Comparing Trends in BMI and Waist Circumference

Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Victoria, Australia.
Obesity (Impact Factor: 3.73). 06/2010; 19(1):216-219. DOI: 10.1038/oby.2010.149


The nature of excess body weight may be changing over time to one of greater central adiposity. The aim of this study is to determine whether BMI and waist circumference (WC) are increasing proportionately among population subgroups and the range of bodyweight, and to examine the public health implications of the findings. Our data are from two cross-sectional surveys (the US National Health and Nutrition Examination Studies (NHANES) in 1988–1994 (NHANES III) and 2005–2006), from which we have used samples of 15,349 and 4,176 participants aged ≥20 years. Between 1988–1994 and 2005–2006 BMI increased by an average of 1.8 kg/m2 and WC by 4.7 cm (adjusted for sex, age, race-ethnicity, and education). The increase in WC was more than could be attributed simply to increases in BMI. This independent increase in WC (of on average, 0.9 cm) was consistent across the different BMI categories, sexes, education levels, and race-ethnicity groups. It occurred in younger but not older age groups. Overall in each BMI category, the prevalence of low-risk WC decreased and the prevalence of increased-risk or substantially increased-risk WC increased. These results suggest that the adverse health consequences associated with obesity may be increasingly underestimated by trends in BMI alone. Since WC is closely linked to adverse cardiovascular outcomes, it is important to know the prevailing trends in both of these parameters.

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    • "More recently, there is evidence that BMI and WC have been tracking differently over the past few decades. In a number of populations, greater increases in WC than BMI have been observed, and WC has continued to increase despite an apparent plateau in BMI trends [8,2324252627. The potential implication of these trends is that even if WC is only equivalent to or modestly better at predicting metabolic outcomes than BMI, WC may be increasingly capturing a different group of the population who have increased health risks related to excess adiposity than would be captured by BMI alone. "

    Full-text · Article · Dec 2015
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    • "In Switzerland, a link between overweight and obesity and low education status has been observed in four cross-sectional National health surveys using representative samples of the Swiss population aged 18–102 years [1]; however differences in financial resources were not taken into account in this analysis. Changes in body composition are observed with advancing age [8,17], highlighting the need to monitor adiposity trends with several indicators, including BMI and waist circumference (WC) [18]. Although sophisticated methods exist for exploring adiposity, simple measures such as anthropometric indicators are useful for routine clinical practice and public health surveillance. "
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    ABSTRACT: Overweight and obesity prevalence is the highest at age 65-75 years in Lausanne (compared with younger classes). We aimed to describe 1) eating habits, daily physical activity (PA), and sports frequency in community-dwelling adults aged 65-70, 2) the links of these behaviors with socio-economic factors, and 3) with adiposity. Cross-sectional analysis of Lc65+ cohort at baseline, including 1260 adults from the general population of Lausanne aged 65-70 years. Eating habits (8 items from MNA) and PA (sports frequency and daily PA: walking and using stairs) were assessed by questionnaires. Body mass index (BMI), supra-iliac (SISF), triceps skin-folds (TSF), waist circumference (WC), and WHR were measured. Prevalence of overweight (BMI 25.0-29.9 kg/m2), obesity (BMI >=30.0 kg/m2), and abdominal obesity was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women.Intake of fruits or vegetables (FV) >= twice/day was negatively associated with male sex (prevalence 81% versus 90%, chi-square P < 0.001). The proportion avoiding stairs in daily life was higher among women (25%) than among men (20%, chi-square P = 0.003).In multivariate analyses among both sexes, eating FV, using stairs in daily life ("stairs"), and doing sports >= once/week were significantly negatively associated with financial difficulties (stairs: OR = 0.54, 95% CI = 0.40-0.72) and positively with educational level (stairs: OR = 1.68, 95% CI = 1.17-2.43 for high school).For all five log-transformed adiposity indicators in women, and for all indicators except SISF and TSF in men, a gradual decrease in adiposity was observed from category "no stairs, sports < once/week" (reference), to "no stairs, sports >= once/week", to "stairs, sports < once/week", and "stairs, sports >= once/week" (for example: WC in men, respectively: Ss = -0.03, 95% CI = -0.07-0.02; Ss = -0.06, 95% CI = -0.09--0.03; Ss = -0.10, 95% CI = -0.12--0.07). In this population with high overweight and obesity prevalence, eating FV and PA were strongly negatively associated with financial difficulties and positively with education. Using stairs in daily life was more strongly negatively associated with adiposity than doing sports >= once/week.
    Full-text · Article · Dec 2013 · BMC Public Health
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    • "In addition, two studies suggest an independent increase in the prevalence of central obesity over and above the prevalence of general obesity in adults [9,10]. Besides, a number of studies demonstrate a steeper rise in the prevalence of central obesity than the prevalence of general obesity although these studies do not indicate whether the central obesity has moved independently further than the general obesity [8,10,13]. Our finding that an increasing number of people with BMI < 25 kg/m2 are at risk for obesity due to excessive WC (≥ 90/80 cm) emphasizes the huge potential for preventing an unexpectedly large burden of obesity that remains to be realized in Chinese adults with BMI < 25 kg/m2. "
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    ABSTRACT: Background Central obesity is thought to be more pathogenic than overall obesity and studies have shown that the association between waist circumference (WC) and mortality was strongest in those with a normal body mass index (BMI). The objective of our study was to determine secular trends in the prevalence of central obesity (WC ≥ 90 cm for men and ≥ 80 cm for women) among Chinese adults with normal BMI from 1993 to 2009 and to examine the impact of performance of combined BMI and WC on the prevalence of obesity in Chinese adults. Methods We used data from the China Health and Nutrition Survey (CHNS) conducted from 1993 to 2009. From which we included a total of 52023 participants aged ≥ 18 years. Results The age-standardized prevalence of central obesity among Chinese adults with BMI < 25 kg/m2 increased from 11.9% in 1993 to 21.1% in 2009 (P for linear trend <0.001). The upward trends were noted in both genders, all ages, rural/urban settings, and education groups (all P for linear trend <0.001), with greater increments in men, participants aged 18–64 years, and rural residents (P for interaction terms survey × sex, survey × age, and survey × rural/urban settings were 0.042, 0.003, and < 0.001, respectively). Trends in the prevalence of central obesity were similar when a more stringent BMI < 23 kg/m2 cut point (Asian cut point) was applied. Central obesity is associated with a higher risk of incident hypertension within normal BMI category. More than 65% individuals with obesity would be missed if solely BMI was measured. Conclusions We observed an upward trend in the prevalence of central obesity among participants with normal BMI irrespective of sex, age, rural/urban settings, and education level. Central obesity is associated with a higher risk of incident hypertension within normal BMI category. Approximately two thirds of the individuals with obesity would be missed if WC was not measured. It is, therefore, urgent to emphasize the importance of WC as a measure to monitor the prevalence of obesity.
    Full-text · Article · Apr 2013 · BMC Public Health
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