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{{Short description|Waist circumference divided by height}} {{Short description|Waist circumference divided by height}}
{{Human body weight}} {{Human body weight}}
The '''waist-to-height ratio''' (WHtR,{{efn|The abbreviation WHR is more commonly used for ], although WHpR is preferred.}} or WSR: waist-to-stature ratio) is the waist ] divided by body height, both measured in the same units.
A person's '''waist-to-height ratio'''{{snd}} occasionally written '''WHtR'''{{efn|As distinct from the better-known WHR or WHpR, ]}}{{snd}} or called '''waist-to-stature ratio''' ('''WSR'''), is defined as their waist ] divided by their height, both measured in the same units. It is used as a predictor of obesity-related cardiovascular disease. The WHtR is a measure of the distribution of ]. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases; it is correlated with ].<ref>{{cite journal | vauthors = Lee CM, Huxley RR, Wildman RP, Woodward M | title = Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis | journal = Journal of Clinical Epidemiology | volume = 61 | issue = 7 | pages = 646–653 | date = July 2008 | pmid = 18359190 | doi = 10.1016/j.jclinepi.2007.08.012 | doi-access = free }}</ref>


More than twenty-five years ago, waist-to-height ratio (WHtR) was first suggested as a simple health risk assessment tool because it is a proxy for harmful central ]<ref name="Vague-1956" /> and a boundary value of 0.5 was proposed to indicate increased risk.<ref name="Hsieh-1995" /><ref name="Ashwell-1996" /> A WHtR of over 0.5 is critical and signifies an increased risk; a 2010 systematic review of published studies concluded that "WHtR may be advantageous because it avoids the need for age-, sex- and ethnic-specific boundary values".<ref>{{cite journal | vauthors = Browning LM, Hsieh SD, Ashwell M | title = A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value | journal = Nutrition Research Reviews | volume = 23 | issue = 2 | pages = 247–269 | date = December 2010 | pmid = 20819243 | doi = 10.1017/S0954422410000144 | doi-access = free }}</ref> In April 2022, the UK's ] (a government body) proposed new guidelines which suggested that all adults "ensure their waist size is less than half their height in order to help stave off serious health problems".<ref>{{cite news |title=Ensure waist size is less than half your height, health watchdog says |work=] | url=https://www.theguardian.com/society/2022/apr/08/ensure-waist-size-is-less-than-half-your-height-health-watchdog-says | date=8 April 2022 | access-date=8 April 2022 | vauthors = Gregory A }}</ref> In September 2022, NICE formally adopted this guideline.<ref>{{cite web |title= Obesity: identification, assessment and management {{!}} Clinical guideline | date=8 September 2022 |publisher=National Institute for Health and Care Excellence | url=https://www.nice.org.uk/guidance/cg189 }} Recommendations 1.2.11 and 1.2.12</ref> WHtR is a measure of the distribution of ]. Higher values of WHtR indicate higher risk of obesity-related ]s, which are correlated with ].<ref>{{cite journal | vauthors = Lee CM, Huxley RR, Wildman RP, Woodward M | title = Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis | journal = Journal of Clinical Epidemiology | volume = 61 | issue = 7 | pages = 646–653 | date = July 2008 | pmid = 18359190 | doi = 10.1016/j.jclinepi.2007.08.012 | doi-access = free }}</ref> A waist size less than half the height helps to stave off serious health problems.<ref>{{cite news |title=Ensure waist size is less than half your height, health watchdog says |work=] | url=https://www.theguardian.com/society/2022/apr/08/ensure-waist-size-is-less-than-half-your-height-health-watchdog-says | date=8 April 2022 | access-date=8 April 2022 | vauthors = Gregory A }}</ref>

== History ==
More than twenty-five years ago, WHtR was first suggested as a simple health risk assessment tool because "it is a proxy for harmful ]";<ref name="Vague-1956" /> it predicts obesity-related cardiovascular disease. A boundary value of 0.5 was proposed to indicate increased risk.<ref name="Hsieh-1995" /><ref name="Ashwell-1996" /> A WHtR of over 0.5 is critical and signifies an increased risk; a 2010 systematic review of published studies concluded that "WHtR may be advantageous because it avoids the need for age-, sex- and ethnic-specific boundary values".<ref>{{cite journal | vauthors = Browning LM, Hsieh SD, Ashwell M | title = A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value | journal = Nutrition Research Reviews | volume = 23 | issue = 2 | pages = 247–269 | date = December 2010 | pmid = 20819243 | doi = 10.1017/S0954422410000144 | doi-access = free }}</ref>


According to ] guidance, the waist circumference is usually measured midway between the lower rib and the ].<ref name="WHO-2011" /> According to ] guidance, the waist circumference is usually measured midway between the lower rib and the ].<ref name="WHO-2011" />


== Guidelines == == Guidelines ==

=== Calculation ===
<!-- use of template suspended pending dispute resolution {{Body roundness index}} -->
<math display="block">\text{WHtR}=\frac{\text{waist circumference}}{\text{height}}</math>
e.g. 1: {{sfrac
|{{calculator|id=waistFormula1|formula=waistcm|default=72|type=plain}} cm
|{{calculator|id=heightFormula1|formula=heightcm|default=160|type=plain}} cm
}} {{=}} {{calculator|id=whtrFormula1|decimals=2|formula=waistcm/heightcm|default=0.45|type=plain}}

e.g. 2: {{sfrac
|{{calculator|id=waistFormula2a|formula=waistinch|default=28|type=plain}} in
|{{calculator|id=heightFormula2a|formula=heightfeet|default=5|type=plain}} ft {{calculator|id=heightFormula|formula=heightinches|default=3|type=plain}} in
}}
{{=}}
{{sfrac
|{{calculator|id=waistFormula2b|formula=waistinch|default=28|type=plain}} in
|{{calculator|id=heightInches2b|formula=heightfeet*12+heightinches|default=63|type=plain}} in
}}
{{=}} {{calculator|id=whtrFormula2c|decimals=2|formula=waistFormula2b/heightInches2b|default=0.44 |type=plain}}

Any unit will do, as long as waist and height share the same unit.


=== United Kingdom === === United Kingdom ===
The UK's ] (NICE):
⚫ All adults "ensure their waist size is less than half their height in order to help stave off serious health problems".<ref name="NICE-2022-2" /><ref name="NICE-2022-1" />


In September 2022, NICE formally adopted this guideline.<ref>{{cite web |title= Obesity: identification, assessment and management {{!}} Clinical guideline | date=8 September 2022 |publisher=National Institute for Health and Care Excellence | url=https://www.nice.org.uk/guidance/cg189 }} Recommendations 1.2.11 and 1.2.12</ref>
⚫ In April 2022, the UK's ] (a government body) proposed new guidelines which suggested that all adults "ensure their waist size is less than half their height in order to help stave off serious health problems".<ref name="NICE-2022-2" /> In September 2022, NICE formally adopted this guideline.<ref name="NICE-2022-1" />
==== Recommended boundary values <span class="anchor" id="Suggested boundary values"></span>====

==== Recommended boundary values <span class="anchor" id="Suggested boundary values"></span><span class="anchor" id="noIncreasedHealthRisks"></span><span class="anchor" id="increasedHealthRisks"></span><span class="anchor" id="furtherIncreasedHealthRisks"></span> ====
[[File:Waist_to_height_ratio_graph.svg|thumb|upright=1.5| [[File:Waist_to_height_ratio_graph.svg|thumb|upright=1.5|
vertical axis: height vertical axis: height
<br>horizontal axis: ] ] <br>horizontal axis: ] ]
<br>colours: NICE risk level <br>colours: NICE risk level
<br>lines: Waist-to-height-ratio <br>lines: Waist-to-height-ratio
]] ]]
{{Template:Body roundness index}}

The October 2022 NICE guidelines recommend boundary values for WHtR (defining the degree of "]" (])) as follows: The October 2022 NICE guidelines recommend boundary values for WHtR (defining the degree of "]" (])) as follows:
{| class="wikitable" {| class="wikitable"
Line 29: Line 52:
! health risks ! health risks
! action? ! action?
|- bgcolor="#99ffcc" |- bgcolor="#ffCCCC"
| 0.4 to 0.49 | 0.6 or more
⚫ | high
⚫ | healthy
| id="furtherIncreasedHealthRisks"| further increased
| not increased
| no, OK | Take Action

|- bgcolor="#ffff99" |- bgcolor="#ffff99"
| 0.5 to 0.59 | 0.5 to 0.59
| increased | increased
| increased | id="increasedHealthRisks"| increased
| Take Care | Take Care
⚫ |- bgcolor="#99ffcc"

⚫ | 0.4 to 0.49
⚫ |- bgcolor="#ffCCCC"
⚫ | healthy
⚫ | 0.6 or more
| id="noIncreasedHealthRisks"| not increased
⚫ | high
| no, OK
| further increased
| Take Action
|} |}
NICE say that these classifications can be used for people with a ] (BMI) of under 35, for both sexes and all ], including adults with high muscle mass. The health risks associated with higher levels of central adiposity include ], ] and ]. NICE have proposed the same boundary values for children of 5 years and over.<ref name="NICE-2022-3" /> NICE say that these classifications can be used for people with a ] (BMI) of under 35, for both sexes and all ], including adults with high muscle mass. The health risks associated with higher levels of central adiposity include ], ] and ]. NICE have proposed the same boundary values for children of 5 years and over.<ref name="NICE-2022-3" />
Line 78: Line 99:
==See also== ==See also==
* {{anli|Allometry}} * {{anli|Allometry}}
* {{anli|Body fat percentage}} * {{anli|Body fat percentage}}
* {{anli|Body mass index}} (Total mass divided by the square of height) * {{anli|Body mass index}} (Total mass divided by the square of height)
* {{anli|Body roundness index}} * {{anli|Body roundness index}}
* {{anli|Body shape}} * {{anli|Body shape}}
Line 92: Line 113:
== References == == References ==
{{Reflist|refs= {{Reflist|refs=
<ref name="NICE-2022-2">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022|title=Obesity: identification and classification of overweight and obesity (update) |url=https://www.nice.org.uk/guidance/GID-NG10284/documents/draft-guideline}}</ref> <ref name="NICE-2022-2">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022|title=Obesity: identification and classification of overweight and obesity (update) |url=https://www.nice.org.uk/guidance/GID-NG10284/documents/draft-guideline}}</ref>
<ref name="NICE-2022-1">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022 |title=Obesity: identification and classification of overweight and obesity (update) {{!}} Recommendations 1.2.11 and 1.2.12. |url= https://www.nice.org.uk/guidance/cg189 }}</ref> <ref name="NICE-2022-1">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022 |title=Obesity: identification and classification of overweight and obesity (update) {{!}} Recommendations 1.2.11 and 1.2.12. |url= https://www.nice.org.uk/guidance/cg189 }}</ref>
<ref name="Vague-1956">{{cite journal | vauthors = Vague J | title = The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease | journal = The American Journal of Clinical Nutrition | volume = 4 | issue = 1 | pages = 20–34 | year = 1956 | pmid = 13282851 | doi = 10.1093/ajcn/4.1.20 | department = primary | doi-access = free }}</ref> <ref name="Vague-1956">{{cite journal | vauthors = Vague J | title = The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease | journal = The American Journal of Clinical Nutrition | volume = 4 | issue = 1 | pages = 20–34 | year = 1956 | pmid = 13282851 | doi = 10.1093/ajcn/4.1.20 | department = primary | doi-access = free }}</ref>
<ref name="Hsieh-1995">{{cite journal | vauthors = Hsieh SD, Yoshinaga H | title = Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women | journal = Internal Medicine | volume = 34 | issue = 12 | pages = 1147–1152 | date = December 1995 | pmid = 8929639 | doi = 10.2169/internalmedicine.34.1147 | department = primary | doi-access = free }}</ref> <ref name="Hsieh-1995">{{cite journal | vauthors = Hsieh SD, Yoshinaga H | title = Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women | journal = Internal Medicine | volume = 34 | issue = 12 | pages = 1147–1152 | date = December 1995 | pmid = 8929639 | doi = 10.2169/internalmedicine.34.1147 | department = primary | doi-access = free }}</ref>

Latest revision as of 13:14, 26 December 2024

Waist circumference divided by height
Part of a series on
Human body weight
General concepts
Medical concepts
Measurements
Related conditions
Obesity-associated morbidity
Management of obesity
Social aspects

The waist-to-height ratio (WHtR, or WSR: waist-to-stature ratio) is the waist circumference divided by body height, both measured in the same units.

WHtR is a measure of the distribution of body fat. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases, which are correlated with abdominal obesity. A waist size less than half the height helps to stave off serious health problems.

History

More than twenty-five years ago, WHtR was first suggested as a simple health risk assessment tool because "it is a proxy for harmful central adiposity"; it predicts obesity-related cardiovascular disease. A boundary value of 0.5 was proposed to indicate increased risk. A WHtR of over 0.5 is critical and signifies an increased risk; a 2010 systematic review of published studies concluded that "WHtR may be advantageous because it avoids the need for age-, sex- and ethnic-specific boundary values".

According to World Health Organization guidance, the waist circumference is usually measured midway between the lower rib and the iliac crest.

Guidelines

Calculation

WHtR = waist circumference height {\displaystyle {\text{WHtR}}={\frac {\text{waist circumference}}{\text{height}}}} e.g. 1: ⁠72 cm/160 cm ⁠ = 0.45

e.g. 2: ⁠28 in/5 ft 3 in ⁠ = ⁠28 in/63 in ⁠ = 0.44

Any unit will do, as long as waist and height share the same unit.

United Kingdom

The UK's National Institute for Health and Care Excellence (NICE): All adults "ensure their waist size is less than half their height in order to help stave off serious health problems".

In September 2022, NICE formally adopted this guideline.

Recommended boundary values

vertical axis: height
horizontal axis: waist circumference
colours: NICE risk level
lines: Waist-to-height-ratio

The October 2022 NICE guidelines recommend boundary values for WHtR (defining the degree of "central adiposity" (abdominal obesity)) as follows:

WHtR central adiposity health risks action?
0.6 or more high further increased Take Action
0.5 to 0.59 increased increased Take Care
0.4 to 0.49 healthy not increased no, OK

NICE say that these classifications can be used for people with a body mass index (BMI) of under 35, for both sexes and all ethnicities, including adults with high muscle mass. The health risks associated with higher levels of central adiposity include type 2 diabetes, hypertension and cardiovascular disease. NICE have proposed the same boundary values for children of 5 years and over.

Boundary values were first suggested for WHtR in 1996 to reflect health implications and were portrayed on a simple chart of waist circumference against height. The boundary value of WHtR = 0.4 was suggested to indicate the start of the 'OK' range. The 0.5 boundary value was suggested to indicate the start of the 'Take Care' range, with the 0.6 boundary value indicated the start of the 'Take Action' range.

Simplified guidelines

The first boundary value for increased risk of WHtR 0.5 translates into the simple message "Keep your waist to less than half your height". The updated NICE guideline says "When talking to a person about their waist-to-height ratio, explain that they should try and keep their waist to half their height (so a waist-to height ratio of under 0.5)".

Age-adjusted boundary values

A 2013 study identified critical threshold values according to age, with consequent significant reduction in life expectancy if exceeded. These are: WHtR greater than 0.5 for people under 40 years of age, 0.5 to 0.6 for people aged 40–50, and greater than 0.6 for people over 50 years of age.

Public health tool

WHtR is a proxy for central (visceral or abdominal) adiposity: values of WHtR are significantly correlated with direct measures of central (visceral or abdominal) adiposity using techniques such as CT, MRI or DEXA.

WHtR is an indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages, as well as in children and adolescents, have supported the superiority of WHtR over the use of BMI and waist circumference in predicting early health risk.

Cross-sectional studies in many different global populations have supported the premise that WHtR is a simple and effective anthropometric index to identify health risks in adults of all ages, and in children and adolescents.

In a comprehensive narrative review, Yoo concluded that "additional use of WHtR with BMI or WC may be helpful because WHtR considers both height and central obesity. WHtR may be preferred because of its simplicity and because it does not require sex- and age-dependent cut-offs".

As an indicator of mortality

Not only does WHtR have a close relationship with morbidity, it also has a clearer relationship with mortality than BMI.

As an indicator of central adiposity

Many cross- sectional studies have shown that, even within the normal BMI range, many adults have WHtR which is above 0.5. Many children show the same phenomenon. Risk factors for metabolic diseases and mortality are raised in these subjects.

See also

  • Allometry – Study of the relationship of body size to shape, anatomy, physiology, and behavior
  • Body fat percentage – Total mass of fat divided by total body mass, multiplied by 100
  • Body mass index – Relative weight based on mass and height (Total mass divided by the square of height)
  • Body roundness index – Body scale based on waist circumference and height
  • Body shape – General shape of a human body
  • Body shape index – Human health index (Waist circumference compared to its allometric average)
  • Body water – Water content of an animal's body
  • Normal weight obesity – Metabolically obese normal weight
  • Waist–hip ratio – Waist measurement divided by hip measurement

Notes

  1. The abbreviation WHR is more commonly used for Waist–hip ratio, although WHpR is preferred.

References

  1. Lee CM, Huxley RR, Wildman RP, Woodward M (July 2008). "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". Journal of Clinical Epidemiology. 61 (7): 646–653. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190.
  2. Gregory A (8 April 2022). "Ensure waist size is less than half your height, health watchdog says". The Guardian. Retrieved 8 April 2022.
  3. Vague J (1956). "The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease". primary. The American Journal of Clinical Nutrition. 4 (1): 20–34. doi:10.1093/ajcn/4.1.20. PMID 13282851.
  4. Hsieh SD, Yoshinaga H (December 1995). "Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women". primary. Internal Medicine. 34 (12): 1147–1152. doi:10.2169/internalmedicine.34.1147. PMID 8929639.
  5. ^ Ashwell M, Lejeune S, McPherson K (February 1996). "Ratio of waist circumference to height may be better indicator of need for weight management". primary. BMJ. 312 (7027): 377. doi:10.1136/bmj.312.7027.377. PMC 2350287. PMID 8611847.
  6. Browning LM, Hsieh SD, Ashwell M (December 2010). "A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value". Nutrition Research Reviews. 23 (2): 247–269. doi:10.1017/S0954422410000144. PMID 20819243.
  7. Waist circumference and waist-hip ratio: report of a WHO expert consultation 2008 (Report). Geneva: World Health Organization. 2011.
  8. "Obesity: identification and classification of overweight and obesity (update)". National Institute for Health and Care Excellence (NICE). 2022.
  9. ^ "Obesity: identification and classification of overweight and obesity (update) | Recommendations 1.2.11 and 1.2.12". National Institute for Health and Care Excellence (NICE). 2022.
  10. "Obesity: identification, assessment and management | Clinical guideline [CG189]". National Institute for Health and Care Excellence. 8 September 2022. Recommendations 1.2.11 and 1.2.12
  11. "Obesity: identification and classification of overweight and obesity (update) Recommendations 1.2.25 and 1.2.26". National Institute for Health and Care Excellence (NICE). 2022.
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  19. Lee CM, Huxley RR, Wildman RP, Woodward M (July 2008). "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". secondary. Journal of Clinical Epidemiology. 61 (7): 646–653. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190.
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Further reading

  • Ashwell M, Gunn P, Gibson S (March 2012). "Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis". Obesity Reviews. 13 (3): 275–286. doi:10.1111/j.1467-789X.2011.00952.x. PMID 22106927. S2CID 7290185.
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