When Savard was a girl growing up in York, Pennsylvania, she and three of her four sisters were always borrowing each other’s clothes. Because they sewed, they noticed that they needed bigger patterns on the bottom and smaller patterns on the top to fit their flat chests, small waists, and big hips. Millie was the only sister who couldn’t partake of the clothes-swapping. Millie took after her dad’s side of the familyher body was more straight up-and-down, what Savard now calls an “underweight apple.”
Savard filed this information away in the back of her head as she went through nursing school and medical school. In 1976, the same year she received her medical degree, her mother was one of 120,000 nurses who agreed to take part in the Nurses’ Health Study, a National Institute of Health-funded study run by Harvard researchers to investigate the risk factors for major chronic diseases in women. Every few years, they sent Marie’s mother a questionnaire. Throughout the 1970s, they’d ask for her height and weight. Sometime in the 1980s, they began asking for her waist and hip measurements. It became a Savard family joke that her mother went to measure her waist and all her father, a mechanical engineer, had to offer was a slide rule.
Meanwhile, Savard began practicing as a general internist and noticing body-shape-specific patterns in her patients. She noticed that her menopausal, bottom-heavy patients had no side effects from estrogen therapy. She’d prescribe hormones for them, and they’d soak it up. But other women would blow up from the hormones. Their breasts would get bigger and their blood tests might come back a little peculiar. Their bad cholesterol would be really low, their triglycerides would be kind of high, and their blood sugar would be borderline. Sometimes their liver tests would be slightly off. The gastrointestinal doctor would notice that there was a little fat in their liver. All of this would happen to the women who were “top-heavy,” as Dr. Savard called it back then, like her sister, Millie.
In 1998, Savard was appointed medical director of the Center for Women’s Health at the old Medical College of Pennsylvania, and she signed the contract to write How To Save Your Own Life. She went on the lecture circuit to talk about women’s health issues. At her talks she used a slide of an apple sitting next to a pear to illustrate belly fat, one of the factors that contributes to heart disease. In the 1990s, researchers were finding that fat was a metabolically active tissue rather than a space-filler, an inert mass. They found that the subcutaneous fat that collects around the thighs, hips, and buttocks, is harmlessat least until it becomes heavy enough to put a strain on the heart and joints. But the visceral fat that wraps itself around our organs and muscles is a much more active organ, releasing fatty acids into the bloodstream, causing inflammation and raising blood pressure. Though studies citing the importance of waist circumference as an indicator of later health problems were out there, the average American who wasn’t up on the Annals of Internal Medicine wouldn’t have noticed.
Savard didn’t connect the dots, either, until the results of the Nurses’ Health Study were published in a book called Healthy Women, Healthy Lives. Savard’s mother sent it to her as a gift in 2002, and when she sat down to read it, all of the seemingly random pieces of information that had been swimming around in her head came together. “It crystallized,” she recalls between sips of coffee, sitting in a conference room after the lunchroom talk. While she was reading the book, she kept a supply of yellow stickies nearby, and she marked page after page, underlining passages that resounded. It was a rush. “I had had this sixth sense that we were missing something,” she says, “that there was something that didn’t add up. And it was like the more I looked in the book, the more I found.”
She kept jumping up and interrupting her reading to check each chapter’s references online. She found that people had been studying body-fat distribution for some time, especially in Europe and in the U.K., where there are more apple-shaped women. “Oh my god,” she thought, “the whole world of women’s health should be viewed through the lens of body shape.” This was why women looked so complicated to researchers, why the studies never showed what the doctors wanted them to show.
The perfect example happened to be in the newsthe NIH had just halted a study on the effect of estrogen on post-menopausal women because of a demonstrated increase in risk of stroke and little evidence that the hormone prevented heart attacks. But the Nurses’ Study found that estrogen reduced the risk of heart disease by 50 percent. How could the studies oppose each other so completely?
Savard realized that the halted study had only looked at apple-shaped women. The researchers discouraged women with hot flashes from applying, since they didn’t want their subjects to be able to tell whether they were receiving the placebo or the hormone. Limiting their subjects this way effectively cut out pear-shaped women, since they don’t have the visceral fat that continues to produce estrogen post-menopause that cuts down on hot flashes.
“I was like, ‘Oh my god, we’re making assumptions about all women based on 65-year-old apple-shaped women who are already naturally full of hormones,” says Savard. “Of course they did worse.” In chapter after chapter she read that women shaped like apples are more likely than pears to get breast cancer, to get heart disease, to get osteoporosis, and to get diabetes as well as its precursor, metabolic syndrome.
All of this could have meant a world of difference for Millie. If someone had linked her borderline cholesterol and blood sugar with her high-risk body shape, she might have been able to guessand preventwhat would be in store if she didn’t lose those inches around her waist. Savard saw now that she could have advised her sister to make certain lifestyle changes that may have kept her from getting diabetes. She could have taken the easiest preventive measures, such as swallowing an aspirin a day or taking a folic-acid supplement. Preventing an incurable disease might have been an effective incentive for her to lose her excess weight.
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©2005 The Pennsylvania Gazette
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