Waist Circumference Should Be a Routine Vital Sign: Consensus Statement

By Reuters Staff

February 06, 2020

NEW YORK (Reuters Health) - Waist circumference better predicts obesity-related outcomes than does BMI and should become a routine vital sign in clinical practice, according to a consensus statement from the International Atherosclerosis Society (IAS) and International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity.

Reliance on BMI measurements has proven inadequate to help clinicians assess and manage obesity-related health risk in their patients, Dr. Robert Ross of Queen's University, in Kingston, Canada, and colleagues note in Nature Reviews Endocrinology.

The group summarizes the evidence that BMI is insufficient to assess, evaluate, or manage the cardiometabolic risk associated with increase adiposity in their report.

Waist circumference is associated with health outcomes within all BMI categories independent of sex and age, they say. And when BMI and waist circumference are considered in the same risk-prediction model, waist circumference remains a positive predictor of risk of death, whereas BMI is unrelated or negatively related to the risk of death.

Waist circumference along with BMI is a better predictor of a high-risk obesity phenotype than either measure alone, and waist circumference provides a simple anthropometric measure to track the efficacy of lifestyle-based strategies designed to reduce abdominal obesity.

The consensus statement recommends that waist circumference measurements be obtained at the level of the iliac crest or midway between the last rib and the iliac crest and that whichever location is chosen that it be used consistently.

Based on the available evidence, the group questions the rationale behind the current guidelines recommending that a single waist circumference threshold be used to denote a high waist circumference. Instead, they recommend carrying out prospective studies using representative populations to address the need for BMI-category-specific waist-circumference thresholds across different ethnicities.

"Despite gaps in our knowledge, overwhelming evidence presented here suggests that the measurement of waist circumference improves patient management and that its omission from routine clinical practice for the majority of patients is no longer acceptable," the authors conclude. "Accordingly, the inclusion of waist circumference measurement in routine practice affords practitioners with an important opportunity to improve the care and health of patients."

"Health professionals should be trained to properly perform this simple measurement and should consider it as an important vital sign to assess and identify, as an important treatment target in clinical practice," they add.

SOURCE: https://go.nature.com/2v7INha Nature Reviews Endocrinology, online February 4, 2020.