Metrics for Assessing Abdominal Obesity

Anthropometric measurements are a tool used to help assess nutritional status. They are useful in identifying the need for, and effects of, nutrition interventions, as well as assessing risk factors for chronic disease. They may include body weight, height and body composition measures, such as, skinfold, circumference, dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). The ratio of weight to height is measured in body mass index (BMI) and is used to estimate adiposity, however it does not provide information on the distribution of body fat or a full picture on individual health risks.

Body fat distribution can be a risk factor for obesity-related disorders. Individuals who have body fat primarily distributed in their upper-body (characterized by an android or apple shape) are at increased risk of insulin resistance, metabolic syndrome, cardiovascular disease and other health concerns.

Waist circumference, a measurement which is affordable and easy to perform in a variety of clinical settings, is used to assess central adiposity and is one of the five criteria for diagnosing metabolic syndrome. Waist circumference screening is recommended annually for individuals who have a BMI of 25 or greater and less than 35 kg/m2 to help identify their risk of comorbidities.

In the United States and Canada, a measurement of 40 inches or greater for males and 35 inches or greater for females is considered indicative of abdominal obesity. Alternative cut off points for waist circumference in assessing abdominal obesity have been developed for other populations, such as greater than or equal to 94 centimeters [37 inches] for males of Mediterranean, Middle Eastern and Sub-Saharan African descent; measurements greater than or equal to 90 centimeters [35 inches] for males of Asian and South and Central American descent; and measurements greater than or equal to 80 centimeters [31.5 inches] in females of these ethnic backgrounds.

While there is still some debate among experts regarding the criteria for waist circumference, especially as it relates to the definition of metabolic syndrome, registered dietitian nutritionists can help individuals understand and lower their risk factors for chronic disease. Weight management interventions provided by RDNs are effective in reducing waist circumference for adults with overweight and obesity, according to research reviewed by the Academy's Evidence Analysis Center. Individual sessions with an RDN, conducted in-person with at least five encounters over a year's time were considered to be the most effective based on subgroup analyses.

References:

• Charney, P., Malone, A. Pocket Guide to Nutrition Assessment, Fourth Edition. Chicago, IL: Academy of Nutrition and Dietetics; 2022.
• Escott-Stump, S. Section 10 Malnutrition: Overnutrition and Undernutrition In: Nutrition & Diagnosis Related Care, Ninth Edition. Chicago, IL: Academy of Nutrition and Dietetics; 2022:789-830.
• Academy of Nutrition and Dietetics. Nutrition Care Manual. Metabolic Syndrome. Accessed June 27, 2022.
• Franz, MJ., Boucher, JL., Franzini Pereira, R. Pocket Guide to Lipid Disorders, Hypertension, Diabetes, and Weight Management, Second Edition. Chicago, IL: Academy of Nutrition and Dietetics; 2017.
• Academy of Nutrition and Dietetics Evidence Analysis Library. "In adults with overweight or obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on waist circumference? " Accessed June 27, 2022: