Are Different Types of Body Fat Created Equal?

No, they’re not. 

Spoiler alert: The fat on your butt and thighs versus fat on your mid-section affect your metabolic health differently.

A standardized tool categorizing severity of obesity with a numeric value at the intersection of someone’s height and weight, the BMI isn’t perfect. For example, the BMI neglects to consider body composition, which is particularly relevant for individuals who are in phenomenal shape but weigh more - mainly avid strength trainers, since muscle weighs more than fat. The BMI also neglects to address a major indicator of metabolic health: how fat is distributed throughout the body.

Body Fat Ratios to Determine Metabolic Health

A 2021 study explored how different body fat measurements— relate to premature death. These include: waist, hip, and thigh circumference along with ratios such as waist-to-hip and waist-to-height.

Note: Researchers assessed participant sex, geography, smoking habits, BMI range, physical activity levels, and comorbidities. However, they did not analyze other significant demographics such as racial / ethnic background differences. These thresholds vary across ethnic groups, which may have misclassified risk.

The waist-to-hip ratio (WHR) measures the ratio of your waist circumference to your hip circumference. It can help determine how much fat is stored on your waist, hips, and buttocks.

The following are considered healthy ratios:

Women: less than 0.8 (obese is greater than 0.85)

Men: less than 0.9 (obese is greater than 1.00)

The waist-to-height measures the ratio of your waist circumference to your height. This measures how much abdominal fat is stored.

The ranges are as follows:

• Below 0.5: healthy range

  . 

• 0.6 or higher: greater risk of weight related conditions

  
  

A 2024 JAMA Open study studying nearly 400,000 adult participants that waist-to-hip ratio (WHR) outperformed BMI in predicting all-cause and cardiovascular mortality.  

The UK’s National Institute for Health & Care Excellence recommends keeping waist circumference under half your height to reduce metabolic risk (total measurements in inches).

Cited by an article published in January 2025, from The Lancet: Diabetes & Endocrinology, “ current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level.” They advocate incorporating waist circumference, WHR (waist-to-hip ratio), or WHtR (waist-to-height ratio) to distinguish clinical obesity versus pre-clinical obesity (when no comorbidities exist). 

An Apple a Day Doesn’t Keep the Doctor Away…

…that is, when using the shapes of two fruits to describe the shape of a body’s fat distribution. 

Pear-shaped Body 

Proportionally more fat is stored in the hips and thighs compared to the upper body, which is considered to be protective fat and linked to lower all-cause mortality. People with pear shaped bodies are linked to having lower blood pressure and cholesterol levels. 

Apple-Shaped Body

These bodies store proportionally more abdominal fat. Visible abdominal fat is the result of visceral fat, which surrounds the organs. Visceral fat is more dangerous than subcutaneous fat as it raises inflammation, insulin resistance, type 2 diabetes, cardiovascular disease, dementia, asthma, and several cancers. Patients prioritizing weight loss should know a concentration of abdominal fat is linked to higher mortality risk compared to BMI and overall obesity where body fat is distributed evenly.

Patients can aim to reduce visceral fat through lifestyle changes through a nutrient dense diet, incorporating strength training into fitness routines, getting an appropriate amount of sleep per night, and learning tools to manage stress, such as meditation. 

Lose More Weight in Less Time

The combination of waist-based measurements with BMI improves health risk assessment and personalizes strategies. Dr. Korman and his team can help you either start or improve your weight loss journey through medical weight loss and surgical weight loss options. Contact the office today for a consultation.