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Waist Measurement and Ratios: Waist Circumference, Waist to Hip Ratio and Waist to Height Ratio

There are a number of waist measurements and ratios which have been developed for the purpose of assessing the risk to health of fat deposited around the waist.

Excess weight as measured by the body mass index is not the only risk to your health. Where that excess fat is located on your body may be another risk.      apple_and_pear_shaped

If you carry fat mainly around your waist (apple shaped; android), you are more likely to develop health problems than if you carry fat mainly in your hips and thighs (pear shaped; gynecoid). This is true even if your BMI falls within the normal range.

The measures we will look at in this section are:

Each has their own merits. We will look at each individually and then compare them. Lets get started with waist circumference measurement...

Waist Circumference

The simplest measurement we can take is the waist circumference itself. To begin:

Where is the Waist?

Confusingly, the waist can be defined as either:

(i) the narrowest circumference of the torso above the hips or

(ii) at the midpoint between the lower ribs and the iliac crest of the hips or

(iii) the horizontal line at the naval.

A panel of experts conducted a systematic review of 120 studies to determine whether measurement protocol influenced the relationship of waist circumference with morbidity of cardiovascular disease (CVD) and diabetes and with mortality from all causes and from CVD1.

In this report, all three common techniques were used: measurement at the minimal waist (33%), midpoint (26%) and naval (27%).

The study showed that all three measures resulted in no difference to the risk outcome, so we will stick with the narrowest circumference ... it feels better!

How to Measure Your Waist

To measure your waist circumference, place a tape measure around your bare abdomen between your hip bones and ribs. Be sure that the tape is snug (but does not compress your skin) and that it is parallel to the floor. Relax, exhale, and measure the narrowest circumference of your torso.

Waist Circumference and Health

Two different sets of values have been proposed.

Lean has suggested2:

Men with waist circumference of 94 cm and above, and women with waist circumference of 80 cm and above should gain no further weight; men with waist circumference of 102 cm and over and women with waist circumference of 88 cm and over should reduce their weight.

Advice from the NIH suggests that3:

Women with a raised waist measurement (more than 88cm, 34.6 inches) or men with a raised waist measurement (more than 102cm, 40.1 inches) are at a higher disease risk compared to people with smaller waist measurements because of where their fat lies.

Waist Circumference Statistics

In 2006 in England4, 37% of adults had a raised waist circumference, compared to just 23% in 1993. This figure can be broken down further to 41% of women and 32% of men.

The proportion of women with a raised waist circumference (more than 88cm, 34.6 inches) increased from 26% to 41% from 1993 to 2006.

In women, the mean waist circumference measured 81.7cm (32.2 inches) in 1993, compared to 86.4cm (34.0 inches) in 2006.

The proportion of men with a raised waist circumference (more than 102cm, 40.2 inches) increased from 20% to 32% from 1993 to 2006.

In men, the mean waist circumference measured 96.8cm (38.1 inches) in 2006, compared to 93.2cm (36.7 inches) in 1993.

We expect similar statistics in other English speaking countries with similar levels of obesity, although data is not readily available.

Waist to Hip Ratio

The waist to hip ratio is the ratio of the circumference of the waist, measured at its narrowest part above the hips and below the ribs, divided by the hip circumference, measured horizontally at its widest part over the buttocks and below the iliac crest.

Divide the narrowest measure for the waist by the widest measure for the hips to obtain the waist to hip ratio.

Waist to Hip Ratio and Health

Many experts have slightly differing views to what this ratio should actually be.

Women with an elevated waist to hip ratio of >0.85, or men with an elevated waist to hip ratio of >1.05, may have a higher disease risk than those with smaller waist to hip ratios because their fat deposits around their abdominal cavity put the function of their vital organs under stress.

Waist to Height Ratio

Also referred to as the waist to stature ratio or waist to tallness ratio, the waist to height ratio is the least familiar ratio calculated to identify risk of disease and risk of death.

The waist to height ratio is the ratio of the circumference of the waist, measured at its narrowest part above the hips and below the ribs, divided by the height, measured barefoot.

Waist to Height Ratio and Health

Again, differing views have been proposed for a healthy value for waist to height ratio.

The initial research groups proposed a value of 0.5 for both Asian men and women6. Some researchers have suggested a value as low as 0.48 for Asian populations7, but later researchers studying much larger groups within a clinical environment (and therfore more accurate data - typically) proposed values of 0.55 and 0.53 for Caucasian men and women respectively8.

So in summary, to determine your waist to height ratio, simply divide your waist measurement by your height.

A healthy result for Caucasian men is 0.55 or less.

A healthy result for Caucasian women is 0.53 or less.

Comparison of the Three Waist Measures with BMI

A large scale study of over 55,000 patients attending over 3,700 clinics was carried out in Germany to look at identifying the accuracy of anthropometric measures of obesity (ie the measures we discuss here) in determining cardiovascular risk9.

The researchers narrowed the group down to 7,500 patients who got in-depth testing and were followed for a year.

They found that waist to height ratio was more strongly associated with cardiovascular risk in both men and women than either waist circumference, waist to hip ratio or BMI.

[In this specific study, waist circumference was measured with a tape measure midway between the lowest rib and the hips; hip circumference was measured at the widest circumference of the hip.]

Bottom Line

From a health perspective, it appears that waist to height ratio may be a better measure of risk for disease and death than either BMI or waist to hip ratio.

From a weight loss perspective, even a small reduction of your weight naturally will improve your health, whether or not you measure any of these ratios or variables.

The medical profession now use the waist measurement as an indication of the risk your weight may impose upon your health. Lose weight and your waistline will almost invariably fall.

Slimmersecrets weight loss program allows you to monitor your waist and many other variables too (including your weight) in order to help you in your successful weight loss campaign. Simply register for free to begin using the tools available to registered members.

 Sign Up Now!

Sources:

1. Ross R, Berentzen T, Bradshaw AJ, et al. Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference? Obes Rev. 2008 Jul;9(4):312-25. Epub 2007 Oct 22. PMID: 17956544. Free full text not available.

2. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995 Jul 15;311(6998):158-61. PMID: 7613427. Full Text.

3. Information for Patients and the Public, Part 1: Assessing Your Risk. National Heart, Lung and Blood Institute.

4. Health Survey for England 2006 Latest Trends.

5. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008 Nov 13;359(20):2105-20. PMID: 19005195. Full Text.

6. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005 Aug;56(5):303-7. PMID: 16236591. Free full text not available.

7. Ho SY, Lam TH, Janus ED; Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committee. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol. 2003 Nov;13(10):683-91. PMID: 14599732. Free full text not available.

8. Miranda Hitti. Waist-to-Tallness Ratio May Measure Risk Better Than Body Mass Index. WebMd Health News.

9. Wittchen HU, Glaesmer H, März W, Stalla G, Lehnert H, Zeiher AM, Silber S, Koch U, Böhler S, Pittrow D, Ruf G; DETECT-Study Group. Cardiovascular risk factors in primary care: methods and baseline prevalence rates--the DETECT program. Curr Med Res Opin. 2005 Apr;21(4):619-30. PMID: 15899112. Free full text not available.

 

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