Why Waist Size Matters

Waist circumference and Waist-to-Hip Ratio: health implications

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Waist Size and Health Risks

Your waist size and your Waist-to-Hip Ratio are indicators of how much body fat you have, and where it is stored. This has a direct impact on your health and the risk of disease associated with being overweight or obese, even if your Body Mass Index (BMI) tells you that you are on the safe side.

This article will discuss how to measure your waist and hip, how to calculate your health risk based on those measurementes and also talk about the science behind body shapes (popular wisdom has identified pear, apple and avocado shapes) and their relationship with health risks.

Waist Circumference and your Health

In our BMI calculator page (Body Mass Index page), we mentioned the shortcomings of the Body Mass Index. Some studies have even shown an inverse relationship between BMI and mortality ( 1 ) that is a lower death rate for people with a higer BMI.

For this reason, other indicators of body fat are necessary, and the Waist Circumference (WC) as well as the Waist-to-Hip ratio (WHR) have also been adopted as tools to more accurately identify individuals who are at a higher risk of developing obesity related health complications.

So even if your BMI is under 25, meaning your weight is within the healthy range, you can still have excess fat in your tummy, which increases your risk of developing life-threatening diseases such as heart disease, stroke and Type 2 diabetes.

For this reason measuring your waist circumference and your WHR are simple ways to check out how much fat you are packing in your belly!

How to measure your waist

It is very easy to measure your waist and your hip girth. But you must be methodical and follow these steps: ( 2 )

Where to Measure your hip and waist.
  • You should stand with feet close together, realxed, you arms hanging at the side and your body weight evenly distributed on both your legs.
  • Wear little clothing.
  • Take the measuerment at the end of a normal expiration.
  • Repeat each measurement twice if the difference between measurements is more than 0.4 inches (1 cm), repeat both measurements, otherwise calculate the average of the two measurements.
  • Tape measure should be parallel to the floor.

How to Measure the Wait Circumference

The waist is located at the midpoint between the lower edge of the last palpable rib and the top of the iliac crest.

The iliac crest is the curved upper edge of a bone known as "ilium" which is part of your hip bone. You can feel it beneath your skin in the hip region when you place your hands on your hips. See the image, where the iliac crest is highlighted in red.

Location of the iliac crest..

Do not measure the waist at the level of the navel (belly button), some reports ( 3 ) indicate if you measure the waist there, you may actually underestimate the true waist circumference.

Place the tape measure and take two measurements here, at the waistline, check if they differ by less than 0.4 inches (1 cm), if so, average the values you measured. If the difference is larger than 0.4 in. (1 cm) repeat the measurement and take two new measurements.

An example on how to calculate the average value:

  • Measurement #1: 36.8 inches
  • Measurement #2: 36.6 inches

Check the difference: 36.8 - 36.6 = 0.2 inches. Which is less than 0.4 inches. So we keep the measurements and calculate their average:

Average waist size

To calculate the average, add both values and divide the total by 2:

36.8 + 36.6 = 73.4 inches

73.4 / 2 = 36.7 inches

Waistline is therefore : 36.7 inches.

Measure your Hip Circumference

This one is easier: place the tape around the widest portion of the buttocks (tape parallel to the floor). Take two measurements and proceed as indicated above (discard if they differ by more than 0.4 in - 1 cm or average if the difference is less).

Lets assume: value #1 is 47.1 inches and value #2 is 47.4 inches. Difference (47.4 - 47.1 = 0.3 in.) is less than 0.4 in. so we can safely average both values:

47.4 + 47.1 = 94.5, and

94.5 / 2 = 47,25 inches for the hip circumference.

The Tape Measure

Use a stretch-resistant tape and apply a constant tension of 0,22 lb. (100 g).

How tight?

The tightness of the measuring tape is critical! Don't pull it so tight that it constricts. It should fit snugly but not constricting.

Outcome of your measurements

Waistline Chart and actions to take

Compare your waistline with the values in the following chart:

Risk Level Women

Waist measurement

Well done!

less than 31.5 in. (80 cm)

Medium. Lose weight

31.5 in. (80 cm) or more

Very High Risk.
Visit your doctor

34 in. (88 cm) or more

Risk Level Men

Waist measurement


less than 37 in. (94 cm)

Medium. Lose weight

37 in. (94 cm) or more

Very High Risk.
Visit your doctor

40 in. (102 cm) or more

The subject of our example, a male with 36.7 inch waist is at a Low Risk Level, his abdominal fat is at a healthy level.

Waist-Hip Ratio or WHR

The Waist-Hip Ratio is a very good way to predict your health risk.

To calculate this Waist-Hip Ratio (WHR) simply divide your waist measurement by your hip measurement.

We will use the values of our previous example:

Waistline: 36.7 in and Hip circumference: 47.25 in.

WHR is: 36.7 / 47.25 = 0.77

WHR Risk Chart

Use the following table ( 4 ) to asess the risk entaile by your Waist-Hip Ratio:

Risk Level Women

Waist- Hip Ratio


less than 0.8


0.81 to 0.85


Above 0.85

Risk Level Men

Waist- Hip Ratio


less than 0.95


0.96 to 1


Above 1

Our subject, a man with a WHR of 0.77 is well below the cutoff level of 0.95 so his risk is "Low".

But what should you do if your WHR falls in one of the other two categories (Moderate or High health risk)? Read on below:

Pear, Avocado and Apple shaped bodies

Although each body is different, popular wisdom has identified some similar body-shape traits and identified them with certain fruit shapes:

images of a pear an apple and an avocado
Pear, Avocado and Apple shapes.

Apple Shaped People

These people carry most of their weight in their abdomen, around their middles.

They have excessively round chests and stomachs. This rounded appearance gives them their name of "apples".

Pear Shaped People

Those who store their fat below their waist: in their thighs, buttocks and hips are more "pear" shaped. Their hips are wider than their shoulders, and they have normal-sized chests and waists.

There is yet another shape, which falls between that of the "pears" and the "apples", an intermediate shape: the "avocado":

There is a scientific basis to this popular knowledge, and these different body shapes are actually reflected by their WHR as we can see in the following table:

Table for men, indicating body shape, WHR and associated health risk level ( 5 ):

Body Shape

Waist- Hip Ratio

- - -

less than 0.85
Low Risk

- - -

0.85 - 0.95
Moderate to High Risk


0.95 - 1.00
High to Very High Risk


1.00 - 1.05
Severe Obesity
Very High Risk


above 1.05
Very Severe Obesity.
Extremely High Risk

A paper (Riopelle, 2017) (4) points out the risks involved in having an apple-shaped body:

"Body shape and fat distribution are more predictive of future disease than Weight and Body Mass Index (BMI). An apple-shaped figure, as opposed to a pear-shaped figure, correlates to a greater Waist-To-Hip ratio and greater health risk for Type 2 Diabetes Mellitus (T2DM)...
BMI can overestimate obesity since it neglects accounting for lean body muscle. The Waist-To-Hip Ratio (WHR) and Waist Circumference (WC) are better alternatives than the BMI to measure body shape.

So, having an apple, avocado o pear shaped body is no laughing matter. You should take immediate action to lose weight.

We discuss Body Mass Index on our "BMI" webpage:

Read More, visit our:

> > BMI Calculator

The Genetics behind Body Shape

Studies in twins suggest that between 22% and 61% of variability in waist-to-hip ratio may be accounted for by genetic factors ( 6 ). And that the patterns of fat deposition in the abdomen (known as "central obesity") which cause apple-shaped or pear-shaped bodies, are "highly heritable" ( 7 ).

two overweight women view of rear and thick waist
Obesity, full hips and wide waist

There is also strong evidence of genetics in the link between insulin resistance and central obesity so the effect of genes is compounded: they cause central obesity and alter metabolism, leading to health risks.

Obesity is the outcome of the interplay between the environmental factors (such as lifestyle) and genes. But recent findings suggest that "there is a genetic component in lifestyle" (6), where genes that affect emotion and apetite are also associated with Body Mass.

Nevertheless we are not slaves to our genes, we can take action and regain control of our bodies, lose weight and improve our health.

Health Risk and Waist-To-Hip Ratio

HWR is better than BMI to predict health risks

People aflicted with coronary artery disease (CAD), central obesity is the key indicator associated with higher mortality. And this is independent of their Body Mass Index or BMI. ( 8 )

In other words BMI is not directly associated with mortality in subjects with CAD. They may even have normal or high BMIs, but it is "central obesity" which is linked with a higher death rate.

Apparently the fatty tissue of central obesity interacts with the vascular system, it increases insulin resistance and hypertension. Visceral fat provokes inflammation and increases the "bad" LDL cholesterol and lowers the "good" HDL cholesterol. All of these factors increase health risks. (8)

Taking Action: Loosing Weight

So, if your Waist Circumference (WC) and ⁄ or Waist-to-Hip Ratio (WHR) or your Body Mass Index (BMI) place you in a risk category, take action right away.

You should lose weight around the stomach.

Weight gain is caused by putting more calories into your body than it needs. The extra energy is stored inside your body as fat.

The key to losing weight is to eat less (put less calories into your body) and lead a more active life (burn more energy). Ideally you should burn more calories than you intake so your body will have to get its energy from the stored fat.

Our website has plenty of information on weight loss, getting fit and nutrition information. You can get started now by visiting our "Fitness" page:

Read More at our:

> > Fitness webpage (Packed with advice and tips on getting into shape)

young woman's bare tummy and slim waist
Slim woman, fit waist and hips

Cite this article:

. ©2018. Why Waist Size Matters. Patagonia Wellness, 11 Oct. 2018. http://www.patagoniawellness.com/fitness/waist-size-matters.html

Tags: Waist Size, Waist Circumference, Waist-to-Hip Ratio, WHR, Obesity, BMI Calculator

Subject: Waist size and its impact on health risk. How to measure your waist and hips, Waist-to-Hip ratio. Body shapes (pear, apple, avocado). Implications regarding weight management.


References and Further Reading

(2) Waist Circumference and Waist-Hip Ratio Report of a WHO Expert Consultation. World Health Organization, Geneva, Dec. 8 - 11, 2008

(3) Croft JB, Keenan NL, Sheridan DP et al., (1995). Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease. Journal of the American Dietetic Association, 95(1):60-64

(5) , Van P. Riopelle Fat Type Level: A Simpler Way for Men to Understand Body Shape and Health Risks (Body fat level). J Obes Weight-Loss Medic. v. 3, no. 17 (): . DOI: doi.org/10.23937/2572-4010.1510017

(6) Heid, Iris M et al., (2010). Meta-analysis identifies 13 new loci associated with waist-hip ratio and reveals sexual dimorphism in the genetic basis of fat distribution. Nature, 42:929, 2010. http://dx.doi.org/10.1038/ng.685, - 10.1038/ng.685

(7) Fu J, Hofker M, Wijmenga C. (2015). Apple or pear: size and shape matter. Cell Metab. 2015 Apr 7;21(4):507-8. doi: 10.1016/j.cmet.2015.03.016.

(8) Coutinho, T., Goel, K., Correa De S, D., Kragelund, C., Kanaya, A. M., Zeller, M., Lopez-Jimenez, F. (2011). Central obesity and survival in subjects with coronary artery disease: A systematic review of the literature and collaborative analysis with individual subject data. Journal of the American College of Cardiology, 57(19), 1877-1886. DOI: 10.1016/j.jacc.2010.11.058