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Measures of central adiposity as an indicator of obesity

Obesity has long been identified as an important risk factor for a number of health problems. Body Mass Index (BMI), the most frequently used measure to determine levels of body fat, provides a proxy measure of total adiposity (the amount of fat around the body), but a number of studies have suggested that the accumulation of body fat around the waist (central or abdominal adiposity) may present a higher risk to health than fat deposited in other parts of the body.

High levels of central adiposity in adults are known to be associated with increased risk of obesity-related conditions including type 2 diabetes, hypertension and heart disease. Although measures of central adiposity are closely correlated with BMI, they have been shown to predict future ill health independently of BMI.

The best evidence to date suggests that measures of general and central adiposity should be used together in order to best identify individuals at increased risk of obesity-related ill health.

It is not clear from the research published to date what constitutes the best measure of central adiposity in terms of predicting ill health or mortality, and this may differ by age, sex, ethnicity, or by the disease being studied. Waist circumference has been most frequently investigated in the published literature and, given that this measure is more easily recorded and interpreted than alternatives such as weight-to-hip or weight-to-height ratios, this currently seems to be the most appropriate option among measures of central adiposity for most public health purposes.

The World Health Organization (WHO) has advised that an individual's relative risk of obesity-related ill health can be more accurately classified using both BMI and waist circumference than by either alone. WHO has developed a set of thresholds to categorise an individual's risk of obesity-related illness based on BMI and waist circumference. The National Institute for Health and Clinical Excellence (NICE) has also endorsed these thresholds for use in the UK. Using the WHO classification, over 50% of both men and women in England were at increased risk of obesity-related ill health, according to the Health Survey for England (HSE) 2007.

People of South Asian origin seem more prone to carrying excess fat centrally than the White population and show raised obesity-related risk at lower BMI and lower waist circumference levels. Therefore it is particularly important for South Asian populations in the UK to be aware of the health risks of increased waist circumference.

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Measures of central adiposity as an indicator of obesity