Lifestyle Corner

Do you gaze in the mirror and see all too well that your figure has morphed from a shapely pear into more of a round or squat apple? Does your changed figure leave you feeling sad and overwhelmed?

If you are in your mid-40s, believe me, you are not alone if you feel betrayed by your body. If you and your mirror aren't harsh enough critics, society piles on the guilt by endlessly parading slender, youthful ideals past you.

Our society's ideals are hopelessly unrealistic. But, don't give up. There are legitimate health reasons to want to slim down, tone up, and recapture the energy and outlook of youth! And, it's easier than you think.

Start here by considering these three waist-worthy facts:

1. Eating more energy (food) than you are burning (exercise) is sure to expand your waist.

2. Pears are healthier than apples. Weight gain around your waist (specifically in your abdominal area) is more of a health risk than weight gained on your hips and thighs.

3. Stress can expand your waistline in life-threatening ways.

The key to success is to learn what to expect waist-wise from the aging process and develop a realistic waist-management strategy. It's also important to be your own best friend-focus on the positive healthful reasons for changing your shape, not society's insistence of the perfectly shaped woman.

Aging Realities

The aging process changes your body in many subtle ways, some of which you can't control. Hormones and metabolism (the rate at which your body burns calories), for example, start playing tricks at mid-life.

Beginning in your late 30s, your metabolism begins to slow down. Everyone's different, but you may notice that you are putting on weight, even if you aren't eating much differently. What's worse: you may notice that you are putting in on in different places-namely, your waistline. You may even notice that you are eating differently-stress may have you running for the refrigerator or the cookie jar in record speed. And, stress, not just the cookie, may be adding to your weight gain.

Stress, combined with your slowing metabolism can be weight-gain whoppers! Stress triggers cortisol, a powerful hormone that stimulates appetite. I call this "toxic stress" because it can add fat deposits around your waistline, literally from the inside out. Cortisol causes the fat cells inside your abdomen actually to fill with more fat. This type of fat accumulation is especially dangerous because it is associated with increased risks for heart disease, cancer, diabetes, stroke, and other life-threatening illnesses-that's why I call it "toxic weight."

In your 40s, your hormones begin to fluctuate and ultimately decline (especially in your late 40s, in the few years before to menopause, which occurs around age 52 for most U.S. women). Mood swings, intense food cravings, difficulty concentrating, and muscle fatigue, are just a few of the symptoms associated with declining hormones-namely estrogen levels.

Pear or Apple?

Weight management experts use the hip-to-waist ratio to calculate potential health risks from obesity. Calculated as the measure of a person's waist at it's smallest point, divided by the circumference of the hips at their widest point, this ratio distinguishes people who carry weight around their waist-"apples"-from "pears" those people who carry more fat on their hips and thighs.

Most women are "pears" because estrogen stores fat in the hips, thighs, and buttocks in women. Fat deposits in these area play an important role during pregnancy, though following menopause, weight gain tends to be distributed differently. Most men are "apples" because testosterone stores fat around the abdomen.

Excess weight in the hips and thigh area does not appear to be associated with any life-threatening condition. Excess abdominal fat, however, has been shown to be more of a health risk because it is more metabolically active than fat located in other areas of the body. For example, abdominal fat seems to trigger increases in blood cholesterol and is associated with insulin resistance, which triggers diabetes. Health risks increase for women for a waist-to-hip ratio of 0.80 and above.

Calculating Your Hip-to-Waist Ratio

Want to know your risk? Here's how to take that measurement:

Relax your stomach. Use a tape measure to find the circumference (measurement around) in inches of your waist at its narrowest point

Waist measurement:______

Then, measure the circumference of your hips at the widest point (around the largest area of your buttocks).

Hip measurement:________

Finally, divide these two measurements:

____(waist) /___ (hip)=________. This is your hip-to-waist ratio.

What's Next?

There's no need to dread growing older. There's plenty to look forward to.

If you perceive the effects of aging as something that can't be changed, you will be overwhelmed. Your self-image is critical at any age. Don't let it be a victim of the aging process.

There are no quick fixes for your waist-line woes. It will take some time and some work to change your lifestyle and begin to see results. It's no secret. Exercise and a low-fat diet WILL help.

Exercise. Physical activity helps turn off appetite initially, but generally increases appetite. Weight remains more or less stable because more calories are burned as muscle mass increases. When combined with a low-fat diet, you'll lose some weight; what's most important though is that exercise will help change your body composition-you'll begin to see the apple transform into a pear Start with adding walking to your daily routine.

Eat smart. Break the "diet" cycle. Focus your weight loss goals to no more than one-half to one-pound per week. Gradual weight loss is easier to maintain and helps refocus goals on improving eating habits instead of striving for quick weight loss. Try these strategies:

• Spread meals throughout the day; the "little and often" pattern calms the pattern of deprivation-overeating many women have with food.

• Respond to hunger by eating. Pack small snacks fruits, vegetables or low-fat food to grab when those hunger pains and stress kick in. Avoid sugar and carbohydrates, like bread and pasta, which will increase your appetite more and lead to binges.

• Don't skip meals. Prepare and eat meals that are similar in size and stop eating when you feel full. This approach helps the body begin to regulate its own calorie intake and prevents overeating.

• Include between 100-200 calories per day of your favorite food choices. These "treats" will help you from feeling deprived, which can lead to cravings.

• Learn to buy, prepare, and consume less food.

You can look and feel great at age 45+. Remember that those age 20+-something women have a lot to learn!

Pamela M. Peeke MD, MPH, Pew Foundation Scholar in Nutrition and Metabolism, is Medical Advisor to the NWHRC; she also is an Assistant Clinical Professor of Medicine at the University of Maryland, Baltimore, and author of the best selling book Fight Fat After Forty (Viking Press, 2000).

Click www.drpeeke.com, Dr. Peeke's Web site featuring health and wellness issues for women.