Tell Tale Waistlines

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The jolly pot bellied male may be at increased risk of developing diabetes, new research suggests.

Men with a waist circumference that exceeds 100 centimetres (40 inches) have 12 times the risk of developing diabetes as those with a waist size of 86 cm (34 inches) or less, according to the study.

Dr. Youfa Wang, an assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said waist size is actually a much better predictor of risk than body mass index (BMI), which is an approximation of body fat, based on height and weight. His research adds to the growing body of evidence that waist size is the single greatest predictor of obesity-related health problems, including cardiovascular disease, diabetes, various forms of cancer and kidney stones.

That is because abdominal fat is worse than other kinds of fat. It is not just an inert blob; rather, it releases a steady stream of fatty acids into the bloodstream, which promotes inflammation, disrupts insulin production and damages cells. The crusade to take waist circumference seriously has been led for many years by Jean-Pierre Després, a professor of human nutrition at Laval University in Quebec City. He argues that waist measurement should be an essential component of any health assessment, a policy that that has now been adopted by the American Heart Association.

For men, serious health problems tend to begin when their waist size exceeds 100 centimetres, and for women when waist circumference gets beyond 90 cm (36 inches). A person is considered overweight if their BMI exceeds 25, and obese if their BMI exceeds 30. While BMI is a good measure on a population level, it is sometimes not a good measure for individuals because people who are muscular or stocky can be considered obese even if they are in good health. (But it is rare for an individual to be in good health and have a big belly.)

The new research, published in this week's edition of the American Journal of Clinical Nutrition, tracked 27,270 men over 13 years. During that period, 884 of them developed diabetes. They were placed into five different groups, based on waist size.  More than two-thirds of all diabetic men had a waist size in excess of 100 cm. By contrast, fewer than half of them had a BMI in excess of 30, the traditional measure of risk. Dr. Wang and his team found that waist circumference was a much better predictor of diabetes than BMI or waist-to-hip ratio. Not surprisingly, the bigger a man's belly, the less likely he was to be active, and the more likely he was to have high blood pressure and high cholesterol. Dr. Wang said while he was reluctant to make a specific recommendation based on a single study, the new research suggests that the cutoff point for a healthy waist size should be lowered to 95 cm (37 inches) -- at least when it comes to assessing risk of developing diabetes. Based on self-reported height and weight, Statistics Canada has calculated that about half of Canadian adults are overweight, including 15 per cent who are obese.