Waist circumference and cardiometabolic risk: a consensus statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association

Abstract

Obesity is an important risk factor for cardiometabolic diseases, including diabetes, hypertension, dyslipidemia, and coronary heart disease (CHD). Several leading national and international institutions, including the World Health Organization and the National Institutes of Health, have provided guidelines for classifying weight status based on body mass index (BMI; in kg/m) (1, 2). Data from epidemiologic studies demonstrate a direct correlation between BMI and the risk of medical complications and mortality rate (eg, 3, 4). Men and women who have a BMI 30 are considered obese and are generally at higher risk for adverse health events than are those who are considered overweight (BMI between 25.0 and 29.9) or lean (BMI between 18.5 and 24.9). Therefore, BMI has become the gold standard for identifying patients at increased risk of adiposity-related adverse health outcomes. Body fat distribution is also an important risk factor for obesity-related diseases. Excess abdominal fat (also known as central or upper-body fat) is associated with an increased risk of cardiometabolic disease. However, precise measurement of abdominal fat content requires the use of expensive radiological imaging techniques. Therefore, waist circumference (WC) is often used as a surrogate marker of abdominal fat mass, because WC correlates with abdominal fat mass (subcutaneous and intraabdominal) (5) and is associated with cardiometabolic disease risk (6). Men and women who have WCs 40 in (102 cm) and 35 in (88 cm), respectively, are considered to be at increased risk for cardiometabolic disease (7). These cutpoints were derived from a regression curve that identified the WC values associated with a BMI 30 in primarily Caucasian men and women living in north Glasgow, Scotland (8). An expert panel, organized by the National Heart, Lung, and Blood Institute (NHLBI), has recommended that WC be measured as part of the initial assessment and be used to monitor the efficacy of weight-loss therapy in overweight and obese patients who have a BMI 35 (7). However, measurement of WC has not been widely adopted in clinical practice, and the anatomical, metabolic, and clinical implications of WC data can be confusing. Therefore, Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; and the American Diabetes Association convened a panel, composed of members with expertise in obesity management, obesity-related epidemiology, adipose tissue metabolic pathophysiology, statistics, and nutrition science, to review the published scientific literature and hear presentations from other experts in these fields. The Consensus Panel met