When Plus Size Is and Is Not a Problem
Is the new trend toward plus sized models dangerous?
Posted Feb 05, 2015
Ashley Graham, a plus-sized model, will make history by appearing in an ad in Sports Illustrated’s annual swimsuit issue. And social media is abuzz with commentary. ETonline applauded the move, describing Graham as "a curvier woman totally rocking a string bikini." USA Today described Graham as "a gorgeous plus-sized model."
But SI's move is not without it's naysayers. "It’s taken over 60 years for a plus-size woman to appear in a Sports Illustrated advertisement", gripes Samantha Allen of The Daily Beast, "and, even then, her body is the smallest, fittest, and curviest it can possibly be." Some commenters, such as Ann Yekaterina, go so far as to object to SI's move as a dangerous one that promotes unhealthy obesity: "I also do not understand our obsession with plus size—as in, why you keep telling people it's healthy to be 50 to 60 pounds overweight."
It's all about that waist.
Is Ashley Graham an example of unhealthy obesity? If we define obesity solely in terms of weight, it would be hard to avoid that conclusion. But her shape suggests otherwise.
Like slender models who are also healthy, Graham has a flat belly and a narrow waist compared to her hips. These features are the biological equivalent of a car's idiot lights: A flat belly and a waist-to-hip ratio of about .7 are signs that all is probably very well within. A protruding belly and waist-to-hip ratio greater than .7 signal otherwise.
Compare these three female shapes. Doctors sometimes refer to the one in the middle as "pear shaped" and the one on the right as "apple shaped". The apple shape is a cause of concern.
Women whose waist-to-hip ratio is about .7 have lower risk of major diseases such as diabetes, cardiovascular disorders, and ovarian cancers. As a woman's waist approaches (or exceeds) her hip size, her risk of disease increases, sometimes quite dramatically. A 2005 study at Columbia-Presbyterian Medical center in New York found that women with greater than the average waist/hip ratio had almost triple the risk for ischemic stroke compared to subjects with below average waist/hip ratio. Another study published in 2005 in the Medical Journal of Australia found that Waist–hip ratio is the dominant risk factor predicting cardiovascular death. And a third study published in 2005 in the American Journal of Epidemiology reported a link between waist-to-hip ratio and breast cancer risk in both African-American and Caucasian women.
Waist-to-hip ratios greater than .7 also greatly impact a woman's ability to conceive. According to a 1993 study published in the British Medical Journal a woman with a WHR of .9 was nearly a third less likely to get pregnant than one with a WHR of .8, regardless of her age or weight. Similar results were also reported in a 2001 study published in Medical Post. Zaadstra, B. et al. BMJ 1993
The importance of a healthy waist-to-hip ratio applies to men as well, although the ideal for men is .9 rather than .7. Men with waist-to-hip ratios around 0.9 suffer less prostate and testicular cancer, and less cardiovascular disease. They are also more fertile. A 2008 study involving 5,000 men published European Society of Human Reproduction and found that men whose waist to hip ratio was either much higher or much lower than .9 had a 60 percent higher chance of having a low volume of semen and 40 percent higher sperm abnormalities.
So the bottom line is this: A plus size isn't a plus size isn't a plus size. How and where the extra weight is carried matters to overall health and fertility. As long as your medical lab tests (e.g., cholesterol, blood pressure, blood sugar) are normal, ignore what other people say about your body shape.
Copyright Dr. Denise Cummins February 5, 2015
Dr. Cummins is a research psychologist, a Fellow of the Association for Psychological Science, and the author of Good Thinking: Seven Powerful Ideas That Influence the Way We Think.
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