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Guidelines on Overweight and Obesity: Electronic Textbook
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According to Waist Circumference

Although waist circumference and BMI are interrelated, waist circumference provides an independent prediction of risk over and above that of BMI. Waist circumference measurement is particularly useful in patients who are categorized as normal or overweight on the BMI scale. At BMIs greater than or equal to 35, waist circumference has little added predictive power of disease risk beyond that of BMI. It is therefore not necessary to measure waist circumference in individuals with BMIs greater than or equal to 35.

Measuring Tape Position for Waist (Abdominal) Circumference

Graphic of Measuring Tape Position for Waist Circumference

The waist circumference at which there is an increased relative risk is defined as follows. Waist circumference cutpoints lose their incremental predictive power in patients with a BMI greater than or equal to 35 kg/m2 because these patients will exceed the cutpoints noted below.

HIGH RISK

Men: >102 cm ( >40 in.)

Women: >88 cm ( >35 in.)


Evidence Statement: Sex-specific cutoffs for waist circumference can be used to identify increased risk associated with abdominal fat in adults with a BMI in the range of 25 to 34.9 kg/m2. An increase in waist circumference may also be associated with increased risk in  persons of normal weight. Evidence Category C.

Waist circumference cutpoints can generally be applied to all adult ethnic or racial groups. On the other hand, if a patient is very short (under 5 feet) or has a BMI above the 25 to 34.9 kg/m2 range, waist cutpoints used for the general population may not be applicable. Evidence Category D.


Rationale: A high waist circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension, and CVD in patients with a BMI in a range between 25 and 34.9 kg/m2 (82). Monitoring changes in waist circumference over time may be helpful, in addition to measuring BMI, since it can provide an estimate of increased abdominal fat even in the absence of a change in BMI. Furthermore, in obese patients with metabolic complications, changes in waist circumference are useful predictors of changes in CVD risk factors (537).

There are ethnic and age-related differences in body fat distribution that modify the predictive validity of waist circumference as a surrogate for abdominal fat (526). These variations may partly explain differences between ethnic or age groups in the power of waist circumference or waist-to-hip (WHR) ratio to predict disease risks (429, 543). 

In some populations, waist circumference is a better indicator of relative disease risk than is BMI: examples include Asian Americans or persons of Asian descent living elsewhere (51, 273, 544). Waist circumference also assumes greater value for estimating risk for obesity-related disease at older ages. The table below incorporates both BMI and waist circumference in the classification of overweight and obesity, and provides an indication of disease risk.

Table IV-2: Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risk*

Disease Risk* Relative to Normal
Weight and Waist Circumference
 
BMI (kg/m2)
Obesity Class
Men less than or equal to 102 cm
(less than or equal to 40 in.)

Women less than or equal to 88 cm
(less than or equal to 35 in.)

Men >102 cm
( >40 in.)

Women >88 cm
( >35 in.)

Underweight
18.5
 
-----
-----
Normal+
18.5 - 24.9
 
-----
-----
Overweight
25.0 - 29.9
 
Increased
High
Obesity
30.0 - 34.9
I
High
Very High
 
35.0 - 39.9
II
Very High
Very High
Extreme Obesity
greater than or equal to 40
III
Extremely High
Extremely High
* Disease risk for type 2 diabetes, hypertension, and CVD.
+Increased waist circumference can also be a marker for increased risk even in persons of normal weight.
Recommendation: For adult patients with a BMI of 25 to 34.9 kg/m2, sex-specific waist circumference cutoffs should be used in conjunction with BMI to identify increased disease risk.  Evidence Category C.
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