February 12, 2020 Editorials

Waist circumference as a vital sign in clinical practice is being recognized in a global consensus paper published in Nature Reviews Endocrinology

Although many studies published over the last decades have consistently shown that a large waist circumference is associated with a deteriorated cardiometabolic risk profile predictive of an increased risk of morbidity and mortality, it is still not systematically measured in clinical practice.

In 2017, the International Atherosclerosis Society (IAS) and the International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity agreed to prepare a joint consensus paper on the importance of visceral obesity and ectopic fat as emerging risk factors for type 2 diabetes and cardiovascular disease. This led to the first consensus document on visceral obesity published in The Lancet Diabetes & Endocrinology. In a second consensus document published in Nature Reviews Endocrinology, the group reviewed the evidence that a body mass index (BMI) measurement alone was not appropriate to accurately assess and manage the patient’s cardiometabolic risk profile. The group emphasizes that the measurement of the waist circumference should be performed in clinical practice, as it is as important as the traditional risk factors such as cholesterol or blood pressure, which are routinely measured.   For instance, given the major gap between the current science on the relevance of measuring waist circumference in addition to BMI and the limited attention that it has received in clinical practice, the working group proposes that the time has come to gather and discuss all relevant information on how a simple tool, waist circumference, could be helpful in clinical practice to identify high-risk individuals with abdominal obesity. The consensus statement emphasizes several important points such as:

  • BMI and waist circumference should be interpreted simultaneously to properly identify the high-risk obesity subgroup (abdominal obesity);
  • Waist circumference must be measured on all patients in clinical practice, as abdominal obesity is a major driver of complications associated with the development of type 2 diabetes and cardiovascular disease;  
  • A decrease in waist circumference is a good marker of cardiometabolic risk reduction following lifestyle interventions.

Health professionals should be trained to properly measure waist circumference and should recognize its added value in the assessment and management of cardiometabolic risk. Waist circumference is a vital sign in clinical practice!