You’re not in your 20s or 30s anymore and you know regular health checks are important. So you go to your GP. During the appointment they measure your waist. They might also check your weight. Looking concerned, they recommend some lifestyle changes.

GPs and health professionals commonly measure waist circumference as a vital sign for health. This is a better indicator than body mass index (BMI) of the amount of intra-abdominal fat. This is the really risky fat around and within the organs that can drive heart disease and metabolic disorders such as type 2 diabetes.

Men are at greatly increased risk of health issues if their waist circumference is greater than 102 centimetres. Women are considered to be at greater risk with a waist circumference of 88 centimetres or more. More than two-thirds of Australian adults have waist measurements that put them at an increased risk of disease. An even better indicator is waist circumference divided by height or waist-to-height ratio.

But we know people (especially women) have a propensity to gain weight around their middle during midlife, which can be very hard to control. Are they doomed to ill health? It turns out that, although such measurements are important, they are not the whole story when it comes to your risk of disease and death.

How much is too much?

Having a waist circumference to height ratio larger than 0.5 is associated with greater risk of chronic disease as well as premature death and this applies in adults of any age. A healthy waist-to-height ratio is between 0.4 to 0.49. A ratio of 0.6 or more places a person at the highest risk of disease.

Some experts recommend waist circumference be routinely measured in patients during health appointments. This can kick off a discussion about their risk of chronic diseases and how they might address this.

Excessive body fat and the associated health problems manifest more strongly during midlife. A range of social, personal and physiological factors come together to make it more difficult to control waist circumference as we age. Metabolism tends to slow down mainly due to decreasing muscle mass because people do less vigorous physical activity, in particular resistance exercise.

For women, hormone levels begin changing in mid-life and this also stimulates increased fat levels particularly around the abdomen. At the same time, this life phase (often involving job responsibilities, parenting and caring for ageing parents) is when elevated stress can lead to increased cortisol which causes fat gain in the abdominal region.

Midlife can also bring poorer sleep patterns. These contribute to fat gain with disruption to the hormones that control appetite.

Finally, your family history and genetics can make you predisposed to gaining more abdominal fat.

Why the waist?

This intra-abdominal or visceral fat is much more metabolically active (it has a greater impact on body organs and systems) than the fat under the skin (subcutaneous fat).

Visceral fat surrounds and infiltrates major organs such as the liver, pancreas and intestines, releasing a variety of chemicals (hormones, inflammatory signals, and fatty acids). These affect inflammation, lipid metabolism, cholesterol levels and insulin resistance, contributing to the development of chronic illnesses.

The issue is particularly evident during menopause. In addition to the direct effects of hormone changes, declining levels of oestrogen change brain function, mood and motivation. These psychological alterations can result in reduced physical activity and increased eating – often of comfort foods high in sugar and fat.

But these outcomes are not inevitable. Diet, exercise and managing mental health can limit visceral fat gains in mid-life. And importantly, the waist circumference (and ratio to height) is just one measure of human health. There are so many other aspects of body composition, exercise and diet. These can have much larger influence on a person’s health.

Muscle matters

The quantity and quality of skeletal muscle (attached to bones to produce movement) a person has makes a big difference to their heart, lung, metabolic, immune, neurological and mental health as well as their physical function.

On current evidence, it is equally or more important for health and longevity to have higher muscle mass and better cardiorespiratory (aerobic) fitness than waist circumference within the healthy range.

So, if a person does have an excessive waist circumference, but they are also sedentary and have less muscle mass and aerobic fitness, then the recommendation would be to focus on an appropriate exercise program. The fitness deficits should be addressed as priority rather than worry about fat loss.

Conversely, a person with low visceral fat levels is not necessarily fit and healthy and may have quite poor aerobic fitness, muscle mass, and strength. The research evidence is that these vital signs of health – how strong a person is, the quality of their diet and how well their heart, circulation and lungs are working – are more predictive of risk of disease and death than how thin or fat a person is.

For example, a 2017 Dutch study followed overweight and obese people for 15 years and found people who were very physically active had no increased heart disease risk than “normal weight” participants.

Getting moving is important advice

Physical activity has many benefits. Exercise can counter a lot of the negative behavioural and physiological changes that are occurring during midlife including for people going through menopause.

And regular exercise reduces the tendency to use food and drink to help manage what can be a quite difficult time in life.

Measuring your waist circumference and monitoring your weight remains important. If the measures exceed the values listed above, then it is certainly a good idea to make some changes. Exercise is effective for fat loss and in particular decreasing visceral fat with greater effectiveness when combined with dietary restriction of energy intake. Importantly, any fat loss program – whether through drugs, diet or surgery – is also a muscle loss program unless resistance exercise is part of the program. Talking about your overall health with a doctor is a great place to start.

Accredited exercise physiologists and accredited practising dietitians are the most appropriate allied health professionals to assess your physical structure, fitness and diet and work with you to get a plan in place to improve your health, fitness and reduce your current and future health risks.

Rob Newton, Professor of Exercise Medicine, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Swedish climate activist Greta Thunberg describes herself as having Asperger’s while others on the autism spectrum, such as Australian comedian Hannah Gatsby, describe themselves as “autistic”. But what’s the difference?

Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD.

Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges.

When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of autism spectrum disorder is made.

Where do the definitions come from?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders.

Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4.

In 2013, the DSM-5 collapsed both diagnoses into one autism spectrum disorder.

How did we used to think about autism?

The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder.

Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress.

Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism.

The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech.

Today, as a legacy of the recognition of the autism itself, the majority of people diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability.

What changed with ‘autism spectrum disorder’?

The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term.

It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things.

The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”.

The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in.

Why do some people prefer the old terminology?

Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism.

The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, Tony Attwood and Carol Gray, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges.

What about identity-based language?

A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”.

The neurodiversity rights movement describes its aim to push back against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism.

The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments.

However the social model contrasts itself against a very outdated medical or clinical model.

Current clinical thinking and practice focuses on targeted supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism.

A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.

Andrew Cashin, Professor of Nursing, School of Health and Human Sciences, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.