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Waist-Hip Ratio: The Block, Apple, Pear and Hourglass

Written by Tom Nikkola - Director of Nutrition & Weight Management

How much do you weigh? What is your percent body fat? How about your waist-to-hip ratio? Chances are, you know the answer to the first question. You might have an idea on the second. But, there’s a good chance you don’t know the answer to the third question. Waist-to-hip ratio (WHR) is not talked about too much, but its value in identifying disease risk could be greater than most people realize. If you look around, you’ll notice a growing percentage of the population, both men and women carrying their weight in their midsection. Carrying extra weight in the stomach has always been common in men, but it’s becoming more common in women in recent years as well. It’s even becoming more prevalent in teenagers. The hourglass shape common in females in the past is far less common today. Aside from a change in physical appearance, the transformation in body shape means an increased risk of several diseases.

Measuring Waist-Hip Ratio

It’s easy to measure waist-to-hip ratio. It only requires a paper tape measure. The World Health Organization suggests “the measurement be made at the approximate midpoint between the lower margin of the last palpable rib and the top of the iliac crest” which is basically the midpoint between your last rib and the top of your hip bone. The waist measurement should be taken a few times at the end of consecutive breaths. The hip measurement should be taken “taken around the widest portion of the buttocks.”[i]

These measurements must be taken with the tape parallel to the floor to be accurate. The paper tape should be drawn tight, but not snug enough that it constricts any tissue on the hips or thighs. There’s no reason to cheat on this test. If your try to makes your measurements smaller than they should be, you’re only hurting yourself.

Once you have your measurements, divide the waist measurement by the hip measurement. The table below shows the WHR levels for men and women.

Waist-to-hip ratio should be used along with other measurements such as body composition to determine overall health, but this easy-to-use test is considered superior to weight or body mass index alone.

Wait-Hip Ratio and Gender

Obviously, men have genetically have a higher WHR than women. They stereotypically have an apple shape when they become overweight. However, healthy men should have a smaller waist than their hips, though it’s not so small to create the hourglass shape women may have. Men’s elevated WHR is due in part to their higher levels of testosterone compared to estrogen. Women with higher levels of estrogen tend to have lower WHRs. Once women pass menopause, their estrogen levels fall and more of their body weight shifts from their hips to their midsection.

Some women may have genetics which give them small hips. Research shows women who live closer to the equator tend to have smaller hips. The belief is these women spend more of their time walking and foraging, as many of these cultures are hunger-gatherers.[ii] Wide hips are beneficial for child birth but not good for walking or running. If you pay attention to elite-level female runners, they tend to have small hips as well. In this case, narrow hips will automatically increase a female’s waist to hip ratio, but there is no evidence to suggest these otherwise healthy women have an increased risk of health problems. To the contrary, you’d expect these women to have a decreased risk of health problems because of their physical fitness, which again shows you cannot use WHR alone to determine one’s level of health.

In non-athletic women with normal-sized hips, carrying extra weight in the waist increases risk, just like in men.

Waist-Hip Ratio and Health Risk

Individuals with higher waist to hip ratios carry more body fat in their midsection. In some people, when you try to squeeze the fat around the stomach, it is firm, almost rock hard. How can someone have a protruding belly but when you squeeze it, it’s so firm? Fat in the midsection is often visceral fat. Visceral fat surrounds organs and is stored under the muscles of the stomach. Subcutaneous fat is easy to pinch and is located right under the skin. Visceral fat appears to be the worst type of fat one can carry, but since all body fat secretes certain hormones, too much is a bad thing. When a significant amount of excess fat is stored as belly fat, it makes for a firm (though still fat) belly.

Overweight men are known to carry most of their extra body fat around their belly, but a growing percentage of the female population is carrying it there as well. An elevated WHR in men or women increases the risk of cardiovascular disease[iii] and diabetes.i Increased inflammation from belly fat likely contributes to the health problems.[iv] Central obesity is also associated with low levels of DHEA in men, a hormone important in the production testosterone.[v] This would explain why overweight men often have lower testosterone levels. In addition, women with PCOS often have an increased WHR ratio, increasing their risk of health problems.  

Waist-Hip Ratio and Attractiveness

Men have been shown to be more physically attracted to women who have a WHR of 0.70,[vi] meaning they are most attracted to women with a waist 30% smaller than their hips. A lower WHR is associated with increased fertility and “neruodevelopmental resources for offspring.” Platek and Singh also explain there is a decreased risk of disease and depression in women with an hourglass shape, which researchers believe may also contribute to physical attractiveness by Most interesting is the fact that even men who were born blind since birth found women with a lower WHR as more attractive, suggesting a lower WHR is seen as desirable for more than just visual reasons.[vii]

Men, if you’re wondering what women find attractive, the research shows the waist-to-shoulder ratio is most significant. However, there isn’t a lot of research related to waist-to-shoulder ratio and health outcomes, which is the main reason for this article. There is probably some connection to the shoulder width of a male, his lean body mass and health, but there doesn’t seem to be much research on it.

What’s your shape?

In healthy men, a blocky, square torso is typical. Physically fit men may have a tapered shape, with their shoulders and upper back providing width down to a narrow waist and hips. Overweight men tend to be more apple-shaped, carrying most of their weight in their stomach. Overweight men often have lower testosterone levels, which means their shoulders, glutes, arms and legs can be can be unusually skinny as well. Without enough testosterone, it’s difficult to maintain muscle.

Healthy women usually have an hourglass shape, though, as mentioned above, some women with small hips may be a little more square. In the past, it was typical that women with some extra body fat would carry it in their hips and thighs, which is considered healthier than when they carry it in their stomach. With extra body fat, they’d build more of a pear shape. Today, though, a growing percentage of females carry body fat in their stomach, giving them the apple shape common in overweight men.

Next week we’ll take a look at some of the reasons we’re seeing such an increase in the prevalence of apple-shaped overweight individuals. Diet and exercise play a role, but there are other reasons we’ll discuss next week as well. Until then, keep the conversation going and post your questions or comments below.

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

[i] World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva. December 8-11, 2008.

[ii] Marlow F, Apicella C, Reed D. Men’s preferences for women’s profile waist-to-hip ratio in two societies. J Evol Hum Behav. 2005;26:458-468

[iii] UT Southwestern Medical Center. Waist-to-hip Ratio May Better Predict Cardiovascular Risk Than Body Mass IndexScienceDaily, 14 Aug. 2007. Web. 11 Dec. 2011.

[iv] Su WS, Clase CM, Brimble KS. et al. Waist-to-Hip Ratio, Cardiovascular Outcomes, and Death in Peritoneal Dialysis Patients. Int J Neph. 2010. Article ID 831243. doi:10.4061/2010/831243

[v] Derby C, Ziber S, Brambilla D, Morales KH, McKinlay JB. Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts male Ageing Study. Clin End. 2006;1:125-131

[vi] Platek SM, Singh D. Optimal Waist-to-Hip Ratios in Women Activate Neural Reward Centers in Men. PLoS ONE 5(2): e9042. doi:10.1371/journal.pone.0009042 

[vii] Karremans JC, Frankenhuis WE, Arons S. Blind men prefer a low waist-to-hip ratio. Evol Hum Beh. 2010;31:182-186

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