Waist measurement is a measurement which indicates the need for weight management and reflects coronary risk related to both overweight and a central fat distribution.

• a healthy waist measurement (reflecting low coronary risk) is below 37 inches/94 cm for men and 32 inches/ 80 cm for women
• the greatest health risks are associated with waist measurements greater than 40 inches/102 cm for men and 35 inches/88 cm for women

NICE have suggested that management of obesity takes into consideration body mass index, waist circumference and presence of co-morbidities (1):

Obesity is graded according to the Body Mass Index (BMI):

• Healthy weight 18.5-24.9

• Overweight 25-29.9

• Obesity I 30-34.9

• Obesity II 35-39.9

• Obesity III 40 or more

Assessment of the health risks associated with overweight and obesity in adults should be based on BMI and waist circumference as follows (1):

• for men, waist circumference of less than 94 cm is low, 94-102 cm is high and more than102 cm is very high
• for women, waist circumference of less than 80 cm is low, 80-88 cm is high and more than 88 cm is very high.

The approach to management of obesity depends on the severity of obesity, the waist circumference, and any accompanying risk factors for complications:

• Overweight patients
  • if no comorbidities present
    • low waist circumference - general advice on healthy weight and lifestyle
    • high waist circumference - diet and physical activity
    • very high waist circumference - diet and physical activity
  • if comorbidities present
    • diet and physical activity; consider drugs
• Obesity I patients
  • if no comorbidities present
    • low waist circumference - diet and physical activity
    • high waist circumference - diet and physical activity
    • very high waist circumference - diet and physical activity
  • if comorbidities present
    • diet and physical activity; consider drugs
• Obesity II patients
  • if no comorbidities present
    • low waist circumference - diet and physical activity; consider drugs
    • high waist circumference - diet and physical activity; consider drugs
    • very high waist circumference - diet and physical activity; consider drugs
  • if comorbidities present
    • diet and physical activity; consider drugs; consider surgery
• Obesity III patients - Diet and physical activity; consider drugs; consider surgery

Notes:

• the level of intervention should be higher for patients with comorbidities, regardless of their waist circumference. The approach should be adjusted as needed, depending on the patient's clinical need and potential to benefit from losing weight

Reference:

1. NICE (December 2006). Obesity guidance