, over time, may stop the kidneys working properly. Ultimately, this can cause kidney failure.
Dr Scott says that belly fat can raise the risk of high blood pressure throughout the body.
‘Belly fat encourages the production of angiotensin, a hormone that causes blood vessels to constrict and blood pressure to rise.’ The obvious answer to reducing these risks is to lose belly fat – and keep an eye on your waist size.
The most common body shapes. One study found being apple-shaped is associated with a risk of developing harmful raised blood pressure within the kidneys
Indeed, in a 2019 study by the Albert Einstein College of Medicine in in the US, women who reduced their proportion of excess belly fat cut their risk of cardiovascular disease.
One of the most effective ways to lose belly fat appears to be through repeated short-duration, high-energy bursts of exercise, such as high-intensity interval training (HIIT) and sprint interval training (SIT).
Sessions may last only 20 minutes a day and be practised as little as three times a week.
In 2021, researchers at the Norwegian School of Sport Sciences reported in the journal Frontiers in Physiology that these exercise regimens can burn off a person’s proportion of belly fat significantly, even if their overall weight does not go down.
However, such intense effort is not the only solution, according to Dr Scott. ‘The good news is that evidence shows that the waist is a prime area for weight loss whenever we improve our cardiovascular fitness by doing any exercise and by moderating our carbohydrate intake – for example, eating less processed food.’
Reassuringly, he says: ‘We don’t need to have a crash diet and an exhausting exercise regimen. This is much more about lifestyle change over time.
‘Use the stairs rather than the lift and do easy exercises that you can do at home without needing equipment, such as squatting and press-ups.
‘You can noticeably improve fitness and shrink your belly with only five weeks of 30 minutes’ brisk walking a day.’
AND THE GOOD NEWS ABOUT BEING SHORT
It’s not just your waistline – your height can also significantly affect your risk of conditions such as diabetes and cancer.
Most of the health risks come from being tall, according to research.
A study of Sardinian soldiers found those under 5ft 4in lived two years longer than their taller comrades, reported the journal Biodemography and Social Biology.
Earlier research in the journal Life Sciences found that countries in Europe with shorter people had 77 centenarians per million, compared with 48 per million in those with taller ones.
CANCER: For every 4in increase in height above the average, cancer risk increases by 18 per cent in women and 11 per cent in men, reported researchers at the Karolinska Institute in Sweden in 2015.
One theory is that taller people have more cells that could transform into cancer – another is that taller people are exposed to higher levels of growth hormones, which can promote cancer.
Research by the Albert Einstein College of Medicine in New York found increased height was associated with a higher risk of all cancers – particularly thyroid, kidney, endometrial, colorectal, colon, ovarian and breast. This may be down to insulin-like growth factor, which causes cells to replicate excessively and prevents rogue cells killing themselves.
HEART RISKS: A 2014 study in the journal Reviews in Cardiovascular Medicine suggested that the tallest 25 per cent of men have double the normal risk of developing atrial fibrillation (AF) – an irregular heartbeat that increases the risk of heart failure and stroke.
Previous research found having larger atrial valves (which sit between the chambers of the heart) can more than quadruple a person’s risk of AF (taller people tend to have larger atrial valves). Tall women are also at risk.
But tall people have a lower risk of heart attacks: the 2014 review found that for each inch above average height, men had a 3 per cent decline in risk. Taller women also had a lower risk. Shorter people’s arteries are smaller and so may be more likely to become blocked.
REPRODUCTIVE PROBLEMS: Tall women are at risk of endometriosis, where womb-like tissue forms elsewhere in the body. A 2020 study in the Annals of Human Biology suggested it’s due to higher levels of oestrogen in puberty, which accelerates height and promotes the growth of endometrial cells.
TYPE 2 DIABETES: Both short women and men are at greater risk, according to a German Institute of Human Nutrition study in 2019 – possibly because small stature is generally associated with higher levels of fat in the liver.