A new study from the University of Pittsburgh and UPMC researchers suggests that measuring your waist in relation to your height may be a better way to predict heart disease risk than using body mass index (BMI).
The research, published in The Lancet Regional Health—Americas, could change how doctors and individuals assess heart health, especially for people who are not considered obese by BMI standards.
The study analyzed data from 2,721 adults who took part in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). None of the participants had heart disease when the study began, and researchers followed them for more than five years.
They looked at three key measurements: BMI, waist circumference, and waist-to-height ratio (WHtR). All three were linked to a higher chance of developing cardiovascular disease at first. However, after adjusting for other factors like age, gender, smoking, exercise, diabetes, blood pressure, and cholesterol, only the waist-to-height ratio remained a reliable predictor.
Lead author Dr. Thiago Bosco Mendes from the University of Pittsburgh explained, “When we considered traditional risk factors, only waist-to-height ratio continued to predict future heart disease.” This means that even people with a normal BMI could still have a higher risk if their waist size is large compared to their height.
Body mass index has long been used to define obesity and assess health risks, but it has clear limitations. BMI cannot show where body fat is located or distinguish between different types of fat.
Visceral fat, which gathers around internal organs, is far more dangerous for heart health than subcutaneous fat, which lies just under the skin. Waist-to-height ratio, calculated by dividing your waist measurement by your height, is better at showing whether someone has too much visceral fat—often called ‘central obesity.’
Researchers found that much of the waist-to-height ratio’s predictive power was seen among people with a BMI below 30—the traditional cutoff for obesity.
Many of these people might appear healthy or have normal weight, but if their waist-to-height ratio is higher than 0.5, they may be at risk for developing heart problems. This includes conditions like coronary artery calcification, an early sign of cardiovascular disease.
Senior author Dr. Marcio Bittencourt, a cardiologist at UPMC, said, “Using waist-to-height ratio as a screening tool could help doctors identify patients at risk of heart disease earlier, even when their weight, cholesterol, and blood pressure seem normal.” He added that this method is simple, low-cost, and easy for both patients and healthcare providers to use.
The study’s findings highlight that heart health is not just about body weight. Where fat is stored in the body matters a great deal. Someone with a normal BMI but excess belly fat can still face significant cardiovascular risks.
This research supports a growing movement among doctors and public health experts to look beyond BMI and focus on more accurate measures of body composition.
For individuals, the takeaway is straightforward: to estimate your risk, measure your waist and divide that number by your height. If the result is above 0.5, it might be time to talk to your doctor about lifestyle changes, such as improved diet, regular exercise, and stress management, to protect your heart.
If you care about heart health, please read studies about how eating eggs can help reduce heart disease risk, and herbal supplements could harm your heart rhythm.
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The study is published in The Lancet Regional Health – Americas.
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