Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar;16(3):177-189.
doi: 10.1038/s41574-019-0310-7. Epub 2020 Feb 4.

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Robert Ross  1 , Ian J Neeland  2 , Shizuya Yamashita  3 , Iris Shai  4 , Jaap Seidell  5 , Paolo Magni  6   7 , Raul D Santos  8   9 , Benoit Arsenault  2   10 , Ada Cuevas  11 , Frank B Hu  12 , Bruce A Griffin  13 , Alberto Zambon  14 , Philip Barter  15 , Jean-Charles Fruchart  16 , Robert H Eckel  17 , Yuji Matsuzawa  18 , Jean-Pierre Després  10   19
Affiliations
Review

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Robert Ross et al. Nat Rev Endocrinol. 2020 Mar.

Abstract

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

PubMed Disclaimer

Conflict of interest statement

I.J.N. reports receiving fees for consulting and serving on the advisory board from Boehringer Ingelheim/Lilly Alliance and AMRA Medical and a research grant from Novo Nordisk. F.B.H. reports receiving speaker fees from Metagenics and Standard Process and a research grant from California Walnut Commission. R.D.S. reports receiving consulting and speaker fess from Amgen, Astra Zeneca, Akcea, Biolab, Esperion, Kowa, Merck, MSD, Novo Nordisk, Sanofi Regeneron, Akcea, Kowa and Esperion. S.Y. reports grants and personal fees from Kowa Company, Ltd., Otsuka Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., Bayer Yakuhin, Ltd., MSD K.K., Takeda Pharmaceutical Company, Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Astellas Pharma Inc., Daiichi-Sankyo Company, Ltd., Astra Zeneka K.K. and Kaken Pharmaceutical Co., Ltd.; grants from Kyowa Medex Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., National Institute of Biomedical Innovation, Hayashibara Co., Ltd., Teijin Pharma Limited, Kissei and Mochida Pharmaceutical Company, Ltd.; and personal fees from Ono Pharmaceutical Company, Ltd., Skylight Biotec, Inc., Pfizer, Astellas Amgen, Sanofi and Aegerion. S.Y. also has patents issued with Fujirebio and Kyowa Medex Co., Ltd. issued. R.H.E. reports his role as a scientific adviser for PROMINENT (Kowa Company Ltd.) and being on the advisory committees for Novo Nordisk and Sanofi/Regeneron. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. The prevalence of abdominal obesity and obesity measured in different studies.
Changes in the prevalence of abdominal obesity (measured using waist circumference) and general obesity (measured using BMI) measured in different studies during the time period indicated on the x axis. General obesity was defined as BMI ≥30 kg/m2. Abdominal obesity was defined as waist circumference ≥88 cm and ≥102 cm for women and men, respectively. However, Xi et al. defined general obesity as BMI ≥28 kg/m2 and abdominal obesity as waist circumference ≥80 cm and ≥85 cm for Chinese women and men, respectively. In addition, Barzin et al. defined general obesity as BMI ≥30 kg/m2 and abdominal obesity as waist circumference ≥91 cm and ≥89 cm for Iranian women and men, respectively. Years given (for example, 1999–2011) indicate the years in which data were collected. F, female; M, male. Data are from refs,–.
Fig. 2
Fig. 2. Overview of potential role of functional and dysfunctional adipose tissue contributing to increased cardiometabolic risk.
The ability of subcutaneous adipose tissue (SAT) to expand through hyperplasia (generation of new fat cells) allows the safe storage of the excess energy from the diet into a properly expanding subcutaneous ‘metabolic sink’. When this process becomes saturated or in situations where adipose tissue has a limited ability to expand, there is a spillover of the excess energy, which must be stored in visceral adipose tissue as well as in normally lean organs such as the skeletal muscle, the liver, the pancreas and the heart, a process described as ectopic fat deposition. Visceral adiposity is associated with a hyperlipolytic state resistant to the effect of insulin along with an altered secretion of adipokines including inflammatory cytokines whereas a set of metabolic dysfunctions are specifically associated with increased skeletal muscle, liver, pancreas, and epicardial, pericardial and intra-myocardial fat. FFA, free fatty acid.
Fig. 3
Fig. 3. Waist circumference is a modifiable risk factor that can indicate cardiometabolic risk, morbidity and mortality.
An illustration of the important role that decreases in waist circumference have for linking improvements in lifestyle behaviours with downstream reductions in the risk of morbidity and mortality. The benefits associated with reductions in waist circumference might be observed with or without a change in BMI.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ng M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–781. - PMC - PubMed
    1. Afshin A, Forouzanfar MH, Reitsma MB, Sur P. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 2017;377:13–27. - PMC - PubMed
    1. Phillips CM. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann. N. Y. Acad. Sci. 2017;1391:85–100. - PubMed
    1. Bell JA, et al. The natural course of healthy obesity over 20 years. J. Am. Coll. Cardiol. 2015;65:101–102. - PubMed
    1. Eckel N, Meidtner K, Kalle-Uhlmann T, Stefan N, Schulze MB. Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2016;23:956–966. - PubMed

Publication types

Grants and funding