Recent research has highlighted the importance of measuring abdominal fat as a key factor in assessing cardiovascular health, suggesting that traditional metrics like body mass index (BMI) alone may misrepresent an individual’s risk of heart disease. Experts in the field are calling for a shift in routine health evaluations to include measurements of waist circumference and waist-to-hip ratio, which they argue provide more accurate assessments of cardiovascular risk.
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In a comprehensive study involving over 250,000 participants followed for an average of two decades, researchers examined the relationship between waist measurements and heart disease risk. Published in the Journal of the American College of Cardiology (JACC), the findings reveal that a significant number of individuals classified as having a normal BMI still exhibited excess abdominal fat. Specifically, 5% of those with a normal BMI had a high waist circumference, while 18% displayed an elevated waist-to-hip ratio. Among those designated as overweight by BMI standards, 39% had a high waist circumference and 40% had an abnormal waist-to-hip ratio.
Body mass index, a widely used measure calculated by dividing an individual’s weight in kilograms by the square of their height in metres, serves as a standard for categorizing people into underweight, healthy, overweight, or obese. However, critics have long suggested that BMI is a limited measure, especially among certain demographic groups, including people of colour.
Dr Michael J. Blaha, the senior author of the study and director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, emphasised the need for a more nuanced understanding of health risk. “Indeed, it appears that waist circumference and waist-to-hip ratio reclassify risk defined by traditional BMI thresholds,” he stated. Blaha observed that even individuals classified as normal weight could have elevated central adiposity and high waist-to-hip ratio, correlating them with heightened cardiovascular risk across various health outcomes.
Lead author of the study, Dr Zeina A. Dardari, echoed these sentiments, warning that reliance on BMI alone might lead to significant misclassifications in cardiovascular risk. “We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings,” she added.
This research aligns with a commentary from a previous 2025 report, where over 50 health experts advocated for regular assessments of abdominal fat. Renowned endocrinologist Dr Robert Kushner, who contributed to this recommendation, highlighted the dangers of belly fat, which he stated is associated with inflammation that can trigger a series of metabolic problems, including elevated blood sugar, high blood pressure, and increased blood lipids. Such conditions are precursors to serious diseases, such as diabetes and heart disease.
Harlan M. Krumholz, the chief editor of JACC, expressed that the study’s findings usher in an urgent need to reformulate how cardiovascular risks are evaluated. “This enormously important study, based on data from hundreds of thousands of participants in large-scale cohort studies, authoritatively shows that waist circumference and waist-to-hip ratio provide critical information about cardiovascular risk, even among people with a BMI considered normal,” Krumholz noted. He added that the location of body fat is of significant relevance and urged for changes in routine cardiovascular risk assessments to include these simple yet vital measurements.
The call to move away from an exclusive focus on body mass index could have far-reaching implications. As health professionals begin to integrate abdominal fat assessments into routine screenings, it may lead to more precise identification and management of individuals at risk for heart disease. The central message remains clear: understanding where fat is distributed in the body can be instrumental in redefining health and preventing cardiovascular illnesses.
In summary, this pivotal research underscores the critical need to rethink traditional metrics of health assessment. As the conversation shifts towards recognising the importance of abdominal fat measurements, healthcare providers are encouraged to adopt a more holistic approach to cardiovascular risk evaluation, ultimately aiming for better health outcomes for patients across all demographics.