Doctors should be trained to routinely measuring waist circumference alongside BMI to properly assess and manage obesity-related health risk, according to a new consensus statement from  cardiovascular specialists.

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, it is still not routinely obtained in clinical practice, says the Consensus Statement from the International Atherosclerosis Society (IAS) and International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity.

Published in Nature Endocrinology Reviews, their statement argues that argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults.

“We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women,” says the statement co-authored by Professor Philip Barter of the University of Sydney’s Central Clinical School Heart Research Institute.

“Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions.”

The review identifies gaps in current knowledge and recommendations,  and offers new recommendations for waist circumference threshold values for a given BMI category, to optimise obesity risk stratification across age, sex and ethnicity.

“From the evidence available, we question the rationale behind current guidelines recommending that a single waist circumference threshold for white adults (men >102 cm; women >88 cm) be used to denote a high waist circumference, regardless of BMI category.

“We recommend that prospective studies using representative populations are carried out to address the need for BMI category-specific waist circumference thresholds across different ethnicities. This recommendation does not, however, diminish the importance of measuring waist circumference to follow changes over time and, hence, the utility of strategies designed to reduce abdominal obesity and associated health risk.

“We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important ‘vital sign’ in clinical practice,” they conclude.