Beyond the Scale: Is checking weight and BMI enough?

Beyond the Scale: Is checking weight and BMI enough?
Beyond the Scale: Is checking weight and BMI enough?

We have all at some point been in our doctor's office for an annual exam. You know the routine; step on the scale, tell them your height and have your blood pressure and pulse checked. During your visit, your doctor might mention your weight or your BMI- body mass index, which can help identify whether you are normal weight, overweight or in the obesity category for your height. It is a good way to identify those who are at risk for complications of too much weight. But are all the people who end up in the normal weight range actually at low risk?

Dr. Richa Mittal

We have all at some point been in our doctor's office for an annual exam. You know the routine; step on the scale, tell them your height and have your blood pressure and pulse checked. During your visit, your doctor might mention your weight or your BMI- body mass index, which can help identify whether you are normal weight, overweight or in the obesity category for your height. It is a good way to identify those who are at risk for complications of too much weight. But are all the people who end up in the normal weight range actually at low risk?

The answer is no.

How can this be? Are we falling short when we do not go beyond what the scale says? Yes, we are.

There are a large number of people who are not being identified as at high risk for developing problems like diabetes, stroke and heart disease. Sure, lab work (if the right labs are checked), may help identify some of these at-risk people, but what about those who are too early in the disease process to actually have abnormal labs?

There is a very simple test that can be measured in your doctor's office that can help identify you as someone who could be at risk for developing problems like high blood pressure, abnormal cholesterol, prediabetes or diabetes, stroke and heart attack (a combination of these factors is called metabolic syndrome)- it is the waist circumference.

Waist circumference, which is measured (at the level of the top of your pelvic bone) with a tape measure, is a simple, inexpensive test that can be used as a substitute for measuring a type of fat called visceral fat. Visceral fat is fat that accumulates around the organs in the middle of the body. Visceral fat is indicative of a high insulin state (more to follow on that in another post) which leads to inflammation and increased risk for the conditions just mentioned. Fat that accumulates in this area is different than fat we store in other parts of our body and puts a person at much higher risk than fat in other areas. In individuals with a BMI of less than 35, measuring waist circumference is particularly useful to identify those at high risk.

What waist circumference is too high? The National Institutes of Health have set cut off points for men and women: For men, greater than 40 inches, or greater than 102 cm and for women, greater than 35 inches, or greater than 88 cm.

Interestingly, certain ethnic groups are at high risk at even lower measurements. This is especially true for Asian Americans and people of Asian descent living elsewhere. The International Diabetes Federation has issued a definition of metabolic syndrome using ethnic-specific criteria to define abdominal obesity. These can vary quite a bit between ethnicities. For example, for South Asians (Malay, Chinese and Asian-Indian), for men greater than 35.4 inches or 90 cm and for women greater than 31.5 inches or 80 cm indicates increased risk for metabolic syndrome.

For more detailed information for different ethnicities, please follow this link:

https://www.hsph.harvard.edu/obesity-prevention-source/waist-circumference-guidelines-for-different-ethnic-groups/

Next time you are visiting with your doctor, take the discussion beyond the scale and discuss whether an increase in your waist circumference (AKA abdominal fat) could be putting you at risk for diabetes and cardiovascular disease. Unless you are armed with all the information you need, you cannot make your best effort to optimize your health.

Until next time, be well!

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.