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The higher the SAD measure, the greater the risk of disease, and although norms have yet to be established for this measure, indications from the Georgia laboratory suggest that a SAD measure of greater than 25cm indicates an elevated health risk.

The abdominal diameter index, also developed by the Kahn team, is an attempt to compensate for the lack of perfect predictability of the SAD measure of visceral fatness.10 Because the sagittal measure includes not just visceral fat but bone, muscle and subcutaneous fat, the Georgia team have attempted to adjust for the non-visceral tissues that are incorporated in the SAD measure by dividing waist thickness by the girth of the mid-thigh. This also adjusts for overall body size as thigh thickness can be a good indication of total body size. ADI then becomes almost twice as powerful for the prediction of cardiovascular risk as the SAD alone.

Again there are, as yet, no well established norms for ADI. Early indications are that ADI measurements of over 0.5 (i.e. the cross-sectional thickness of the waist is over half the circumference of the mid-thigh) are highly predictive of risk for coronary heart disease.

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But society’s ideals are at war with our bodies’ natural design. The war takes place on a vulnerable battleground: our minds. For some women, these conflicts may be temporary (a bout of crash dieting, perhaps) and will be followed by some kind of acceptable truce (“Okay, I’ll eat normal meals, but no more desserts”). Other people, however, need additional support to resist social pressure. Without such protection, people become victims of a strange syndrome, one whose symptoms are a distorted body image, bizarre eating patterns, illness, and much unnecessary suffering.

How does our culture develop and transmit this deadly message about thinness? Why should thinness be the social currency we value? Let’s look.

Envision the “ideal” female figure. What comes to mind? In this society, many people—men as well as women-probably conjure up an image of Miss America or a Playboy centerfold. Purely in the interest of science, a team of researchers carefully analyzed the body measurements of these icons of feminine beauty over the past few decades. They made a surprising discovery: As a general trend, each year the women chosen as these ideals have been thinner than their predecessors. This is odd when you realize that the average weight of the population has increased over the same time period. Thus there has been a widening gap between the “ideals” of female beauty and most women’s actual weights. These beauty queens’ relative body weights are actually lower than those of 95 percent of the female population!

My heart goes out to today’s woman, whose body may be perfectly normal but who believes that she must compete against this absurdly distorted vision of ideal beauty.

Our culture’s perception that the ideal female form should be abnormally slender is a fairly recent phenomenon. One of my bulimic patients, an eighteen-year-old college student, told me she had watched a Marilyn Monroe film on television. “Marilyn Monroe was such a pig!” she exclaimed. “She was so fat!” Strange to think that what was seen as sexy and attractive thirty years ago is now condemned as “fat.”

Although there are some historical precedents for similar distortions of the feminine ideal, such as the Victorian eighteen-inch waist, never before have they had such an impact on the vast majority of women. Media, such as women’s magazines, very often add to the confusion about body image. For example: The number of articles about dieting appearing in these publications has doubled every decade since World War II. Yet these same magazines present page after page of recipes for “luscious desserts” and “family-pleasing treats” illustrated with glistening, mouth-watering photographs. Mixed signals? You bet.

Since World War II, our food-buying and eating habits have also undergone a radical change. Food is plentiful, and its variety is enormous. Many of today’s foods are very palatable but rich in calories due to their high fat and sugar content. Fast food-from chain restaurants to microwave meals in our own homes-has revolutionized how and what we eat. And in our sedentary society, the only exercise some people get is pressing buttons on their television’s remote control. Given these facts, it actually does make some sense for people to be on their dietary guard.

For some people, however, an irresistible force (social pressure to be thin) meets an everyday temptation (tasty, abundant food) and produces an extreme reaction (an eating disorder). People at special risk include those who:

• have low self-esteem

• are overly sensitive to the opinions of others

• carry the concept of self-control to extremes

• have difficulty separating from their families

• Work in occupations that require a high level of body-awareness, such as modeling, dancing, or acting

When people with these characteristics suffer stress—for example, the death of a relative, a move to a new school or city, or a personal loss such as the breakup of a romance—an eating disorder is sometimes the result.

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George, a computer consultant from Manalapan, New Jersey, was just about to turn 50 when he found out that he had diabetes and heart disease. “I wasn’t really surprised, since both conditions ran on both sides of my family and I had been overweight for years,” he says. But it was enough to motivate him to trim 40 pounds off his 6-foot-2-inch frame by eating more healthfully and exercising regularly. “I didn’t want a life of excess medications and insulin shots,” he explains.

For years, he was happy about his new 185-pound physique, but he knew he could stand to lose a little more. At age 58, he was still stuck with what he calls “4 or 5 pounds too much George.”

On the suggestion of one of his grown kids, he visited Ann M. Chicchi, a registered dietitian in East Brunswick, New Jersey. She looked at George’s overall diet and exercise plan—which was good— and did some fine-tuning. She gave him a lower-calorie, low-fat eating plan that incorporated all of the nutrients that George needed. The plan also kept his carbohydrate intake at a level that was more appropriate for someone with diabetes and high triglycerides.

George took the food plan and molded it to fit his eating style. Instead of three large meals a day, he created a fourth small meal of whole-grain foods. “The complex-carbohydrate portion that Ann allotted for my breakfast I found more satisfying as a snack of whole-wheat crackers or bread around 9 o’clock at night,” he says. He still had a good-size breakfast each morning, but he also had something low-fat and nutritious to nosh on before bedtime.

The result was that he finally shed those last few nagging o pounds, and his next blood work came back much improved as well.

So now “4 or 5 pounds too much George” can call himself I cr3″ “just-right George.”

WINNING ACTION

When you hit the wall, call in a pro. If you’re having trouble taking off those last few pounds, consider enlisting the help of a registered dietitian. To find one near you, contact your doctor or your local hospital for a referral. If group support is more your style, look in the Yellow Pages under “Weight Control Services” for organizations such as Weight Watchers and TOPS (Take Off Pounds Sensibly).

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