Employers spend valuable time analyzing health risk assessments, studying biometric aggregates and determining best practice for employee wellness programs. While all those are critical aspects of gauging workforce wellness, adding a simple waist measurement to the mix is an excellent way to determine disease risk, as excess fat around the waist has been correlated with type 2 diabetes, hypertension and heart disease.1
To correctly measure your waist, stand and place a tape measure around your middle, just above the hipbones, exhale and measure the waist: 35 inches or more for women and 40 inches or more for men indicates high risk for disease.1 Pant size is often erroneously used as waist measurement. However, waist measurement can be up to four inches larger than pant size, depending on belly extension.2
Increased waist circumference can be a marker for disease risk, even in people with normal weight.1 People who are “thin on outside and fat on the inside” are considered TOFI, a phrase coined by Eric Braverman, MD to describe people who appear slender yet have a high body fat percentage.
“Body fat is your biggest long-term risk for infirmity”, said Robert Lustig, MD and Professor of Pediatrics in the division of Endocrinology at the University of California, San Francisco. “Nothing correlates with diabetes, heart disease and cancer better than your fat.”3
According to Dr. Lustig, waist circumferences of greater than 40 inches for men and 35 inches for women is a likely indictor of visceral fat, which is correlated with insulin resistance and risk for metabolic disease. He adds “the journey through obesity and chronic metabolic disease begins and ends with the hormone insulin, the energy-storage hormone. There is no fat accumulation without insulin. The more insulin, the more fat, period.”3.
Weight Loss Challenges are common within employee wellness programs, but they tend to focus on weight loss rather than fat loss. While that may sound like a subtle difference, due to the idiosyncrasy of our language, there’s a significant difference between weight and body fat percentage.
Weight is measured by a standard scale, resulting in one number. But, that number doesn’t indicate the amount of body fat or muscle within the body. Muscle keeps us strong, lean and optimizes our metabolic rate (rate calories are burned). On the other hand, while some body fat is beneficial, excess body fat is linked to disease. Therefore, aiming for a healthy body fat percentage is more important than weight. Healthy body fat percentages for adults are 10-18% for men and 18-25% for women.2
Our bodies benefit from moderate amounts of both body fat and dietary fats. Fat cells cushion vital organs, provide warmth and protect against famine.3 However, there are two types of body fat:
- Subcutaneous fat lies beneath the skin, helps us survive and is correlated with longevity. This type of fat is rarely associated with disease.
- Visceral fat is found inside the abdomen, organs and muscles and is detrimental to health. It drives inflammation, causes insulin resistance and promotes diabetes, heart disease, dementia and aging. “It’s the visceral fat that doctors care about, because it’s the visceral fat that kills you,” said Lustig.3
While body fat is a better indicator of disease risk than weight, most doctors today still use a standard scale to obtain weight and use the Body Mass Index (BMI) to estimate obesity. BMI calculates the ratio of height and weight to estimate obesity (18.5-24.9 normal, 25-29.9 overweight and 30 plus is in the obese range). The problem with BMI results is that they can erroneously categorize a person with high muscle mass and low body fat as “obese” (due to higher scale weight) and a slender person with low muscle mass and high body fat (due to lighter scale weight) as “normal” because muscle weighs more than fat.
There’s several ways to measure body fat including:
- DEXA Scan (Dual Energy X-Ray Absorptiometry), which is commonly used for bone density testing and distinguishes between muscle mass and body fat.
- Bio-Electrical Impedance measures the speed which an electrical impulse moves through muscle (fast) and fat (slow).
- Underwater hydrostatic or the “dunk tank” weighs the density of fat and muscle under water (fat floats and muscle sinks).
- Manual calipers, are commonly used in gyms and pinch areas such as back of the arm and thigh to measure body fat.
Employers would benefit from keeping healthy body fat percentages on their wellness radar as excessive body fat can hike healthcare costs. Posting simple posters with healthy body fat percentages in the lunchroom, launching fat loss (instead of weight loss) challenges within employee wellness programs and offering opportunities for employees to have their body fat measured.
Health Fairs are a great place for employees to have their body fat tested. However, the key for wellness administrators is to standardize the measurement method (waist circumference, specialized scale and/or service, etc.) and protocols (such as not eating or exercising 2-3 hours before test, etc.) to ensure accurate and consistent results. Once results are determined, education and encouragement to follow a healthy diet and exercise program, promoting fat loss, is critical.
Start with a whole food diet void of refined carbohydrates (sugar, high fructose corn syrup, refined flour, etc.) and alcohol. Meals should contain lean protein, high-fiber low-glycemic complex carbs, moderate amounts of healthy fat and plenty of water. And emphasis should be placed on a low glycemic or low sugar diet to stabilize blood sugar and moderate the release of insulin.
Healthy dietary fat contains essential fatty acids and the fat soluble Vitamins A, E and D. Given the enormous amount of confusion about dietary fat, below is summary of healthy fats to eat and bad fats to avoid:
Healthy Fats to Eat in Moderation:
- Omega 3 fats are anti-inflammatory and beneficial to the heart: salmon, albacore tuna, mackerel, herring, sardines, swordfish, pacific oysters, rainbow trout, halibut, flax seed and oil, walnuts, pumpkin seeds and omega 3 eggs. Whenever possible, aim for “wild” fish vs. “farmed”.
- Monounsaturated fat lowers cholesterol: almonds, avocados, olive oil, olives, cashews, hazelnuts and Brazil nuts.
Bad Fats to Avoid:
- Hydrogenated oil or “trans fats” is a synthetic fat found in some margarine, Crisco, commercial peanut butter, processed baked goods, snacks, junk food and candy. It’s popular among processed food manufacturers as it’s inexpensive and extends the shelf life of products. But, it’s unhealthy and linked to heart disease.
- Fried foods are high-fat foods. Plus, low quality fat (such as hydrogenated oil) is often used for frying and generally over heated, resulting in oxidized fat causing inflammation in the body.
In addition to a eating a healthy diet, exercise is critical for fat loss. “Dropping pounds feels good, but if those pounds are precious muscle, you’re hurting your fat loss ability,” said Ahmad Ahmadzia, Founder and CEO of Efitportal.com, who recommends combining cardio exercise with resistance training and encourages circuit based strength training or high intensity interval training.
Roseann is UBF's health management practice leader and is the glue that turns wellness into health management. Roseann has many years of experience in health and wellness management as well as much knowledge of nutrition and its industry.