For years, conventional wisdom and some research held that the pear was better than the apple, as least for body shape and health.
"We never believed that," said Dr. Soma Sen. "Having too much weight on any part of your body is certainly not good."
Part of her charge as a cardiologist at Park Nicollet Medical Center is coaching patients as they struggle to cut fat that has accumulated around the abdomen (the apple shape), or on the buttocks and thighs (the pear).
A recent study confirmed what Sen and many other experts had surmised: Far from being benign or even offering some protection against diabetes, heart disease and strokes, the gluteal fat of a pear-shaped body generates the same damaging proteins produced by belly fat.
The findings help "dispel the myth that gluteal fat is innocent," said the study's lead author, Ishwarlal Jiadal of the University of California, Davis.
The research also buttresses efforts by the Mayo Clinic and others who are developing individualized approaches to help overweight people get healthier. Mayo experts hope they can offer more effective advice than simply telling patients to eat less and exercise more.
For most people, too much weight, wherever it appears on the body, "puts you at risk of diseases that will shorten your life," said Sen, who heads Park Nicollet's women and cardiovascular health program. "The new research helps makes that clear."
But the California study actually goes much further, said Dr. James Levine, an obesity expert at the Mayo's clinic in Scottsdale, Ariz. In January, the nationally known endocrinologist helped launch a major initiative there seeking new ways to treat overweight people.
"This is exciting, because it's telling us that individuals put on fat in different ways, and it requires a very individualized approach to help them take it off," Levine said. "What works for one person may not work for another, and we don't fully understand why."
It's not that obese people don't care, he insisted.
"On average, my patients have tried 17 times to take off weight without success," Levine said, "and they're still coming back, quite remarkably, to try an 18th time — if we can just figure out the right approach."
Helping people lose weight is complicated by the fact that there are several types of fat, each with different health risks, Levine said. But the risks appear greater with some people than others.
"One person carries abdominal (fat) tissue and is at great risk of premature death, (while) another person with the same tissue is healthy and not at risk. What's the difference?" he asked. "That's what we have to find out."
That's the mission of the Obesity Solutions Initiative, a collaboration between Mayo and Arizona State University. Levine is co-director.
Women tend to store fat on the buttocks, thighs and hips — fat called gluteal adipose tissue. But when they reach menopause and begin producing less estrogen, the fat deposits tend to shift to the belly. Men are more likely to store fat in the belly — called visceral adipose tissue. In addition, people can carry subcutaneous fat, a layer under the skin.
In the past, patients have been told that gluteal and subcutaneous fat were less dangerous, and possibly even somewhat protective compared with visceral fat. But the new study indicates that an oversupply of fat anywhere can increase risk of chronic diseases, maybe even dementia.
"Historically, fat was very beneficial for humans," Sen noted. "It helped us get through periods of starvation that were a regular part of life. Now we don't need it so much, but our bodies don't know that."
So physicians, dietitians and other experts are trying to figure out how to more effectively help overweight patients. "What causes obesity? Genetics, of course," Levine said. "But we're more than a collection of genes. We're individual human beings affected by poverty, cultural traditions, depression, family responsibilities, sexual abuse, transportation needs, mental illness and a bunch of other things."
Levine and Sen both say one problem facing obese patients is that many doctors have only a rudimentary understanding of obesity and don't have time during a typical office visit to explore its complex causes.
"On one hand, it's a simple matter of calories in and calories out — to lose weight, you must burn more than you eat," Sen said. "But it's important to help patients understand how to make that work with how they live. It has to fit who they are."
That's where Levine hopes to offer a helping hand.
His team is studying millions of health records and is working to refine a diagnostic tool that doctors can use to better calculate the risks of fat carried by their patients and to tailor plans to help them shed dangerous weight.
"If we're not publishing results, if we're not getting better information into doctors' offices within a year, come jump on us," he said. "This is really important, and putting the apple-versus-pear argument to rest can only help us focus on getting results."