Association of Diabetes Care & Education Specialists

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Waist Circumference: An Easy Measurement Provides Great Information

Nov 27, 2012

I just saw a title that sparked my interest.  Stone Heath Newsletters reported “Waist circumference (WC) trumps body mass index (BMI) for mortality risk prediction.”  I love that a simple measurement provides great information. The abstract from “Body mass index versus waist circumference as predictors of mortality in Canadian adults,” just published in the International Journal of Obesity, reports that increased death risk from all causes, cancer, and cardiovascular disease (CVD) are associated with elevated BMI, WC and waist to hip ratio (WHR). However, WC actually did better than the other two measures.  In addition, it is easy, quick and inexpensive. 

Is there a negative to doing a waist circumference?  Yes. I have found that patients dread the tape measure, possibly even more than the scale.  I am part of a team teaching a 12-week weight management class, specifically for people with diabetes.  As part of the assessment, I perform WC at the start, halfway point, and completion of the program.  It amazes me, and the participants, to see how much WC can change with weight loss.  It is common to see a two to four inch loss in the 12 weeks.  To no surprise, this loss is often accompanied by decreased need for diabetes, HTN, and cholesterol medications!

Measuring a WC is easy.  I have some hints. It is to be done where the waist is narrowest.  When someone is overweight, especially with an apple rather than pear shaped body, this is often the area that the waist measurement is greatest.  For an accurate measurement, find the arch of the back and slide your hand to the furthest inward spot.  This is the height for the measurement.  Then, stand to the side of the person and run the tape measure around on the horizontal. Being in the front or back of the person can put your face in private areas so stand to the side.  This also allows you to see the tape on the horizon.  If the person is quite large, ask them to hold the end as you walk the tape around.  Have the person relax their arms at their sides (lifting decreases the circumference) and breathe normally, then read the measurement.  It is important to have a tape measure that is large enough. There are some made specifically for WC.

What do the results mean?  A man’s waist greater than 40 inches (102 cm) or a woman’s greater than 35 inches (88 cm), is related to increased risk for type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease.  Educating the patient about the benefits of a smaller WC may help to encourage weight loss and decrease the risk of diseases and mortality. 

Do you do WC measurements with patients?  Do you have hints?  Do you think it is provides good information?

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  1. Dec 05, 2012

    Thanks for all of the great comments! Sounds like this is a good measurement and being used routinely. One comment, sometimes the navel doesn't work, especially if the belly has really sagged (very overweight or those who have lost some weight) and I have had patients that had big surgical scars without a navel. But, probably a good landmark most times.
  2. Dec 04, 2012

    We ask the patient's on their pre class assessment what their waist circumference is. Some patient's know and some don't. We discuss how to measure in class. I would use waist circumference as a measure of weight loss if I were following them for weight loss or pre diabetes. Our diabetes classes are three days in a row and then we might see them for follow up or support group. It is worth mentioning so the patient has an understanding as to what it means and thanks for giving accurate detail as to how to measure waist circumference.
  3. Dec 03, 2012

    Karen, Thanks for this information. Although a more hands on method, WCseems to be easier for patients to understand or conceptualize. I appreciate the advice on how to actually perform a measurement--very helpful! Kellie
  4. Dec 03, 2012

    I have always measured at the belly button and tried to keep the tape horizonal.
  5. Dec 03, 2012

    I am very familiar with this measurement. In fact it is required in many of my NIH studies. The research that you referenced validated its use in many studies that predict motality. We had to be certified in the measurement and need to use a special tape measure with a level built into it. I agree, it is very embarassing for the patient as times especially when the patient is very large. Some tape measures are not large enough so make sure you use the extra long version. Once we had the shorter tape type and it added to the patient's discomfort.
  6. Nov 29, 2012

    A paper in the 2010 issue of JCEM conclucdded "Neck circumference is associated with CVD risk factors even after adjustment for Visceral Adipose Tissue (VAT) and BMI. These findings suggest that upper-body sc fat may be a unique, pathogenic fat depot." I've witnessed practitioners imply asking patients white size shirt they wear (a man's perspective, of course), so no actual measurement is even necessary. The association, however, was even stronger for women. For more details, see: J Clin Endocrinol Metab. 2010 August; 95(8): 3701–3710. Published online 2010 May 19. doi: 10.1210/jc.2009-1779PMCID: PMC2913042 Neck Circumference as a Novel Measure of Cardiometabolic Risk: The Framingham Heart Study Sarah Rosner Preis, Joseph M. Massaro, Udo Hoffmann, Ralph B. D'Agostino, Sr., Daniel Levy, Sander J. Robins, James B. Meigs, Ramachandran S. Vasan, Christopher J. O'Donnell, and Caroline S. Fox
  7. Nov 29, 2012

    In our practice, we always do WC with the initial assessment and again at the 3-month follow up. I learned quickly to have the patient hold an end of the tape and walk around. I do like the idea of standing at the side to be less intrusive. Patients celebrate the WC decrease just as much as the weight loss.
  8. Nov 28, 2012

    Thank you for your post Karen! In my experience, using waist measurement promotes less consternation from patients. Once a patient is on the scale, they usually start to explain that they drank too much water, just ate a big meal, or are wearing heavy clothes. They usually do not respond this way to the measuring tape. Using the Waist to Height Ratio (WHtR), dividing waist size by height, is especially helpful in predicting certain health risks and mortality, according to research presented at the 19th European Congress on Obesity in Lyon.
  9. Nov 27, 2012

    Thanks, Karen for the great tip!

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