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Q. Is waist measurement
so important? I’ve always had a big waist, even when I’ve been
what I consider, a normal healthy weight.
A. The
use of waist measurement as an indicator of disease risk
is a valid clinical technique. This is well researched
and supported both internationally and in Australia.
Agencies supporting this view include the National Health
and Medical Research Council, The Australian Government
Department of Health and Ageing, Diabetes Australia,
The Dietitians Association of Australia, and The World
Health Organisation.
The NSW
Cancer Council and Diabetes
Australia in fact have both recently had their own waist measurement
campaigns.
Increased body fat distributed around the abdominal area is a potential
risk factor for disease independent of total body fat i.e. having weight
around your middle (apple shape) is more of a health risk than weight
on your hips or thighs (pear shape).
Waist measurement is regarded as a more accurate indicator of risk
than Body Mass Index (BMI)* in
considering associated health risks. However, combining your BMI measure
and waist measure may provide a more accurate indication of your status.
Waist measurement also offers high predictive validity and less potential
for error when compared to waist to hip ratio measurements, another
popular screening technique.
For a comprehensive discussion of the evidence please go to ‘Clinical
Practice Guidelines for the Management of Overweight and Obesity in
Adults’, The Australian Government Department of Health and Ageing
and The National Health and Medical Research Council, updated 2004.
Q. I don’t
consider myself ‘fat’ but the tape says my waist measurement is
in the “hazardous” range. Are you promoting the wrong message?
A. The information on the
tape is designed to raise people’s awareness about their
level of risk for chronic illnesses like heart disease,
diabetes and some cancers, not fatness. “Hazardous” indicates
an increased level of risk and a gentle reminder that
you may need to assess your lifestyle.
Q. The tape measurements
don’t take into account height, body type or age. Isn’t this over
generalising to suggest these measurements are relevant to everyone?
A. These internationally
accepted measurements are considered valid independent
of body type or height. It is however acknowledged that
the relationship between waist circumference and body
fat differs with gender, age and between ethnic groups.
The “cut-off “ measures used here are for adult males and females of
European descent (Caucasian). Cut–offs are slightly lower for people
of Asian and Indian descent and are thought to be slightly higher for
people of Pacific Islander or African descent. We are aware that these
World Health Organisation measures do not take into account age. As
you can appreciate, with any population health campaign, it is always
a challenge to tailor health information for each individual. We acknowledge
this, which is why we state in the brochure; “waist measure is an indication
only. If you are concerned and want more information about your health
risks please visit your doctor.”
Far more accurate methods of determining fat as a proportion of body
mass include imaging techniques such as MRI. The expense and relative
scarcity of the necessary equipment however normally preclude such
techniques even at a clinical level.
Q. The
only people in our workplace who were in the tape’s “normal” range
appear slightly underweight to me. I think you should check your
tape measure.
A. It may be that community
perceptions of what is a ‘healthy weight’ may not align
with the current internationally accepted guidelines.
Rates of overweight and obesity have been on a steady
increase for decades. In NSW rates increased from 38%
to 53% between 1990 and 2005 (the Central Coast is slightly
above the State average). A curious aspect to this trend
is that as a greater percentage of our population enters
these weight categories, the more being overweight is
normalized. “Overweight or obese men and women are
increasingly likely to see themselves as having an acceptable
weight. On an age standardised basis, the proportion
of overweight or obese adults who perceived themselves
as having an acceptable weight increased from 37% in
1995, to 41% in 2001, and 44% in 2004-05”. Australian
Bureau of Statistics, January 2008.
Q. A number of the
women in our workplace are fit, active, ride bicycles to work or
do regular walking, exercise, bring fresh food in for lunches,
eat healthy, are aged over fifty and do not look overweight but
look healthy. According to the tape they are in the “hazardous”
range.
A. The waist circumference
measures in the “hazardous” and “harmful” range represent
an increased risk for certain diseases. Other risk factors,
including lifestyle, need to be taken into account when
assessing an individual’s risk. An active lifestyle and
healthy diet are certainly major factors in reducing
risk and are promoted and encouraged by the Measure Up
4 Health campaign. Once again, as you can appreciate,
with any population health campaign, it is always a challenge
to tailor health information for each individual. We
therefore rely on individuals to make a reasonable assumption
about whether the information is appropriate for them.
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