The Importance of Waist Circumference

Why Your Middle Is a Measure of Health Risk

Updated on July 17, 2022

Medically reviewed by Danielle Weiss, MD

Your waist circumference is an important number to know, especially if you're living with a chronic health issue such as heart disease or have a risk factor for diabetes, such as family history.

In fact, research shows waist circumference may be as important as body mass index (BMI)—the ratio of weight to height that can indicate obesity—for predicting disease risk and overall health status. This is because BMI does not account for how fat is distributed in the body.

In contrast, a large waist circumference indicates an accumulation of fat in the intra-abdominal region—and fat in this area can impact internal organs and is more metabolically active than fat in other areas of the body.

A person with a larger waist-to-hip ratio faces an increased risk for developing type 2 diabetes, regardless of whether or not they are overweight.

How to Measure Your Waist Circumference

Getting an accurate waist measurement is fairly simple:

Stand up straight and relax. Exhale normally.
Locate your hip bones and wrap a tape measure around your body just above them. A good spot to aim for is halfway between your hip bone and the lowest rib. In most people this spot should is just above the bellybutton but it can vary.
Make sure the tape measure is flat against your body and parallel to the floor. It should be snug against your skin but not tight.

how to measure waist circumference — Hugo Lin / Verywell

Waist Measurement Recommendations

The Centers for Disease Control and Prevention warns that exceeding the following waist circumference can increase risk of developing obesity-related conditions:

Assigned Male at Birth: 40 inches
Non-pregnant Assigned Female at Birth: 35 inches

The American Heart Association (AHA) advises waist circumference be evaluated in people with a BMI of 25 or higher. However, at least one study has revealed that the risk for developing diabetes was stronger for people who had a lower BMI but had a high waist circumference.

A BMI below 18.5 is considered underweight, between 18.5 to 24.9 is optimal, between 25 to 29.9 is overweight, and over 30 is technically considered obese. Body mass index can be calculated by comparing height to weight.

To find your BMI, divide your weight in pounds by your height in inches; multiply the result by 703 to convert from lbs/inches² to kg/m².

When used alone, a BMI measurement is not especially accurate at predicting health and heart disease risk. Used in conjunction with waist circumference, it provides a clearer picture.

Body Mass Index

The most commonly used measure to correlate weight and height is the body mass index (BMI). It uses weight and height to try and estimate body fat. The resulting number is then used to categorize people as underweight, normal weight, overweight, obese, or morbidly obese. BMI is not perfect, however, and does not account for other factors that determine body composition like age, muscle mass, or sex. BMI calculations may, for example, overestimate body fat in athletes or in older people. Additionally, BMI can also stigmatize and shame people who do not meet what is considered an ideal weight or body shape.

Risks of Having a Large Waist Circumference

There are several serious risks associated with a waist circumference larger than 35 inches in people assigned female at birth or 40 inches in those assigned male at birth, including:

Type 2 diabetes
Cardiovascular disease
High blood pressure
Insulin resistance and hyperinsulinemia
Glucose intolerance
Hyperlipidemia, or elevated cholesterol
Dementia
Impaired pulmonary function
Metabolic syndrome
Certain types of cancer
Death

Waist Circumference and Metabolic Syndrome

Metabolic syndrome is a cluster of medical conditions that occur together and increase one's risk for diabetes, heart disease, and stroke. Abdominal or central obesity (having a large waist circumference) along with insulin resistance are considered the two most important risk factors.

Causes of a High Waist Circumference

A larger waist circumference is often caused by intra-abdominal visceral fat. Visceral fat is fat that develops between and around internal organs. This type of fat differs from "regular" fat that sits just beneath the skin and can be pinched. This type of fat is deep within the abdomen and is considered to have very high inflammatory activity.

Fat cells were once thought to function solely as energy storage. However, it is now known they also secrete hormones. They play a part in response to infection, inflammation, and injury, among other things. They also secrete both inflammatory and anti-inflammatory substances. Inflammation may be a major factor in the onset of diabetes. Fat cells secrete adiponectin, a protein hormone which improves insulin sensitivity and lowers the risk of atherosclerosis and diabetes. However, less adiponectin is produced as fat cells increase.

If you are stressed physically, mentally, or emotionally, you may have high levels of the stress hormone cortisol. Chronically elevated levels cause your body to deposit more visceral fat in the abdomen.

How to Trim Your Waist

There are several effective ways to reduce your waist circumference in a healthy manner.

Lifestyle changes, including eating a healthy diet and getting regular exercise
Quitting smoking and maintaining it
If you have type 2 diabetes, the medication metformin may provide benefits in helping to reduce waist circumference.

Work with a primary care provider to determine the best method for you to reduce your waist circumference if you're over the recommended guidelines.

A Word From Verywell

There are many measures of overall health and wellness. Waist circumference happens to be just one. It is not the be-all, end-all metric, but it can be a helpful clue in determining your long-term health. If you are concerned about your waist measurement, consult with a healthcare provider about safe ways to lose weight and reduce your risk of chronic disease.

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