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WAIST CIRCUMFERENCE (ABDOMINAL GIRTH) AND HEALTH:
IT IS MORE THAN JUST RISK OF STROKE

(August 2003)

Overweight and obesity represent the biggest epidemic in America today. About 60 percent of adults are either overweight or obese, and that often leads to diabetes, heart attacks, gallbladder disease, high blood pressure, strokes, and even some cancers. Overweight and obesity are generally defined by the Body Mass Index (BMI) - weight in kilograms divided by the square of the height in meters. A normal BMI is less than 25; 25 to 29.9 is overweight; 30 to 34.9 (at least 20 percent over ideal weight) is mildly obese; 35 to 39.9 is substantial obesity; and 40 and over is extreme obesity.

CLICK HERE to find your own BMI.

A related concern is abdominal obesity - a big gut. That is said to be a significant risk factor for strokes. It can be measured either as the ratio of waist circumference to hip circumference or just by determining waist circumference. For men, a waist circumference of more than 40 inches (102 centimeters) is considered excessive indicating obesity; for women, more than 35 inches (88 centimeters) is abnormal. A fascinating study reported in October 2002 in the Archives of Internal Medicine examined the effects of an excessive abdominal girth on blood pressure, diabetes, blood cholesterol levels, and levels of high density lipoprotein cholesterol (HDL - good cholesterol) which protects against coronary heart disease and heart attacks. The investigators analyzed the results of the Third National Health and Nutrition Examination Survey; 14,924 adults around the United States, a representative sample, were divided into normal weight (BMI less than 25), overweight (BMI 25 to 29.9), and obese (BMI over 30). Within each of the three groups, the participants were divided into those with normal waist circumference and those with abdominal obesity (circumference over 40 inches for men, 35 for women).

The results were consistent and impressive. In every weight category (normal, overweight, obese) those with larger waist circumferences (bigger bellies) had (with few exceptions) higher blood pressures, higher blood cholesterol levels, lower HDL levels, and higher blood levels of neutral fats (triglycerides).

Then, the investigators looked at specific diseases, including hypertension (systolic pressure over 140 millimeters of mercury, diastolic over 90 millimeters of mercury), diabetes, and something called the metabolic syndrome - any combination of three or more of the following: high blood sugar, high blood cholesterol level, high normal or elevated blood pressure, high blood triglycerides, and abdominal obesity.

Women with large waist circumference, but a normal BMI value, had a modestly increased risk of hypertension, diabetes, and metabolic syndrome; if they were overweight and had excessive abdominal girth, the risks were increased two to four fold; if they were obese and also had abdominal obesity, the risks of all three abnormalities were increased phenomenally by 15 to 29 fold. The results for men were much less impressive, but the risk for the metabolic syndrome for overweight or obese men with large waists was about doubled.

Commentary: Ths is a very impressive study. It confirms that a big gut is bad for your health whether you are normal weight, overweight, or obese. This is especially true for women. For women who are overweight, the increased risk from a big belly is substantial; for obese women, it is even greater.

The study, the first of its kind, does not answer all the questions. It is still unclear whether waist circumference is a better measurement than the waist:hip circumference ratio which may actually be a better indicator of health risks. A lot more analysis of specific diseases will be needed after following people over a long period of time, and during follow up studying additional illnesses, including stroke (for which abdominal obesity is a known risk factor), heart attacks, and cancer.

It would also be useful to divide obesity into mild, moderate, and extreme categories. In this study, they were lumped together.

Other variables needing analysis are the effects of change of waist circumference over time and health risks within specific age groups.

Still, this is a very substantial contribution.

for the dangers of abdominal obesity and for the health dangers of concentrating your weight in your belly.

There is a lot more we need to know including:

- which is better, waist circumference or waist:hips ratio

- health risks in different age groups

- how much actual disease risk there is among normal weight people with larger waist circumferences

- should there be more specific categories for excessive abdominal girth (eg, 20 percent larger, 50 percent larger, 75 percent larger, etc)?

But, there is already enough evidence to state: "a flat belly is a good idea" - or at least try and avoid a pot belly.

In considering whether you have abdominal overweight (or obesity), it is a good idea to check both your waist circumference and your waist:hips ratio. If the waist circumference is large (over 40 inches for men, 35 inches for women) and your waist:hips ratio is more than 1, there should be more concern; if it is less than 1, there should be less concern.

Janssen, I, et al. Body mass index, waist circumference and health risk. Archives of Internal Medicine. Vol 162 (October 14) Pgs 2074-2079. 2002.