Waistline Measures Risk for Heart Disease More Accurately Than BMI

A growing waistline warns of increased risk for heart disease, even for those of normal weight according to their Body Mass Index (BMI). The findings come from a new study published in the May 10 issue of the Journal of the American College of Cardiology. The results of the study indicate that having excess belly fat is just as great a risk factor for cardiovascular disease as having very high blood cholesterol, or smoking a pack of cigarettes a day, especially among men.

The researchers pointed out that their findings challenge the theory known as “obesity paradox” that suggests that having a higher BMI provides a better chance for survival of coronary artery disease than for people of normal weight. However, the findings indicate that it may be possible for people to be overweight without significantly increasing their heart risk, as long as the extra fat they carry is located in places other than their belly.

According to lead study author Dr. Thais Coutinho, a cardiology fellow at the Mayo Clinic in Rochester, Minnesota, “We suspected that the obesity paradox was happening because BMI is not a good measure of body fatness and gives no insight into the distribution of fat.” She further explained, “BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body.” A BMI between 18.5 and 25 is normal, while between 25 and 29.9 is considered overweight, and a total of 30 or more is considered obese.

For their analysis, the researchers reviewed data gathered from five studies spanning the globe that involved nearly 16,000 people from United States, Denmark, France and Korea who suffered from coronary artery disease. Findings showed that for people with coronary artery disease coupled with central obesity, the risk of death was almost doubled. During the study, central obesity was determined by waist circumference and waist-to-hip ratio. Coutinho said, “All it takes is a tape measure and one minute of a physician’s time to measure the perimeter of a patient’s waist and hip.”

In a news release, Dr. Francisco Lopez-Jimenez, lead investigator in the study, and director of Mayo’s Cardiometabolic Program explained, “Visceral fat has been found to be more metabolically active. It produces more changes in cholesterol, blood pressure and blood sugar. However, people who have fat mostly in other locations in the body, specifically the legs and buttocks, don’t show this increased risk.”

The study authors noted that to accurately assess the health risk of patients, healthcare providers need to go beyond the indications of BMI and counsel those with large waistlines, or high waist-to-hip ratios on the importance of weight loss.

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