Tag: cardiovascular risk

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Take Charge of your Waistline

Measuring your waistline is a lot easier and cheaper to do (not to mention less painful) than getting your cholesterol tested, but it reveals much the same information. As a consumer of health care, I’ve always wanted to have simple, do it at home tests and treatments for health conditions. Here is one I want to share with you.

As an absolute measure, the waistline for women should not exceed 35 inches. For men, the upper limit is 40 inches. Why is that? The Nurses Health Study was one of the largest and longest studies that looked at the relationship between waist size and death from heart disease in middle aged women. This 16 year study of 44,000 women found that women with waist sizes of 35 inches or higher had nearly double the risk of dying from heart disease compared to women who reported the lowest waist sizes (28 inches or less). Double.i

Furthermore, women with the largest waists had a similarly high risk of death from cancer and from any cause compared to women with the smallest waists. The risks increased steadily with every added inch around the waist.

Having normal weight and a large waistline doesn’t help. In fact, normal weight women with a waist of 35 inches or higher had three times the risk of death from heart disease compared to normal weight women whose waists were smaller than 35 inches. Triple.

As long as you have your tape measure out, let’s talk about waist to hip ratio. If you measure your waist and your hips, you can compare the numbers and come up with your waist to hip ratio.

Waist/Hip Ratio

The World Health Organization states that abdominal obesity is defined as a waist to hip ratio above .90 for males and above .85 for females. The gender difference is because women normally have larger hips than men.

The ratio is: Waist in inches divided by Hips in inches.

As an example, a woman with a 28 inch waist and 36 inch hips would have a ratio of 28/36 = .77 (well below .85). As you can imagine, she would be considered attractive. This is because we are wired to see that fertility and better health outcomes are expected with a healthy waist to hip ratio. If a larger woman had measurements of a 32 inch waist and 44 inch hips, the ratio would be 32/44 = .72  (an even better ratio). As you can see, a ratio accounts for various sized people. It’s only when the ratio approaches equal, or that the waist is larger than the hips that we get into trouble. In the first example above, suppose the woman with the 36 inch hips gained weight to where her waist was 34 inches and her hips were 37 inches. 34/37 = .92 (This is above the safe limit of .85).


Despite the angst many women feel about having large hips, they represent no adverse health outcomes. Hips (under the influence of progesterone) store water and fat because childbirth and nursing require a lot of both. Big hips aren’t a problem for your health and in most cultures are considered sexy (for good reason because again, they signal fertility).

After smoking, abdominal obesity is the single greatest modifiable risk factor for all the major killer diseases of modern times. Most premature deaths are related to metabolic syndrome. Waist measurement and waist to hip ratio are the easiest ways to monitor these risks.

So how do we measure?

You will need a cloth tape measure (Metal tape measures just don’t conform well enough to your shape). To measure your waist, slide your hands down your sides to reach your last rib. This should be the narrowest part of your waist. Note that this is above the level of your navel, not at the waistline of your jeans. Wrap the tape around at this circumference and take your measurement.

To measure your hips, find the bones at the sides of your hips and wrap the tape around at that level. Keeping the tape level will include much of the muscular part of your butt. The fattier part of your butt (if you have that) will be below this level.

The fact that you will always use bony landmarks to measure yourself means that your measurements can be consistent over time. I wouldn’t recommend measuring yourself more than once a week as changes happen very slowly. As you can read from the statistics above, these are very important measurements for a long life and good health.

Body Mass Index.

Another commonly used measure is Body Mass Index (BMI). This is the measure used by the government and life insurance companies use to determine whether you are underweight, normal, obese or morbidly obese. The formula compares your height and weight. This method has advantages and disadvantages. A disadvantage is that very muscular individuals like weightlifters are classified as obese using this method, even though they may have very low body fat. They just have more muscle than most people. Not a problem. Muscle is like money in your metabolic bank.

BMI does however have a couple of advantages. One is that it is easy to get the information. The average person usually knows their height and weight. The big advantage though is that it is more accurate for the morbidly obese compared to measuring waist and hips. This is because as individuals get fatter, their abdomen sags below the belt line. To learn your BMI, fill in the fields below:


The normal BMI for men and women is between 18.5 and 24.9. If you fall into this range, congratulations – keep up the healthy lifestyle.

If your BMI is below 18.5, you are considered underweight. This is not good. There are increased risks of premature death associated with being underweight. Sometimes underweight is caused by other conditions such as anorexia, malnutrition/malabsorption syndromes, smoking, cancer, lung or gastrointestinal disease. There is such a thing as being too thin.

If your BMI is between 25 and 30, you are considered to be overweight. Health risks increase with increasing weight. A BMI of 25 to 27.5 is associated with a 7% increase in the risk of premature death. A BMI of 27.5 to 30 correlates with a 20% higher risk.

If your BMI is between 30 and 39.5, you are classified as obese. A BMI between 30 and 35 equals a 45% increase in risk of premature death. A BMI of 35 to 40 is associated with a 94% increased risk of premature death!

If your BMI is over 40, you are classified as morbidly obese. BMI in the range of 40 to 60 equals a nearly three fold increase in the risk of premature death.ii

Body Composition

Perhaps the best measure of fitness is found by looking at the ratio between your weight and your waistline. This is particularly important for people who begin exercising and find that though their “clothes fit better”, they haven’t lost much if any weight. The reason this frequently happens is because muscle weighs more than fat. If exercise helps you to gain muscle while losing fat, your weight on the bathroom scale will not reflect your fat loss. This can be discouraging.

The most important measure of fat loss is reduction in waistline. Muscle gain will be reflected in increases in the chest, arms, back, butt and legs – not in the waist. In fact, increasing muscle tone in the abdomen will make the waist a little smaller. You can measure the girth of your arms and legs to track specific increases in muscle size if you are a bodybuilder, but for most of us, the simplest measure is overall weight compared to waistline. That way, we can know our percentage of body fat and our percentage of lean mass.  Let’s try this out;


Most people rely on the bathroom scale to measure success in getting to a healthy weight. This can be dangerous. If you lose weight without reducing your waistline, you are losing muscle mass. Muscle is what burns fat. The less muscle you have, the less fat you burn. This is why people who go on starvation diets generally end up fatter than they started once they start eating normally. Their burn rate has decreased.

I suggest you enter a target weight (such as from when you felt your best or from the BMI calculator) into the Body Composition calculator above and see what that does to your body fat percent. Then enter progressively lower waistlines until you get to a healthy percentage of body fat. The calculator will show you how much muscle you have to gain and how much fat you have to lose. Remember, your target waistline is the most important part of this equation. This knowledge can help you to plan a good diet and exercise program and also help you to track how well you are reaching your goals.

So what is a good level of  body fat? The answer is different for men and women. The following ranges are suggested by the American Council on Fitness.

First, there is an essential amount of body fat, without which your body would not function well. For men, that amount is between 2 and 5%. For women, it is between 10 to 13%.

Competitive athletes aim for a body fat range of 6 – 13% in men and 14 – 20% for women.

Fit individuals range from 14 – 17% body fat in men and 21 – 24% in women.

The average persons body fat  ranges from 18 – 24% in men and 25 – 31% in women.

Obese men have greater than 25% body fat and obese women have greater than 32% body fat.

Some authorities suggest that the percentage of body fat normally goes up as we age. I’m sure it does, just as surely as tree rings add girth to trees with every passing year, but I don’t know that it’s helpful. Every extra pound of fat adds 3 to 7 miles of blood vessels that our hearts have to push against. That can’t be good.

Come back to this site as often as you like to track your progress. Changing your body composition is challenging. All of us at Wells Chiropractic wish you the best in achieving your health goals.

David Wells, D.C., L.Ac., MS (Nutrition)

i Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women.

ii  https://www.hsph.harvard.edu/news/press-releases/overweight-obesity-mortality-risk/