Waist-to-Hip Ratio
Evaluates abdominal adiposity.
- The patient should be standing with feet shoulder-width apart.
- Use a non-stretch measuring tape.
- Hold the tape snugly (not constricting), keep it level and parallel to the floor, and record measurements at the end of normal expiration.
- Measure waist circumference at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest (WHO) or at the top of the iliac crest (NHANES III).
- Measure hip circumference around the widest portion of the buttocks.
Advice
- Combine results with BMI, waist circumference, and waist-to-height ratio for a more robust obesity evaluation.
- Increased metabolic risk (including heart disease, diabetes, hypertension, dyslipidemia, and mortality) is associated with a ratio:
- ≥0.90 in men.
- ≥0.85 in women.
Management
For individuals with an elevated waist-to-hip ratio who meet criteria for obesity:
- Investigate potential underlying causes (e.g., medications, endocrine etiologies).
- Provide lifestyle counseling (e.g., nutrition, exercise, sleep).
- Screen and optimize metabolic parameters (e.g, lipids, HbA1c/fasting glucose).
- Assess cardiovascular risk, if appropriate (e.g., AHA/ACC 2013 ASCVD Risk Calculator, PREVENT).
- Address weight-related disease complications (e.g., obstructive sleep apnea, arthritis, metabolic dysfunction-associated steatotic liver disease).
- Evaluate candidacy for weight-loss interventions (e.g., GLP-1 medications, bariatric surgery).