Why fat distribution matters more than weight
The location of fat stores has a greater impact on metabolic health than total fat mass. Visceral fat — stored deep in the abdominal cavity, associated with the apple shape — is metabolically active in a harmful way. It releases inflammatory cytokines and free fatty acids directly into the portal circulation, contributing to insulin resistance, dyslipidaemia, and elevated cardiovascular risk. Subcutaneous fat stored in the hips and thighs (pear shape distribution) is far less metabolically active and carries substantially lower risk.
The waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) quantify this. The WHO defines elevated cardiovascular risk at WHR > 0.85 in women and > 0.90 in men. The WHtR threshold of 0.5 — "keep your waist circumference below half your height" — is a simple rule of thumb that performs comparably to more complex measures in predicting cardiometabolic risk across populations.