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Although the increased health risks associated with abdominal fat have been well documented, it is good to see additional confirmation in recent weeks.
While BMI has always been considered a reasonable indicator of the health risks associated with excess body fat, there have been questions as to whether there may be a better alternative. It is believed that the type of fat usually associated with expanded waistlines indicates a higher overall risk to health than more widely distributed body fat, putting “apple” shaped people at greater risk of developing heart disease and type 2 diabetes than “pear” shaped people, due to an increased proportion of fat located around their internal organs.
Different types of fat
There’s a second, even more important, problem. BMI is a good proxy for total body fat, but it cannot distinguish between different types of fat distribution.
Excess fat that is found deep down in the region of the stomach gives someone a large waist circumference and an ‘apple’ shape. This is often associated with risk factors for serious conditions such as heart disease, raised blood pressure and diabetes.
Excess fat that is found under the skin, around the bottom, hips and thighs is usually accompanied by a smaller waist circumference and a ‘pear’ shape. This is generally accepted to be less harmful to health.
So a measurement that can distinguish between ‘apples’ and ‘pears’ would be a more effective way of screening for these diseases.
I have argued since 1996 that we should assess risk based on waist-to-height ratio (WHtR); saying that “Your waist circumference should not be more than half your height (WHtR 0.5)”.
This is the point at which some action to decrease your waistline should be considered.
My colleagues and I recently published a review of 78 studies in 14 different countries, including Caucasian, Asian and Central American subjects, which has confirmed that WHtR is a better predictor of cardiometabolic risk than BMI and that WHtR 0.5 is a suitable boundary value.
Simple risk assessment
The WHtR measurement offers the exciting possibility that it could be used to assess risk for adults in several ethnic groups. This is because the BMI boundary values were derived from Caucasian populations.
They might not be appropriate for Asians, who tend to carry more fat centrally so their risk seems to increase at a BMI lower than 25 (between 20 and 25 is considered a healthy BMI).
WHtR might also be a simple way to assess health risk in children.
And of course waist circumference and height can be measured with a simple tape measure in any units: inches, centimetres etc, unlike the BMI which requires weighing scales and must be expressed in metric units.
The public health message is simple – “keep your waist circumference to less than half your height”.
Dr Margaret Ashwell OBE
Related articles
- Why Your BMI Can Be Misleading (everydayhealth.com)
- Missing the point (bbc.co.uk)
- Bye-Bye BMI, Hello . . . Neck Circumference (fitsugar.com)
- Excess Abdominal Fat is Not Only Ugly, but Extremely Dangerous to Your Health – This is More Than a Vanity Issue! (traveling-health-organic.com)
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