Whether it's pleasantly plump or straight like a string bean, bodies come in all shapes and sizes. That shape isn't necessarily an indicator of overall health. But storing fat in different areas of the body can be a strong predictor for certain diseases, including stroke, diabetes, heart disease and others, according to the Harvard T.H. Chan School of Public Health.
Subcutaneous Versus Visceral Fat
One important indicator of body shape is fat — both the type of fat someone carries and where it's carried on the body. Not all bodily fat is created equal.
"Fat that you can squeeze is called subcutaneous fat, and it's much harder to lose," says Tamyra Rogers, MD, a family medicine practitioner in San Antonio, Texas. Subcutaneous fat sits under the skin and is found primarily in the thighs and butt, says Rogers. It has some health benefits, including storing energy for the body and protecting bones and muscles from injury. Too much subcutaneous fat can increase the risk of disease as well, according to the American Diabetes Association (ADA).
Then there's visceral fat, which is always dangerous according to Dr. Rogers. Visceral fat is undetectable from the outside and surrounds vital organs like the pancreas, liver, stomach and intestines. A September 2017 study published in PLOS One revealed that visceral fat — particularly in women — was strongly associated with cardiovascular disease, insulin resistance and hypertension.
To measure visceral fat, place a tape measure just above your hipbone around your bare stomach. Make sure the tape is level, relax, exhale and measure without sucking in. If this measurement is greater than 35 inches for women and 40 inches for men, that's an unhealthy amount of fat according to Mayo Clinic.
Not sure what body type you are? Here are four different body shapes based on how people can store fat, and how each one may impact overall health.
1. Apple Shape
People with an "apple shape" carry fat in their midsection with less fat on their arms, hips and legs. This is the type of body shape with the most associated health risks.
"If someone is an apple shape, it usually means that this person has a big waist-to-hip ratio, which indicates a lot of visceral fat," says Dr. Rogers. "When fat surrounds organs we get problem with inflammation in the body, and inflammation causes disease."
According to Dr. Rogers, inflammatory diseases associated with high levels of visceral fat include cardiovascular disease, diabetes and an increase in endometrial, breast and colon cancers. In a July 2019 study of 156,000 postmenopausal women published in JAMA Network Open, subjects who carried extra fat in their midsection had a much higher likelihood of death from cancer and cardiovascular disease than women without midsection fat, even after adjusting for socioeconomic status and other lifestyle factors.
While visceral fat may be more dangerous than subcutaneous fat, it's also much easier to lose, Dr. Rogers says. Visceral fat responds particularly well to aerobic exercise and strength training, according to information from Johns Hopkins University. Experts recommend at 150 minutes of moderate-intensity physical activity per week, including muscle-strengthening exercises on two or more days each week, according to the U.S. Department of Health and Human Services.
2. Pear Shape
People who carry fat in their butt and hips with less fat in the shoulders and bust are considered "pear shaped," says Lina Velikova, MD, PhD, a clinical immunologist and professor at the Medical University of Sofia at Bulgaria.
"Being pear-shaped is safer since fat stored in legs has little potential of reaching vital organs," Dr. Velikova says. "On the other hand, people with this body type often develop problems with their veins and joints since they're being asked to support a lot of weight."
While spot reduction weight loss is not possible, an April 2018 review published in the Journal of the American Heart Association found that study participants lost subcutaneous fat in their legs and arms with the help of a high-protein diet (between 15 and 30 percent of their daily caloric intake).
3. Straight or Ruler Shape
A common misconception is that people with a straight or "ruler-shaped" body — meaning no areas of visible fat — are generally healthy. Looks can be deceiving, Dr. Velikova says. "Just because their fat isn't located in a specific place, like with an apple or pear-shaped body, doesn't mean they don't have it," she says.
This concept is often referred to as "skinny fat," meaning that although someone might have a healthy Body Mass Index (BMI), they still carry visceral fat around their internal organs. This presence of fat can lead to the same type of health problems as people with an apple shaped appearance, says Dr. Velikova.
"It's common with this body type that you can lose bone density over time, which can lead to osteoporosis," she says, adding that people with lean figures often have a harder time building muscle — something that's necessary for good bone density.
When your hips and bust are similarly sized and you have a narrow waist, you've got an hourglass figure. For years, experts have considered this "healthiest" body shape since the waist-to-hip ratio is low, according to Dr. Rogers. Those with an hourglass shape tend not to have a lot of the associated health risks that the other body types have, but they can still carry visceral fat near their internal organs or extra subcutaneous fat around their stomach area, she adds.
The tricky part? Visceral fat can't be seen or easily measured, says Dr. Rogers, who uses a specialized scale and MRI in her own practice to differentiate between visceral and subcutaneous fats in her patients. The best bet for keeping visceral fat at bay is a diet full of healthy fats, low carbohydrates and regular exercise, she says.
- The Harvard T.H. Chan School of Public Health: "Healthy Weight"
- American Diabetes Association: "Subcutaneous Abdominal Fat and Thigh Muscle Composition Predict Insulin Sensitivity Independently of Visceral Fat"
- PLoS One: "Body fat distribution, in particular visceral fat, is associated with cardiometabolic risk factors in obese women"
- JAMA Network Open: "Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women"
- Johns Hopkins Medicine: "The Skinny on Visceral Fat"
- Obesity: "Postmenopausal Sex Hormones in Relation to Body Fat Distribution"
- Journal of the American Heart Association: "Relationship Between Changes in Fat and Lean Depots Following Weight Loss and Changes in Cardiovascular Disease Risk Markers"
- The Journal of Strength & Conditioning Research: "Regional fat changes induced by localized muscle endurance resistance training."
- Journal of Hepatology: "The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content"
- U.S. Department of Health and Human Services: "Appendix 1. Physical Activity Guidelines for Americans"
- Mayo Clinic: "Belly fat in men: Why weight loss matters"
- Mayo Clinic: "Belly fat in women: Taking — and keeping — it off"