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Rachel V Thomas

Healthy BMI But Belly Fat? Why Your Waist May Predict Heart Risk Better

If you believe having a healthy body mass index (<span>BMI</span>) means you have a low risk of <span>heart disease</span>, you may be wrong. A new study suggests that abdominal fat may predict cardiovascular disease risk better than BMI alone.

The study, published in the Journal of the American College of Cardiology (JACC), found that failing to account for <span>waist circumference</span> (WC) or waist-to-hip ratio (WHR) may lead to misclassification of cardiovascular disease risk.

“Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” said Michael J. Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.

“We saw individuals with clinically determined normal weight who had elevated <span>central adiposity</span> and high WHR, associating them with higher risk across most outcomes,” Blaha added.

<h2>Why BMI Alone May Not Predict <span rel="noindex">Heart Risk</span></h2>

BMI is calculated by dividing weight in kilograms by height in meters squared and is commonly used to diagnose overweight and obesity. However, BMI does not show where body fat is distributed.

<ul><li>Visceral fat surrounds the internal organs in the abdominal area and is associated with chronic conditions such as heart disease and diabetes.</li><li>Subcutaneous fat is located directly under the skin and is not as strongly associated with these conditions.</li></ul>Central adiposity refers to the accumulation of both visceral and subcutaneous fat around the abdomen. Despite evidence linking central adiposity to adverse cardiovascular outcomes, BMI remains the most commonly used measure to determine overweight and obesity and assess future cardiovascular risk.

The study examined whether adding WC and WHR to BMI could better predict future cardiovascular risk. Researchers looked at more than 260,000 people over an average of 20 years. They found that central adiposity could identify cardiovascular risk that BMI alone may miss.

Among people classified as having normal weight by BMI:

<ul><li>5% had high waist circumference</li><li>18% had high waist-to-hip ratio</li></ul>Among people with overweight:

<ul><li>39% had high waist circumference</li><li>40% had high waist-to-hip ratio</li></ul>Among people with obesity:

<ul><li>9% had low waist circumference</li><li>45% had low waist-to-hip ratio</li></ul>

People with normal weight or overweight who had clinically defined high WC or WHR had a 15%–50% greater risk for most heart problems.

People with obesity and low WC did not have a significantly different risk of outcomes compared with those who had normal weight and low WC, except for all-cause mortality, for which their risk was significantly lower.

“Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range. Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes,” said Zeina A. Dardari, lead author of the study.

“We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings,” she added.

<h2>What Were the Study's Limitations?</h2>

The researchers did not have information on several factors that can influence cardiovascular disease risk, including:

<ul><li>Physical activity</li><li>Diet</li><li>Genetic risk for obesity</li></ul>

The study also included only one assessment of waist circumference and waist-to-hip ratio. This limited the researchers' ability to understand how changes in abdominal fat accumulation over time may influence cardiovascular disease risk.

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Belly Fat

Heart disease

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Heart Risk

Central adiposity

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If you believe having a healthy body mass index (BMI) means you have a low risk of heart disease, you may be wrong. A new study suggests that abdominal fat may predict cardiovascular disease risk better than BMI alone.The study, published in the Journal of the American College of Cardiology (JACC), found that failing to account for waist circumference (WC) or waist-to-hip ratio (WHR) may lead to misclassification of cardiovascular disease risk.“Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” said Michael J. Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.“We saw individuals with clinically determined normal weight who had elevated central adiposity and high WHR, associating them with higher risk across most outcomes,” Blaha added.Why BMI Alone May Not Predict Heart RiskBMI is calculated by dividing weight in kilograms by height in meters squared and is commonly used to diagnose overweight and obesity. However, BMI does not show where body fat is distributed.Visceral fat surrounds the internal organs in the abdominal area and is associated with chronic conditions such as heart disease and diabetes.Subcutaneous fat is located directly under the skin and is not as strongly associated with these conditions.Central adiposity refers to the accumulation of both visceral and subcutaneous fat around the abdomen. Despite evidence linking central adiposity to adverse cardiovascular outcomes, BMI remains the most commonly used measure to determine overweight and obesity and assess future cardiovascular risk.What Did the Study Find?The study examined whether adding WC and WHR to BMI could better predict future cardiovascular risk. Researchers looked at more than 260,000 people over an average of 20 years. They found that central adiposity could identify cardiovascular risk that BMI alone may miss.Among people classified as having normal weight by BMI:5% had high waist circumference18% had high waist-to-hip ratioAmong people with overweight:39% had high waist circumference40% had high waist-to-hip ratioAmong people with obesity:9% had low waist circumference45% had low waist-to-hip ratioPeople with normal weight or overweight who had clinically defined high WC or WHR had a 15%–50% greater risk for most heart problems.People with obesity and low WC did not have a significantly different risk of outcomes compared with those who had normal weight and low WC, except for all-cause mortality, for which their risk was significantly lower. “Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range. Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes,” said Zeina A. Dardari, lead author of the study.“We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings,” she added.What Were the Study's Limitations?The researchers did not have information on several factors that can influence cardiovascular disease risk, including:Physical activityDietGenetic risk for obesityThe study also included only one assessment of waist circumference and waist-to-hip ratio. This limited the researchers' ability to understand how changes in abdominal fat accumulation over time may influence cardiovascular disease risk.

healthy bmi but belly fat? why your waist may predict heart risk better

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