Solace for the Pear-Shaped

A woman's figure may figure in diabetes

For women weight watchers, the battle of the bulge is often lost at the hips. No matter how they exercise, excess pounds seem to pile up there and at the buttocks and thighs. But at last there seems to be some compensation for the pear-shaped. (No, not another grapefruit diet.) According to Dr. Ahmed Kissebah of the Medical College of Wisconsin, overweight women whose body fat is concentrated below the waist run a relatively low risk of contracting diabetes, a frequently serious disease that disrupts the normal metabolism of sugar into energy and afflicts one out of 20 Americans. Conversely, Kissebah warns, women with what he calls "upper-body obesity" (excess fat deposited mainly around the waist, chest, neck and arms) are high-risk candidates for the disorder, which may cause blurred vision, persistent drowsiness, frequent urination, cramps in legs, feet and fingers, and can eventually lead to coma and even death. "To put it simply," says Kissebah, "the bigger the waist, compared with the hips and thighs, the higher the risk of developing diabetes."

Kissebah bases his observation on a six-year study of 52 women, 25 of them fat on top, 18 with lower-body obesity, plus a control group of nine women of normal weight. All were carefully matched for height, age and, in the case of the obese women, weight. All, says Kissebah, were "apparently healthy females whose doctors told them that they didn't have diabetes."

Kissebah found otherwise. When the women were tested, significant differences between the groups appeared. While women of normal weight and those with lower-body-obesity fell within the normal range on the tests, all of those with upper-body-obesity had high blood levels of insulin, sugar and fats, common indexes of diabetes. Furthermore, when glucose-tolerance tests were given, 15 out of the 25 scored within the diabetic range. Statistically, says Kissebah, the group was eight times as likely as normal women to develop the symptoms of the disease.

Seeking an explanation for these findings, Kissebah examined fat and muscle biopsies taken from the abdomen and thighs of his subjects. He discovered that fat cells taken from the abdomen of upper-body-obese women were enlarged, appearing like so many overstuffed pillows. In lower-body obesity, by contrast, fat cells were normal in size, though excessive in number.

Preliminary studies at Wisconsin have also shown that the overpacked fat cells have a smaller number of the receptors to which insulin attaches, controlling the utilization of sugar. This may account for the elevated levels of blood sugar and insulin. The tendency to acquire oversize fat cells may in turn be regulated by hormones, suggests Kissebah. Women with upper-body obesity, he found, have a higher ratio of male hormones to female hormones than their lower-body-obese counterparts or women of average weight. The very distribution of their adipose tissue--around and above the waist--is more like that of pot-bellied men. Significantly, obese men have a higher incidence of diabetes than obese women.

Doctors have long known that overweight increases the risk of diabetes. The rule of thumb is that the risk doubles for each additional 20 lbs. of flab. Kissebah hopes his study will refine the rule. About 40% of American women are overweight, he points out, but only a quarter of that group have upper-body obesity. Such women, he suggests, should all be tested for diabetes and strongly urged to reduce. Diabetic tendencies and symptoms can often be effectively controlled or even eliminated by proper diet and weight loss alone.

As a fringe benefit of his study, Kissebah may have solved the age-old riddle of why it is so much easier for some women to lose weight above the waist (where fat cells may be enlarged) than to slim down their hips. Says he: "It is much easier to shrink fat cells than to do away with them."

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