MARIE Savard was on the island last week, the featured speaker at a corporate wellness health fair organised by Colonial Medical Insurance in collaboration with The Athletic Club.

An internationally-acclaimed internal medicine physician and women's health expert, Dr. Savard is the author of , a book which speaks on a novel approach to losing weight, living longer and feeling healthier.

While here, she spoke with Mid-Ocean News reporter HEATHER WOOD and photographer CHRIS BURVILLE on the importance of viewing life from an apple-and-pear perspective.

Q: What drew you to women's health?

A: As a female doctor it came naturally, I suppose. I've been fascinated with women's health issues for years. I trained as an internist and always took care of men and women but as a physician in the days when there weren't that many women physicians ? at least not in the United States ? I noticed I was kind of drawn to the diseases and things that women had.

And there was always this difference with women based on their body shape. I always observed that there was a certain pattern with women ? the ones who had the diabetes, the heart disease, the breast cancer ? and nobody was talking about that.

And the other thing I'd noticed early on, that those women with more upper body fat, if they went through menopause and you put them on oestrogen, they would suddenly start bleeding heavily and they would blow up. They would be uncomfortable. Yet a woman who's pear-shaped, someone who is narrow on top and large on the bottom, would be a sponge for oestrogen after she went through menopause.

Q: What led you to believe that your theories were scientifically true?

A: My mother was one of the original nurses involved in the famous Nurses' Health Study which has been the source of so much important information for women. It involved the largest observational study of women in the United States ? 120,000 women ? and began in the 1970s and it's from there that a lot of the research on hormones and everything else has come from today. They published a book summarising their research.

Because my mother was one of the subjects, she kept abreast of the study and sent the book to me. What they found, and detailed in page after page, was that the risk of heart disease, diabetes, of osteoporosis, breast cancer, ovarian cancer ? of so many diseases facing women ? depended on their body shape. They compared the shapes by referring to them as apples versus pears.

Q: From there you determined to share that information?

A: It was then I thought, 'You know what? This is the hook to get women to pay attention to their health.' Women tend to think, 'That's not going to happen to me. I'm not going to get heart disease. Somebody else is going to get diabetes ? it doesn't run in my family.'

Frequently, they would go to the doctor's office with their chest pains and the doctors would ignore them. I realised that if they knew they had something as powerful as the shape of their body to tell them what they are at risk for that would be extraordinary. So I dug deeper and deeper and started to find amazing research.

Q: And it was then you discovered the apple versus pear theory to be correct?

A: Yes. And, based on that understanding, if you show me any woman, I can forecast her health destiny just by observing her body shape. Women's bodies can be categorised as either 'apple-shaped' or 'pear-shaped' depending on where they are most likely to put on fat, even if they aren't currently overweight.

Women who tend to gain weight around their waists are said to have apple-shaped bodies because, like the fruit, their weight collects around their middles. Women who tend to add extra pounds around their hips, buttocks and thighs are said to have pear-shaped bodies because, like the fruit, they are widest at the bottom.

These terms have been around for decades but they have mainly been used as physical descriptions much the way we might say that a woman is blonde or brunette. Only now are we realising the powerful physiologic effects of being either an 'apple' or a 'pear'.

Q: Do most women who are aware of the two categories instinctively realise what they are?

A: Most women think they already know what they are but many can get confused about what is an apple and what is a pear. The key to being certain is the waist-to-hip ratio (WHR).

Get a flexible tape measure and measure around your waist. If you have a visible waist, measure around the narrowest part.

If you don't have a waist measure around the widest part of your middle, usually about one inch above your navel. Do not suck in your gut. Hold the measure loosely, without putting pressure on the skin.

That number is your waist circumference. Next, measure around your hips ? not at the hip bones but about three to four inches lower, around your buttocks. You're looking for the biggest part of your body.

Divide your waist measurement by your hip measurement and you come up with a ratio, the scientific definition of whether you're an apple or a pear. If your WHR is 0.8 or lower, your body is classified as pear-shaped. If your WHR is higher than 0.80, your body is classified as apple-shaped.

Q: Which means?

A: If you are considered pear-shaped, that means you are genetically predisposed to have the least dangerous kind of fat.

Women who fall into that category pack on what's called the subcutaneous fat ? a kind of hormone ? driven fat. Subcutaneous fat is the stuff that jiggles, the soft stuff we pinch and poke and generally hate to see on our bodies. It's fat that you get at puberty for the first time, fat that is strictly a storage vehicle of energy for women to help when they go through child bearing and breast feeding.

Pear-shaped women are actually nature's idea of perfection. They have more regular periods. They have reduced risk of heart disease ? that's what's exciting.

Q: And apple-shaped women?

A: Fat differences are what make apple- and pear-shaped women so varied in terms of how they look, their risk of disease, and their metabolic activity.

To be an apple-shaped woman means your body chemistry is dominated by androgen, the typically male hormone. Apple-shaped women tend to gain weight in the same way men do ? round the waist, with much of it in the form of visceral fat.

Apple-shaped women have the type of fat that promotes heart disease, whereas pear-shaped women have the type of fat that protects against heart disease. Overall the disparity between the body shapes is so dramatic it's as though we are looking at two entirely different groups of people.

It's important that apple-shaped women, the straight-up-and-down types, are alert to their health risks and what they can do about them. And pear-shaped women need to be reassured that they don't have those same health risks, that, if anything, they should have better self esteem.

In the United States, and I'm sure it's the same in Bermuda, women are who bottom heavy ? women who have a big butt, hips and thighs ? they hate it. They want to be like those little waif things on the magazines who aren't necessarily healthy. The Gwyneth Paltrows of the world are straight up and down. When she gains weight as she gets older, it's going to go to her middle. She doesn't have that protective healthy fat that the pear-shaped woman has.

Q: And this is now universally accepted as a determinant for future health?

A: World-wide, everybody is going to be looking at body shape. I was certainly one of the first to put the information together in one prose so that a consumer could read it, but the same information was revealed in a study that was published in a journal of the American Medical Association in December of last year.

There was a world-wide study involving, I think, 27 different countries and 52,000 men and women. They were trying to look at the particular risks for heart disease and whether there were differences by country, ethnicity, whatever.

They found that the shape of a man or a woman was three times more powerful a predictor of heart disease or heart risk than their Body Mass Index or their weight versus height.

At the end of the article, they stated we had to stop focusing on the scale. And that's what I write about in my book. Let's stop focusing on how much people weigh and focus on their shape ? the inches around their waist, their health.

Q: On reflection, had you observed this in your own patients?

A: One story I talk about in the introduction to my book is that the fuel to writing the book itself was the fact that I saw it through my practice, I saw it through my research, I saw it in my own family. I had four sisters. Three of us, when we were younger, were classic pear shapes ? sort of skinny on top and bigger on the bottom.

We could share clothes. We would sew and we would laugh because we would get patterns that would suit us, ones that were smaller on top and bigger on the bottom. I had one sister who had gorgeous muscular legs ? she was the one who wore the mini-skirts.

She couldn't wear our clothes because she could never fit into a belt. She didn't have the same waist size. She was straight.

Sure enough, flash forward years later. She gained weight and gained it all in the middle and now has Type 2 Diabetes, high blood pressure and all of the problems related to it. That was one of the final triggers for me.

I wanted to speak to women to get them to know that years before they end up with diabetes they can identify what they're at risk for and that's the hook to get them to take whatever that individual step is that will make a difference.

Q: Can diet transform a woman from one shape to another?

A: We now know there's so much people can do but you can't change your shape. If you're naturally born as an apple, you can't ever become a pear. You can't suddenly pack on the fat selectively in your butt, hips and thighs.

What you can do is shrink inches around your waist and reduce the risk of the diabetes, heart disease, whatever, because you're getting rid of the dangerous fat.

A woman who's apple-shaped will tell you right away, 'I've never had a waist. I could never wear a belt. I've got strong, great, gorgeous legs. I can wear the mini skirts, but I gain all the weight in my torso area.'

Those women are genetically programmed to gain visceral fat, the fat that men store selectively ? we often call them beer guts. It's not passive blubber that sits there and once you've got it, it ain't going anywhere.

This fat is very active, spewing out chemicals and things that raise your insulin, your blood sugar, your celiac protein and increase your oestrogen levels. What's really interesting about that is that when women go through menopause they start packing on more of this fat because they've lost their (healthy) oestrogen and their ovary function.

This potent oestrogen places them at a much greater risk of breast cancer or cancer of the lung and the uterus. It's another danger that somebody who is apple shaped has to consider.

Q: So it's not so much about dieting as it is about diet? What can women do?

A: There's a lot women can do. First, they should know what their natural body shape is and embrace that, whatever it is. If you're a pear shape, don't give in to eating disorders or low self- esteem ? your shape is just nature's idea of health and kind of who you are.

Pear-shaped women have great risks of cellulite. They have varicose veins. Their bones are less dense because they don't have that male hormone balance so they need to be more careful about calcium and worry about their bones.

Researchers believe that low-fat eating is crucial for weight loss and weight maintenance in pear-shaped women. Once they lose the weight from their pear zone, the fat cells are still there ? they decrease in size not number ? so they will still have disease protection.

If they maintain a low-fat diet they should be able to keep from filling those fat cells back up again. One very pear-shaped woman I know swears by what she calls a No Cheese Diet whenever she wants to lose weight.

All she does is stop eating cheese and other blatantly fatty foods for three months and she drops a full pant size. Given the metabolic actions of pear-zone fat this makes perfect sense.

A study published in 2004 found that eating a high-carbohydrate, low-fat diet helps women significantly decrease their thigh fat in just 12 weeks.

Q: Are there outside factors that affect one's shape or is it all genetics?

A: There are lots of things that can sabotage your shape. One is stress. Stress produces cortisol, which is probably turning many of us into apples. More and more women are becoming apple shaped and they think stress is a big factor.

A second is lack of sleep. We always recognised a proper night's sleep as a good thing, but now we're really seeing the research. Getting seven or eight hours of sleep is critical. It reduces visceral fat because it lowers your cortisol.

World-wide studies show apple-shaped men and women who were pre-diabetic ? if they lost two inches around their waist it reduced the likelihood of diabetes or heart disease by 60 or 70 per cent.

Believe it or not, the one thing you can do that's going to lose visceral fat more than anything else is exercise. People who exercise are going to lose more than people who just reduce calories. Of course the combination of both is optimum but exercise is really critical.

Liposuction doesn't work. They did a study where people removed fat from around the abdomen in hope that maybe the diabetes risk would go away ? they did liposuction just under the skin without removing the dangerous fat. The results were published in a study in the New England Journal of Medicine ? they found no difference in the blood sugar insulin.

What they realised is that the fat which lies immediately under the skin is not dangerous. It's the internal fat, the organ fat, the liver fat, that we need to get rid of. We need to burn it off, shrink the fat cells, starve them basically by exercise and then eventually by diet.

Q: Any diet?

A: There is a very definite pattern of diet that's been shown to reduce inches around the waist. I call it the three Fs ? fat, fibre and fitness.

Healthy fats are great and important for apple-shaped adults because they reduce the risk of heart disease. So all mono-saturated fats ? things like canola oil, olive oil, and oil from fish sources are great. Now there's even exciting products being produced such as egg products without cholesterol with all the good protein.

Then there are trans-fats, the fats they put in a lot of foods and margarines as a preservative because it prolongs the shelf life.

Those shorten your shelf life. They lower your good cholesterol and increase your risk of cancer. But if you're eating healthy fats, where do red meats fit in? Where does pork fit in?

Basically, it says that you wouldn't be eating those because any other source of animal protein is already going to have saturated fat with it. So they are fine.

They are a good source of protein, but not the absolute best food you can eat. We now know that a diet should be as plant based as possible plus fish. That is probably the healthiest way to go ? that's kind of the Mediterranean-type diet.

So, eat lots of healthy fats and eat fibre. Fitness is also important. We need daily exercise to achieve fitness of sleep and fitness of spirit in terms of social relationships. All of those things are all important in reducing stress.

Q: Earlier you mentioned that women who are pear-shaped should automatically adopt a healthy sense of self-esteem. That's not always easy though wouldn't you agree?

A: It's easy for me to tell women to love their shape but I realise we all care about looking a certain way. The good thing that I'm hearing as I speak to more people is that they're recognising what's healthy for them. They're saying to me, 'Thank you for making me not feel so bad about my body.'

There was a period of time when we probably thought the skinnier you were the healthier you were. If you think about it when you went to the doctor's office what's the first thing the doctor did? Put you on the scale.

Some of my female patients wouldn't come to me in the old days because they hadn't lost weight. But today we've got the J. Lo's (Jennifer Lopez). People are starting to put padding in their butts and thighs to achieve that look. The pendulum is swinging and I think it will swing so that curves are okay.

Q: What's a healthy waist size for an apple-shaped woman?

A: As close as possible to 30 but definitely well under 35 inches around the waist. For Asian women, because they are naturally tinier, they have risk of diabetes at 32 inches, but pretty much for the rest of us it's 35. Men in general are 40 inches. Forty or above for men is a big red flag.The challenges apple-shaped women face are heart disease, diabetes and cancer. Their diet should consist of high complex carbohydrates, accompanied by moderate fats and protein.

The worst foods for them are white flour foods and when it comes to menopause, they should try and avoid hormone therapy if possible.

For pear-shaped women, their health challenges are varicose veins and osteoporosis, they should try to keep a diet that's low in fat, with moderate protein and high complex carbohydrates. The worst foods for them are cheese, butter, salty foods and candy. At menopause, hormone therapy can help stave off bone loss.

We really are all unique and I think at the end of the day, that's the message to women: not only knowing your family history and what is it about you that's unique and the choices that you can best make.