BMI: Why waist-to-hip ratio may be a better health measurement

Evan Walker
Evan Walker TheMediTary.Com |
A statue with blue tape around the waist and hipsShare on Pinterest
Experts say weight-to-hip ratio is a more accurate way to determine overall health risks. lambada/Getty Images
  • Body mass index (BMI) has long been used as a tool for weight management and intervention, but experts say it has many flaws.
  • They say waist-to-hip ratio may be a more accurate indicator of risk of mortality from all causes.
  • They add that waist-to-hip ratio may be a more useful tool in healthcare interventions.

Waist-to-hip ratio may be a better tool for determining weight management than body mass index (BMI), according to a new study.

Research published this week in the journal JAMA Network Open reports that waist-to-hip ratio may be more useful than BMI in determining health risks and medical interventions.

For their study, the researchers examined data from 387,672 participants based in the United Kingdom. They compared data on BMI, fat mass index, and waist-to-hip ratio.

“Compared with BMI, [waist-to-hip ratio] had the strongest, most robust, and consistent association with all-cause mortality and was the only measurement unaffected by BMI. Current WHO recommendations for optimal BMI range are inaccurate across individuals with various body compositions and therefore suboptimal for clinical guidelines,” the researchers wrote.

“Future research is needed to explore whether using WHR as the primary clinical measure of adiposity (body fat) would help to improve long-term health outcomes in distinct patient populations compared with BMI. Our results provide further support to shift public health focus from measures of general adiposity, such as BMI, to adiposity distribution using [waist-to-hip ratio],” the study authors added.

Waist-to-hip ratio is the circumference of the waist divided by the circumference of the hip.

In both men and women, a waist-to-hip ratio of 1.0 or above is considered at risk for conditions such as heart disease.

Those who carry excessive fat around their midsection may be at greater risk of developing type 2 diabetes, coronary heart disease, and high blood pressure.

rationale="Governmental authority">BMI is a commonly used tool for weight management and is calculated by dividing a person’s weight in kilograms by their height in meters squared.

Experts say BMI can be a problematic tool.

“BMI historically has been ‘the’ tool used in weight management in doctor’s offices, hospitals, etc. Even to this day it is still used. That’s because it is extremely easy to calculate. All you need is height and weight. However, BMI is fraught with problems, one of them is that you can have a weight lifter with 8% body fat with a BMI of 35 and you can have someone who has 35% body fat with the same BMI. It’s nonspecific,” said Dana Hunnes, PhD, a senior clinical dietitian at the UCLA Medical Center in Los Angeles who was not involved in the new study.

“Waist-to-hip ratio does do a better job of capturing visceral fat, mid-body fat, waist fat, the fat that is most harmful in terms of all-cause and cause-specific mortality,” Hunnes told Medical News Today. “So yes, given that this is a better measure, surrogate for adiposity in general and adiposity distribution, I do think that we should be using it more often.”

Despite the flaws of the BMI, experts note it is still a commonly used tool.

“It has a very significant amount of flaws in it… but it is a useful tool,” said Dr. Dan Azagury, the section chief of Minimally Invasive and Bariatric Surgery at Stanford University in California who was not involved in the study.

“It’s still a useful tool for multiple reasons,” he told Medical News Today. “One is, it is pretty deeply ingrained in a lot of the things that we use… The guidelines from the [Food and Drug Administration] and the [National Institutes of Health] around management of obesity are still around BMI.”

“What your insurance will pay, what treatment they will pay for is based on BMI,” Azagury added. “So while I agree that it’s flawed, it’s here and it’s so widely used that we’re probably going to have to live with it for a lot longer.”

Share this Article