Fat distribution is now regarded as of equal or greater importance to total fat as a health risk and new techniques of measuring fat distribution have recently been developed. Abdominal fat has been regarded as one of the key indicators and measures of this include waist-to-hip ratio (WHR) and the Gonidty or C-Index. Visceral fat, which in the future is likely to prove to be the most powerful predictor of disease, can only be measured in vivo, or in live organisms, through the imaging machines discussed below. How-ever, estimates can be made from techniques that measure abdominal fat including WHR, and the C-index, and more recently using techniques to measure sagittal diameter (SAD), or a measure of abdominal thickness known as the abdominal diameter index (ADI).

Conicity Index (C-Index). The C-Index was developed by Dr Radolfo Valdez and colleagues from Pennsylvania State University in an attempt to combine the best aspects of BMI with WHR or body fat distribution. The C-Index quantifies fat shapes as lying between two extremes; the first a cyclinder, i.e. very lean, and the second, bi-conical.

So far the C-Index has had only limited validatory research carried out on it, some suggesting it may not add significandy to other anthropometric measures. However, variations to this in the future may offer promise for a more sensitive measure.

The C-Index requires measures of height, weight and waist circumference and the following formula:

C = abdominal girth (at umbilicus) in metres/0.109/weight (kg)/height(m)

The range of scores is from 1.00 to 1.73 but, as yet there are no normative figures for comparison. People scoring towards the low end i.e 1.00, are closer to the ideal than those scoring towards the high end i.e. 1.73. The validity of the measure is so far unknown, although reliability and sensitivity could be expected to be quite high.

*65\186\4*

As a physician who has treated hundreds of patients with eating disorders over the past fifteen years, I much prefer the “no-fault” approach to managing eating disorders. Simply put, if you have an eating disorder, or if you are the parent of an anorexic or bulimic child, don’t condemn yourself: You are not to blame.

“Fault” and “blame” are unnecessary-even harmful-concepts. They result in mental roadblocks, such as: “I am sick [or my child is sick] because I am a bad person [or parent]. If I could just snap out of it [or fix the problem], I could make myself [or my child] well.”

Thinking in terms of “fault” is counterproductive. You don’t suffer from an eating disorder because you are “bad” or because you are “not trying hard enough.” On the contrary, I believe you are actually trying very hard to deal with the stresses in your life. Unfortunately, the method you have chosen-starvation or rigid dieting or purging-is just making your problems worse.

People who skip meals to lose weight often succumb to the urge to binge. They wind up eating more than if they had just stuck to the old three-square-meals-a-day formula. Learning to then purge as a way to exert “damage control” over bingeing makes it that much easier to binge in the future, leading to a vicious cycle. Some girls starve themselves as a way of coping with their fears of growing up. The damage starvation does to their bodies may delay their physical and emotional development, but it can’t stop the process of growing older. Rather than helping to overcome the challenges of maturation, an eating disorder can cause physiological havoc that leads to disease, more mental turmoil, and sometimes even death.

Someone on the outside might wonder why people try to cope with their pain through such misguided means as disturbed eating. The answer, I think, is that often they fear their lives will just get worse if they don’t do something-anything. The problem thus arises not from lack of effort but from using the wrong tools. In a time of stress and change, they seek to control one basic element in their lives-food-somehow believing that if they can control their eating habits, they can keep all their other troubles at bay. Attempting to force the body to ignore its inherent biological rules of eating, however, is like believing you’ll always win at gambling in Las Vegas-eventually the “house” always wins.

I conceive of eating disorders as arising, not from some inherent flaw within a person, but from the clash between social values and biological drives that exist within an emotionally vulnerable individual.

*2/35/5*

You’ve probably heard that old admonition to think before you speak. Well, Sue McGovern thinks before she eats—and it has helped her maintain a 30-pound weight loss for 20 years.

Sue, a 42-year-old resident of Shillington, Pennsylvania, never paid much attention to her food choices while she was growing up. “It was nothing for me and two or three of my friends to devour a half-gallon of chocolate-almond ice cream and a 12-pack of doughnuts in a sitting,” she says. “We didn’t think of these episodes as binges. They were simply a way of life.”

For Sue, that way of life eventually started showing on the scale. By the time she was ready to enter college, she weighed 175 pounds.

“But because I was tall and in reasonably good shape, I never looked fat—just big,” she recalls. ‘

In college, Sue didn’t have a car, so she traveled everywhere via *i foot, bike, or skateboard. To her pleasant surprise, she began losing © weight without changing her eating habits. She was down to 155 pounds when she graduated.

But once Sue started working full-time, her active lifestyle ground to a halt. “That’s when I realized that I had to make better food choices if I didn’t want to regain the weight that I had lost,” she says. “I read all that I could about good nutrition and healthy eating, and I changed my eating habits accordingly.”

For the first time in her life, Sue began thinking about what she was putting in her mouth. She stopped eating for the sake of eating and instead chose foods with the greatest nutritional value. Red meat, chips, chocolate, and other high-fat, high-calorie foods disappeared from her diet. Grains, vegetables, and tofu became her staples of choice. “I discovered all kinds of healthful foods that I’d never had before,” she said. “I was intrigued by tofu, sprouts, and herbs. And I spent hours picking berries and wild nuts.”

Through a combination of healthier eating habits and daily exercise—jogging was her activity of choice—Sue managed to take off another 10 pounds. Her weight has remained in the range of 140 to 145 pounds for about 20 years.

WINNING ACTION

Ask yourself, “Is this good for me?” Sometimes, our food choices become so ritualized that we never consider what’s in them or how they’re affecting our bodies. The next time you reach for a snack or sit down to your “usual” meal, ask yourself whether the food has any nutritional value. If you’re looking at a plateful of nothing but calories and fat, choose something else. You and your body deserve better.

*57\89\8*