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This apple does not keep the doctor away

Thursday, November 13, 2008 Posted by Peter Janiszewski, PhD
By now, hopefully all are aware that body weight on its own or relative to height, as used to derive the body mass index (BMI), is a very imprecise indicator of health risk. In fact, research suggests that approximately 25% of individuals with an obese BMI are perfectly healthy, whereas 18% of individuals with “healthy” BMIs present with obesity-related metabolic complications.

One key factor mediating the health risk of an individual at any weight or BMI is the location of their excess fat – are they apple or pear shaped? We now know that carrying your weight predominantly in the central or abdominal region (apple shaped) is particularly dangerous.

Just last year, along with Drs. Janssen and Ross, I had published a paper in the journal Diabetes Care (which you can read in full here) which investigated the ability of an elevated waist circumference (an indicator of abdominal obesity) to predict risk of disease independent of BMI as well as commonly obtained metabolic risk factors (such as levels of blood glucose and lipids, blood pressure, etc.). Our results were the first to clearly demonstrate that even after you account for your BMI and common clinical markers, those that are apple-shaped (elevated waist circumference) carry a significantly higher risk of diabetes.

Thus, the results of a study which was just published yesterday in the prestigious New England Journal of Medicine demonstrating that an elevated waist circumference predicts greater risk of death from all causes regardless of BMI level, should not come as much of a surprise. While prior studies have shown the same effect, this study (which you can read in full here) is important due to its sheer magnitude – including a ~10 year follow-up of about 360,000 Europeans. Specifically, the authors found that for a given BMI, an increase in waist circumference of 5cm was associated with a 13-17% increased chance of death in both men and women.

These results, along with countless prior studies, are in complete agreement with current clinical guidelines which recommend that physicians measure waist circumference along with BMI to assess a patient’s risk of disease. Thus, if your waist circumference is greater than 102cm (men) or 88cm (women), you may be at risk of disease and premature death even if you are at a healthy weight. Conversely, if your BMI is in the overweight or obese range, but your waist circumference falls below the above cutpoints, you may not have much to worry about.

If you take away nothing else from the above, understand that the number on your bathroom scale tells you little about your health, while the shape of your body tells all.

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We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. Our research focuses on the relationships between obesity, physical activity, and health risk. This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Enjoy.


The opinions expressed here belong only to Peter and Travis and do not reflect the views of any organization. Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.

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