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WHY DO WOMEN NEED FAT? Will Lassek

AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

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Dr. Lassek's talk may be viewed here: http://www.youtube.com/watch?v=gJhT_ANNy4E Abstract: One puzzle is why human males have such a strong preference for women with hourglass figures and low weights that can compromise fertility. The second is why slender young women typically have about one third of their weight in body fat, more than bears starting to hibernate, and why human infants are also very fat. Finally, why do women typically gain another twenty pounds or more during their reproductive years? The answer may lie in the roles that fat plays in providing essential fatty acids needed for the growth of a very large brain and in regulating overall fetal growth.

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Page 1: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHY DO WOMEN

NEED FAT?

Will Lassek

Page 2: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Look here first

Page 3: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Who is the most attractive

imaginary woman?eg. animated films,

video games,comics, graphic novels

Page 4: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles
Page 5: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Jessica Rabbit“most attractive

imaginary woman”

650 undergradsof Steve Gaulin“sexiest cartoon

character”Cadbury contest

Page 6: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

What is hermost

unusualattribute?

Page 7: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Jessica Rabbit

Waist/Hip Ratio: 38%

Waist/HeightRatio: 15%(10 inches)

Page 8: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

38% 68% 74%

Playmate undergrad

WAIST/HIP

Page 9: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

15% 10 in

36%24 in

44%28 in

Playmate undergrad

WAIST/HEIGHT

Page 10: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHERE DOMEN LOOK

FIRST &LONGEST?

Page 11: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Cornellisen, et al. 2009

eye tracking:WAIST is

where men look first and most when judging attractiveness

Look here first

Page 12: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Why should we care what menfind attractive?

Look here first

Page 13: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Men should admire qualitiesthat help women havechildren that survive

Page 14: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

HOW IS WOMEN’SWAIST FAT

CONNECTEDTO HAVING CHILDREN?

Page 15: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

14161820222426283032

20 22 24 26 28 30 32 34 36Waist, inches

BM

IWaist & BMI (Body Mass Index)

small waistrequires low BMI

correlation = 0.93

Playmatesundergrads

Jessica’s BMI?

Page 16: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Jessica Rabbit

waist/height15%

predictedBMI:

10(from waist, hip, height)

Page 17: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Average weight of young US women by BMI

90

100

110

120

130

140

150

16 17 18 19 20 21 22 23 24 25

BMI

Pou

nds

BMI <20<120 pounds

Page 18: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Men prefer women with low BMI’s Martin Tovee, et al. 1999

attractivenessscores

Page 19: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0

10

20

30

40

50

14 15 16 17 18 19

BMI

Per

cent

Cumulative BMI % age 18-20, 1971-75(before the obesity epidemic)

half of young women had BMI’s <20

Page 20: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

HOW DOES A MOTHER’S

SMALL WAIST & LOW BMI

AFFECT HER CHILDREN?

Page 21: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

OVULATORY INFERTILITY & BMI: 116,671 nurses, Rich-Edwards 2002

21

BMI<21:HARDER

TOGET

PREGNANT

Page 22: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

In foraging/subsistence populations thinner women have fewer children

Hadza

Marlowe 04

Andes

Mueller 79

Papua New

Guinea

Brush 93

Page 23: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0 1 2 3

Low BirthWeight

Preterm

Hospital

<1919-2425+

Lower BMI, bad for infants

(infant)Murakami 2005

Page 24: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Low BMI & fetal or infant death

the lower the BMI,the moreinfant deaths

23

England

BMITennant, 2011

17

Page 25: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

PUZZLEWHY DO MEN PREFER WOMEN

WITH LOWER FERTILITY& LESS HEALTHY INFANTS?

AND (OR) WHY DO MOST YOUNG

WOMEN HAVE SMALL WAISTS& LOW BMI’S?

Page 26: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT HAPPENS TO A FIRST-TIME

AMERICAN MOTHER EVERY 86 SECONDS?

Page 27: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WH, 1932 (1847) Catherine

Page 28: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

FTA, 1932 (1929)

Page 29: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Evolution of pelvis in humans

pelvis changed to allowupright walking and running

Page 30: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

a

Smallest pelvic outlet dimension: interspinous diameter ~ 9 cm

Interspinous

Page 31: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Average biparietal diameter at term: 9.5 cm

Page 32: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

humans have much less ofbrain growthbefore birth,but head isstill too big

chimpanzee

human

Page 33: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Almost half of babies from “normal”vaginal deliveries have bleeding in brain

46%

Rooks, 2008

Page 34: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

LARGER HEAD LEADS TO BLOCKED LABORAND DEATH IN CHILDBIRTH

Spain, ~1100 AD

Page 35: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

HOW COMMON WASDEATH IN CHILDBIRTH

BEFORE C-SECTIONS?

Page 36: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHICHSEX

LIVES LONGER?

Page 37: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Average age at death,US 1999-2010

60 62 64 66 68 70 72 74 76

men

women

Page 38: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Percent surviving to age 65,US 1999-2010

60 65 70 75 80

men

women

Page 39: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Average adult age at death:30,000 BC to 1799 AD

26 28 30 32 34 36

~3000 skeletons examined by Larry Angel, 1984

men

women

Page 40: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Sweden, 1800-1899Hogberg, 1985

1 in 14 mothers died in childbirth

Page 41: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Sierra Leone 2.0%Afghanistan 1.9Malawi 1.8Angola 1.7Niger 1.6Tanzania 1.5Rwanda 1.4Mali 1.2

Maternal deaths in 2000, WHO

many mothers still die inchildbirth

Sierra Leone 1/50

Page 42: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0

5

10

15

20

25

1 2 3 4 5 6Birth

% C

-sec

tion

sFirst C-sections by birth

most risk ofblocked labor with first birth

US, 1990

Page 43: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Every 86 seconds a first-time American mother has a C-section

Page 44: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT IS THE BENEFIT OF A

SMALLER WAIST& LOWER BMI

IN A FIRST-TIME MOTHER?

Page 45: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

33.4

33.6

33.8

34.0

34.2

34.4

34.6

34.8

10-14 15-19 20-24 25-29 30-34 35-39

BMI before pregnancy

Hea

d s

ize

cmLower BMI, smaller newborn

head for 1st birth

Page 46: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

05

10152025303540

12 14 16 18 20 22 24 26 28BMI before pregnancy

Per

cen

t C

-sec

tion

sLower BMI, fewer C-sections

for 1st birth

less blocked babies

Page 47: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

High blood pressure duringpregnancy can also be bad

preeclampsia/eclampsia

Page 48: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0

1

2

3

4

1 2 3 4 5 6 7Pregnancy

Per

cen

t More high blood pressure with

first pregnancy

Page 49: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

468

1012141618202224

14 16 18 20 22 24 26 28 30

Per

cent

pre

ecla

mps

iaBMI & high blood pressure

in 1st time mothers

lower BMI,less risk

Page 50: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT ARE THE BENEFITS OF A

SMALLER WAIST& LOWER BMI

IN A FIRST-TIME MOTHER? (2)

Page 51: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

1. LESS RISK OF MOTHER & CHILD

DYING IN CHILDBIRTH2. LESS HIGH

BLOOD PRESSURE

Page 52: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT HAPPENS TOWOMEN’S WAIST FAT

(AND WEIGHT)AFTER

HAVING A CHILD?

Page 53: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

252627282930313233

15 15 20 25 30 35 40 45 50Age Group

Wai

st, i

nche

sMinimum waist (inches) in women

with children, US 1988-94

NP

Page 54: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

120

125

130

135

140

145

150

18 22 26 30 34 38 42 46Age

Wei

ght,

poun

dsAverage weight in American women

before obesity epidemic 1959-61

as add 25-30 pounds,more new fat in waist

Page 55: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

20 21 22 23 24 25 26

Age 17-18

All Adults

BMI

Average BMI in European women

122 pounds

150 pounds

Page 56: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHY IS IT BENEFICIALTO HAVE MORE

WAIST FAT AFTER HAVING A CHILD?

Page 57: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0 1 2 3

LBW

Preterm

Hospital

Adjusted Odds Ratio

<1919-2425+

Bigger waist, bigger babies

(infant)Murakami 2005

Page 58: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

27.0

27.5

28.0

28.5

29.0

29.5

30.0

30.5

0 1 2 3 4 5 6Births

Pel

vic

wid

th, c

mPelvic width and births, NHANES III

birth canal expands with each birth, soless blocked labor

Page 59: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

LESS HIGH BLOOD PRESSURE2nd CHILD WITH SAME FATHER

Page 60: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

30

40

50

60

70

80

90

100

110

120

38 40 42 44 46 48 50 52 54 56 58 60 62

Waist/Height x 100

Insu

linBigger waist, more insulin resistance

more insulin resistance =more sugar for baby

= bigger baby

Page 61: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

708090

100110120130140150160170

36 38 40 42 44 46 48 50 52 54 56 58 60 62

Waist/height x 100

Tri

glyc

erid

esBigger waist, more triglycerides

more fat inmother’s blood =bigger baby

Page 62: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0102030405060708090

100

20 21 22 23 24 25 26 27 28 29 30 31+

Cumulative BMI in women 15+

Per

cent

BMI in women 15+ in 190 countries

2/3rds are 25+“overweight”

Page 63: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHERE WOMEN

DON’T ADD WAIST FAT,

CHILDREN SUFFER

(CONTROLLING FOR INCOME)

Page 64: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

5

10

15

20

<22 22 23 24 25 26 27 28 29+

Female BMI

Low

Bir

th W

eigh

t %

Low birth weight & average BMI in women (income controlled)

Page 65: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0

10

20

30

40

50

<23 23 24 25 26 27 28 29+Female BMI

Dea

ths

per

100

0 b

irth

sNewborn death rate & average BMI

in women (income controlled)

Page 66: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

25

50

75

100

125

<23 23 24 25 26 27 28 29+

Female BMI

Dea

ths

per

1000

bir

ths

Child death rate & average BMI in women (income controlled)

Page 67: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

SO, WHY DOES A WOMAN

NEED WAIST FAT?

Page 68: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WAIST FATDETERMINESTHE SIZE OF

HER CHILDREN

Page 69: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT ABOUT

FAT in the HIPS

& LEGS?

Page 70: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Jessica Rabbit

HIP/HEIGHT= 53%(36 in)

Page 71: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

53% 53%

Playmateundergrad

53%

BMI <20

Hip/height

Page 72: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Men’s ranking of desirability ofwomen’s body areas

Rank Score 1-5Chest 1 4.13

Buttocks 2 4.09

Legs 3 4.04

Hips 4 3.98

Montoya, 2006

Page 73: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Almost all cultures value fat in women’s legs & hips

Brown & Konner, 1987

Page 74: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

What % of weight is fat?

Ambelosi baboon

Page 75: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

What % of weight is fat?

bear ready to hibernate

Page 76: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

What % of weight is fat?

typicalundergrad

Page 77: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

height: 64”weight: 132 lb

BMI: 22.2fat: 32%(42 lb)

Page 78: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHY DO WOMENNEED

SO MUCH FAT?

Page 79: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

2/3rds of fat is in hips & legs

(white = fat)

Page 80: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

LOWER BODY FATIS LOCKED AWAY

UNTIL LATE INPREGNANCY

Page 81: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

1800

2000

2200

2400

2600

0 1-6 7 8 9 nurseMonths of pregnancy

COST

30%of fetalgrowth

Mothers eat less in late pregnancy& while nursing (calories/day)

Page 82: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

AS EAT LESS,LOWER BODY FATIS MOBILIZED IN

LATE PREGNANCY& WHILE NURSING

~1 ounce/day

Page 83: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT IS INONE OUNCE OF LOWER-BODY

FAT?

Page 84: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0 50 100 150 200 250

human

baboon

beef cow

guinea pig

sheep

rabbit

rat/pig

Maternal energy cost of nursing: cals/kgPrentice 1988

300 calories/day

2% FAT

Page 85: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHAT IMPORTANTORGAN IN

A NEW BABYGROWS THE MOST

& ADDS THE MOST FAT?

Page 86: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Brain triples in size in 1st year

300

400

500

600

700

800

900

Bra

in w

eig

ht,

g

Page 87: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Fat = 52% dry weight of brain

ProteinFat

Page 88: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Nerve cells are mostly membranes made of fat with embedded proteins

Page 89: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Nerve cell membranes would cover 5 football fields

Page 90: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

DHA = 1/3rd of membrane fat

DHA

DOCOSAHEXAENOIC ACID

Page 91: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

DHA (docosahexaenoic acid) omega-3

22 carbons6 double bonds

omega-3 fats must come from diet

Page 92: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

DHA is active in every part of nerve cell

Calderon 07makes & grows dendrites

transmits signal

makessynapse work

grows axon

preserves

Page 93: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

60

65

70

75

80

85

low medium highMother's dietary DHA

% h

igh

er I

QChildren of mothers with more DHA

while pregnant have higher verbal IQ’s

Hibbeln, 07

Page 94: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

420

440

460

480

500

520

540

1 2 3 4+

Milk DHA index

Mat

h Sc

ore

More DHA in mother’s milk: higherPISA math score in 28 countries

Page 95: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHERE DOES MILK DHA

COME FROM?

Page 96: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Where does milk DHA come from?

BODY FAT80%

CURRENTDIET

Fidler 2000

Page 97: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

DHA mainly from stored fat80% of 120 mg

MILK DHA = 96 mg*

ONE OUNCEOF FAT =

96 mg* DHA

*120 mg DHA/day* European mothers

Page 98: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

SO, WHY DO WOMENNEED SO MUCHLOWER-BODY

FAT?

Page 99: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

LOWER-BODYFAT PROVIDES

ESSENTIAL FATSNEEDED BY BRAIN

Page 100: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

WHY AREOUR

NEWBORNBABIESSO FAT?

Page 101: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

TYPICAL NEWBORNHAS 2 POUNDS OF FAT

WITH1500 MILLIGRAMS OF

DHA

(1.6%)

Page 102: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

HOW CAN WOMEN STORE MORE DHA WHEN

DHA % IN FAT IS LOWBECAUSE OF

LOW DHA FROM DIET?

Page 103: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

Percent DHA in body fatImaichi 65, Leaf 95

0.0 0.2 0.4 0.6 0.8 1.0 1.2

US

Japan

Page 104: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

0

5

10

15

20

25

30

1 2 3 4 5 6+Milk DHA index

Fem

ale

obes

ity

%DHA in mother’s milk &

female obesity in 43 countriesUSA?

Japan?paleolithic?

Page 105: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles
Page 106: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

161820222426283032

30 32 34 36 38 40 42 44 46 48 50 52 54Waist/Height x 100

BM

IWaist/Height & BMI (Body Mass Index)

small waistrequires low BMI

correlation = 0.93

Playmates undergrads

Jessica?

Page 107: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

1%2%

Page 108: AHS13 Will Lassek MD -- Why Women Need Fat: Three Evolutionary Puzzles

5

6

7

8

9

10 to 14 15 to 19 20 to 29

BMI

Low

bir

th w

eigh

t %

Lower BMI mothers have more low birth weight babies