Measuring Waist Circumference

Benjamin A. Steinberg, BA; Christopher P. Cannon, MD


August 17, 2006

Question: I've read a lot about the importance of "metabolic syndrome", and I've also read that I can accurately assess almost all of my patients' risk simply by measuring their waist circumference. So, should I be measuring waist circumference in my patients?


Yes; careful statistical analysis has demonstrated that waist circumference is not only an important and easily measured marker for the metabolic syndrome, but it also captures new information. Why is this? There are 2 reasons.

First, waist circumference is a good measure of visceral adiposity -- the body fat that is very metabolically active and that can contribute to cardiovascular risk. Until now, the medical community has tended to focus on weight only, and more recently on body mass index (BMI), but both of these measurements have shortcomings.

For instance, the use of only weight or BMI to measure obesity does not account for patients with greater muscle mass (eg, athletes who have more weight and greater BMI, despite the fact that it is almost entirely lean mass). Further analysis (see Related Links) of the data from the large, international INTERHEART study[1] (among others) demonstrated that for predicting the probability of a future myocardial infarction in a diverse population of individual patients, calculating the waist-to-hip ratio is superior than calculating the BMI. Thus, a waist measurement > 40 in (102 cm) in men and > 35 in (88 cm) in women can stand as a cardiovascular risk factor in itself, as all the more, because it is part of the definition of metabolic syndrome.

As a result of these new analyses, some experts have advocated that waist circumference should be added as a vital sign for clinic visits, because it can provide critical risk stratification in the cardiovascular disease population. (See Figure for how to measure a patient's waist circumference). In addition, the clinician -- and even the patient -- can readily monitor waist circumference over time, to see very clearly whether adherence to a "diet and exercise" program is resulting in medical (and psychological) improvement.

Abdominal obesity in metabolic syndrome: risk predictor?

Question: Is there a difference between high visceral fat and total body fat?


Evidence continues to suggest that patients with an increased waist circumference (the so-called "apple" body habitus) have a worse prognosis compared with individuals with a similar body weight that is distributed differently (the "pear" body habitus). Goodpaster and colleagues[2] employed computed tomography to study the relationship between fat distribution and metabolic syndrome, and they identified visceral abdominal fat as the most significant predictor of the presence of metabolic syndrome, particularly in normal-weight individuals. This abdominal concentration of body mass has also been associated with insulin resistance, although the mechanism remains unclear.

Thus, you can tell your patients that although there is no question that any weight loss is a good thing; trimming down the midsection will provide the biggest bang for the buck.


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