Questions about Body Fat and Cellulite

Question 1: I recently read an article about the dangers of obesity and it mentioned that even "being only slightly overweight" increased health risk. But the article didn't specify whether the type of excess weight mattered.

I am a 170-pound male with a height of 5'9," but I have a 32" waist. I may be "overweight," but I am not "overfat." Am I at risk for heart disease?

Dr. Mitchell answers:
According to the Body Mass Index (BMI) standards set by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases:

• A BMI of less than 18.5 is considered underweight.
• A BMI of 18.5 to 24.9 is considered healthy.
• A BMI of 25 to 29.9 is considered overweight.
• A BMI of 30 or more is considered obese.

People who are overweight or obese are at risk for a number of diseases including coronary heart disease, heart failure, diabetes, high blood pressure, arthritis and gallbladder disease.

But as you have noted, these standards don’t make any distinction between weight that is due to muscle vs. weight that is primarily made up of fat. Your BMI is 25.1. Most Americans with a BMI greater than 25 are indeed "over-fat," so the research conclusions are generally valid, but probably do not apply to bodybuilders. Waist measurement can also be an indicator of health and fitness, and yours is well within the healthy range for men.

Question 2: Please tell me if there is anything I can do to get rid of cellulite. I'm a 45-year-old woman, I'm not overweight, I follow a healthy diet, and I exercise at least 10 hours per week.

But I still have dimpled skin on my stomach, thighs, quads and buttocks. Is there anything that can clear this up?

Dr. Mitchell answers:
When it comes to cellulite, there's no simple cure. It pains me to think of the millions of dollars women have spent on ineffective treatments for cellulite. First let's talk about what cellulite actually is.

Cellulite is the way the human body stores fat, especially in women – in case it’s needed during pregnancy or breastfeeding. Also, have cellulite more often than men because the structure of female fat cells are different from those of men. Women's fat cells line up under the skin like identical books on a very thin bookshelf, while men's fat cells are smaller and supported by crisscrossing fibers. Women also are more likely to store their fat under the skin, and rapid weight gain or loss, as with pregnancy, can destabilize the limited support of the fat cells.

I wish I had a good answer for you, but you are already doing your best to prevent fat by keeping a normal weight and exercising. Creams with retinol might temporarily reduce the appearance of cellulite, but these results are far from proven. The FDA has recently approved a suctioning and gentle massaging technique called endermologie that may also temporarily reduce the appearance of cellulite, but you would have to pay a salon about $150 for each treatment.

Keep up the good work – in addition to physical fitness, exercise has numerous health benefits. For cellulite, though, at this point there is no “miracle cure.”

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic – East. Her column also appears in the Milwaukee Journal-Sentinel.