Show Marie Savard a woman, and she can instantly tell if they’re more susceptible to heart disease or osteoporosis and if they should take up cardio or strength training as the best way to lose weight. Savard Nu’70GrNu’72 M’76 is a successful and well regarded internist, women’s health expert and advocate for patient rights—but she’s hardly a clairvoyant. So, how does she know a woman’s health future just by looking at her?

The secret, said Savard in a Feb. 14 talk at the Penn Bookstore, lies in a woman’s body shape. “Most women know instinctively where they carry their fat,” she said. That is, most women know where they gain weight. The “apple” woman, with long legs and narrow hips, probably knows she puts on weight in her middle, resulting in a waist that is relatively large. The “pear,” with a smaller upper half, may wonder why, despite dieting, she still gains weight in the bottom, hips and thighs. Understanding this difference between apples and pears—and the health risks associated with each body type—is key to unlocking a healthy life for all women, said Savard.

“ All fat is not created equal,” said Savard, who is also a trustee of the University and sits on the Board of Overseers for Penn Nursing. “It’s not how much we weigh, we now know…It’s what kind of fat we have.” The results, which Savard talks about in her new book, “Apples and Pears: The Body Shape Solution for Weight Loss and Wellness” (Atria, 2005) may be surprising. Granted, pears tend to put on weight in their lower half that seems impossible to get rid of, but that unsightly cellulite is actually not very dangerous, compared to excessive weight around the middle, known as visceral fat. While it’s natural to have some fat cushioning our organs, excessive visceral fat causes problems. “That’s the fat we feel there is an epidemic of in this country,” said Savard. “It’s the type of fat you need to eliminate.”

And with good reason: even normal-sized apple-shaped women may have more high risks in their future than a slightly overweight pear-shaped one, said Savard. Those risks may include heart disease, Type II diabetes and some types of cancers, including breast and along the lining of the uterus. Stress and sleep disturbances are the main culprits for this weight gain in “apples.” The bright side is that by losing two inches around their waists, apple-shaped women can lower their risk for these diseases by 50 or 60 percent, said Savard. “It’s the waist that matters, not weight,” she added.

While it seems as though pear-shaped women get off easy, Savard said they are at risk for eating disorders, varicose veins and osteoporosis—and with age and after pregnancy, pear-shaped women can add visceral fat, essentially turning themselves into apples. Dieting may actually worsen a pear-shaped woman’s perception of her body because that thigh and bottom fat she’s trying to lose—known as subcutaneous fat—is extremely stubborn, while belly fat comes off quickly. Losing upper body fat may actually cause a woman to feel disproportionately pear-shaped, said Savard. She added that these women should remember that pear-zone fat is simply nature’s way of storing up fat in times of famine.

To maintain a healthy life, Savard suggested pear-shaped women should eat a low-fat diet with plenty of calcium and add strength training to their exercise regime, while apple-shaped women should eat plenty of complex carbohydrates and moderate protein and make sure they do sufficient cardiovascular activity. “Shape is not your fault,” said Savard, herself a slim pear shape. “Know what you are, take your measurements. We are women with shapes, not women with weight problems.”

Savard’s book is available at the Penn Bookstore. For more information and the simple test to determine if you’re an apple or a pear, go to www.applesandpears.org.