The longer your waistline...

Although body mass index (BMI) is a popular indicator of normal, overweight, or obese, it is certainly an imperfect indicator. BMI takes into account only height and weight, but not muscle mass or weight distribution.

Scientists are now finding that waist circumference may be the best indicator of disease risk related to excess weight – waist circumference has been associated with diabetes, heart disease, inflammation, elevated cholesterol, sleep apnea, and hypertension. Waist circumference has gained interest because it is an indicator of visceral fat, believed to be more deleterious to health than subcutaneous fat. The exact mechanisms by which visceral fat confers greater risk than subcutaneous fat are still unclear, but it is known that these two types of fat have different gene expression profiles, visceral fat more frequently expressing certain substances that may contribute to chronic diseases.1,2

A study that followed over 100,000 individuals for nine years has found that waist circumference correlates with risk of death, supporting the previous links between visceral fat and disease. When comparing waist size only, they found that very large waist circumferences – 120 cm (47 inches) for men and 102 cm (40 inches) for women – were associated with a doubling of the risk of death from all causes.

The most striking finding in this study was that increased waist circumference is an important predictor of mortality regardless of BMI. Even in those with “normal” range BMI, increased the risk of death. A 4-inch increase in waist circumference was associated with a 16% increase in mortality risk in men and 25% increase in mortality risk in women. 

This means that excess fat around the waist is a significant risk – even in “normal weight” individuals.3 This data suggests that the size of one’s waist is even more important than the number on the scale.

Of course there is no way for us to control our bodies’ distribution of fat – whether our excess fat goes to our hips or around our organs – but we can control how much excess fat we have. Any and all excess fat is dangerous - it increases insulin levels and promotes inflammation, not to mention placing unnecessary demand on the heart. Focusing on nutrient density - emphasizing foods that minimize calories and maximize disease-protective nutrients – is an effective way to keep excess fat – both visceral and subcutaneous – to a minimum.



1. Matsuzawa Y. Establishment of a concept of visceral fat syndrome and discovery of adiponectin. Proc Jpn Acad Ser B Phys Biol Sci. 2010;86(2):131-41.

2. Bergman RN, Kim SP, Catalano KJ, et al. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity (Silver Spring). 2006 Feb;14 Suppl 1:16S-19S.

3. Jacobs EJ, Newton CC, Wang Y, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010 Aug 9;170(15):1293-301.

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Comments (6) Read through and enter the discussion with the form at the end
Matt Stone - August 25, 2010 10:12 AM

The dangers of having a little body fat are a little overplayed in this post. Yes, you can be both lean and healthy as is seen all over rural Africa, but statistics gathered from the NHANES study show lowest mortality and morbitity rates in the BMI range of 25-30 for adults and 30-35 for people over the age of 70. In fact, once over 70, the lower your BMI below the overweight category (25-30), the higher your mortality and morbidity rates - and it's quite dramatic.

I know personally my health and sense of well-being declines along with my weight - and the leaner I get, the more cranky I get, with increasing minor health problems like indigestion or constipation.

Geoffrey Levens - August 25, 2010 10:50 AM

I do not understand how waist circumference would be a more accurate predictor than BMI. For example, if a man who is 6'3" tall has a waist circumference of 37 inches he could be moderately lean but if a man who is 5'3" tall has the same sized waist he would likely be a blimp!!!

And then in my case, I have a slightly large waist for my height but I am not sure it is "fat" since when I do the pinch test the skin fold is not more than 1/4-3/8 inch thick, 1 inch lateral to navel. I have done a lot of abdominal exercise for many years as part of martial arts training...

Michele Banks - August 25, 2010 12:46 PM

I'm more concerned with the overall health of the individual first. Through various nutritional tests, I would then determine what should be the most critical steps to take to increase the quality of health and then decrease the inch or weight accordingly.

I'm afraid that there is so much mis-information out there that the truth will be buried. Obesity in elderly stages of life is deadly also. It is a bad mis-conception that they should not lose weight. However, what is correct, is that they should consume more healthy fats and more protein than younger folks because their bodies do tend to waste away due to disease, improper diet and lack of exercise. The heart cannot keep up with the high-weight demand with a poor muscular-skeletal system which is typical for the elderly, so heart attacks and related circulatory issues will contribute to any earlier trip to the grave than otherwise would have been if all systems were healthy.

StephenMarkTurner - August 26, 2010 6:32 AM

I'm confused by Matt's comment that lower BMI is associated with higher morbidity in people over 70.

It's just my own observation looking around where I live, but it seems to me that there are absolutely no severely overweight seniors whatsoever, and lots of lean seniors.

Regards, Steve

Vennesa - August 26, 2010 4:08 PM

I agree with Steve. I don't think I've ever seen a fat 90 year old.
And Matt, the leaner I get, the happier I am and the more motivated I am to continue eating healthily. I feel great. In the past, when I tried to lose weight by cutting calories, I definitely felt deprived and cranky.

pete bircsak - August 27, 2010 12:57 PM

I think the reason you dont see obese 90 year olds is that they leave before 90.

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