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September 21, 2018

Waist not, want not

There are approximately 23 million men in Kenya today. Most of these men do not know where to wear their trousers. We can excuse the 13 million males who are under the age of 16 years, as strictly speaking they should still be in school. Head-teachers work very hard to ensure that schoolboys wear their trousers or shorts at the natural waist.

The problem seems to begin on finishing school when the level at which trousers are worn drops until about the age they get their first job, at which point the waist level is back to the natural waist. After the age of 35 years when a pot-belly emerges and the man is now proud to be addressed as ‘baba’, the trouser waist level begins to rise ever so gradually peaking at around the old retirement age of 55 years.

Thereafter as the good days of living interchange with the progressive reality of dealing with chronic diseases and people start to loose weight, the trouser waist level drops, so that by the time a man is in his late 60s or early 70s the trouser waist level has began to settle again around the natural waist. But why should the point at which trousers are suspended matter? Is it simply a matter of fashion? Is there something that head-teachers know that makes it important to inculcate in the young mind a concept of an ideal waist?

In a typical youth, there is no doubt where the waist is – it is the narrowest part of the body between the chest and hip. The confusion for a lot of men arises because of individual levels of fitness. With rising obesity it becomes difficult for the overweight man to determine exactly where their waist is and then there is further confusion on whether to wear the trouser, above or below their potbelly. A primary source of this confusion is alcohol.

Studies have shown an association with the quantity and duration of alcohol taken and expanding waistlines. Men who drank more than 21 beers a week were after 10 years, one and a half times more likely to have a large waist, measured as more than 100 cm diameter compared to those who did not drink at all. The waist circumference is not only useful in determining how much beer you drink, it is also a useful indicator of the health of your heart, and whether you are at risk of diabetes mellitus.

Analysis of many studies comparing the prevalence of diabetes and waist circumference have found a relationship especially when used for long term follow up, that is you know what your waist circumference was in college and now ten years later it has ballooned, yet you are not pregnant- that shows risk.

Because many of these studies are done in the west among Caucasian populations there is the lazy notion that perhaps African figures are different and that therefore these correlations do not apply. They do! What it not a good measure of potential for disease is the waist-hip ratio. In fact a ‘good’ waist-hip ratio is much admired. One scholar reviewed thousands of ancient texts on what was the mark of an attractive woman throughout history. He found that men judge women with a low waist-hip ratio to be most attractive physically. A small waist was associated with youthfulness, fertility and long-term healthiness irrespective of culture.

So the hip is something that men see in women in relation to the female waist. However men do not have hips of their own to use as a health marker. The importance of the waist in men’s health rather than the hip is reinforced by the fact that shorter than average adults are at a higher risk of developing obesity and therefore diabetes and cardiovascular disease, independent of their body mass index.

A short leg length, a marker of early childhood deprivation can lead in later life to adult chronic disease. In other words, the nearer your waist is to the ground as a proportion of your total height the greater are the chances of developing disease.

The bad news does not stop there. A large waist circumference has also been found to be associated with reduced lung capacity. A man with a large potbelly just cannot shout to save his life, running away from danger is never an option and things have to happen at a certain pace to avoid exhaustion.

Plutarch the philosopher who studied in Plato’s academy graduating in 67 AD talking to his fellow citizens, mainly men, once said “It is a hard matter to argue with the belly, since it has no ears”. Very true! It is we who should be watching and listening to our bellies for they have a lot to say about what is going on within our bodies. And one message that should be clear is that we should not treat our stomach like a waist basket.

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