traditionally ascribed to prosperity the tummy or middle abdominal tire of fat is now believed to be a reliable marker of potential cardiometabolic disease besides conferring upon the person a bulging figure the potbelly lends to the classical now medically characterized appleshaped obesity this abnormal easilyacquired fat is composed of adipose tissue where metabolic hormones come to roost and play havoc insulin the hormone associated with diabetes is not really deficient to begin with but encounters resistance in its action on glucose metabolism this resistance is borne in the fat around the middle most type ii or maturityonset diabetics who these days are in their late thirties are appleshaped and have associated high blood pressure abnormal lipids and even deranged liver function in fact the term metabolic syndrome or syndrome x has been coined to describe patients with such abnormal parameters unfortunately the accumulation of waist fat is seen to start after the 3rd decade when prosperity seemingly sets in the active mobile sportsindulging young man becomes a desk attached longhoursworking executive he works in front of a screen and lazes on couches eats fast food often deep fried and high on carbs has no time for exercise but lobbies and hobbies at cocktail parties this food and wine goes straight to his middle and sticks there and naturally he has no time to shake it off the stress of modernday life adds to his now podgy profile and before he realizes it he is on antihypertensives statins aspirin and even antidiabetics indians mostly being mesomorphic in structure and not tall by constitution become perfect apples quite early in their productive economic and reproductive life the diagnosis of metabolic syndrome is made not so much by the bp instrument glucometer or stethoscope as by the measure tape approximately waists of more than 39 in men and 34 in women with body mass index bmi of more than 30 classify patients as overweight pushing them toward central obesity so strong is the correlation between this pad of fat and disease that most patients can get off or definitely reduce the obesityinduced bp and sugar medication with successful weight loss and shrinkage of a few inches research has shown pears to score over apples and women with pearshaped figures wide hips are seen to be less at risk than the apples lifestyle alteration is the key to allow successful tightening of the belt cardio briskwalking exercise caloriecounting selection of foods abstinence from excessive alcohol and intake of prescription medication is enough to tilt back the scales central obesity can have a genetic preponderance and also tends to abound in the nouveau rich or that class of society where unhealthy foods abound education and awareness of this bad apple needs to spread so that citizens in the zenith of their lives are not robbed of health the bulging middle cuts a dirty picture but there is more kahani to it than meets the eye beware for this is not the apple of the