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Make waist measurement routine practice in obesity

From Dr David Haslam

Hertfordshire

Clinical director, National Obesity Forum

I enjoyed Malcolm Kendrick's piece on obesity (Clinical, 10 August), but he is quite wrong to suggest BMI and diabetes are not linked. The evidence is overwhelming, not only from massive trials such as the Nurses Health Study, but also from various diabetes prevention studies which demonstrate that reduction in BMI also reduces the likelihood of developing diabetes.

He is absolutely right, however, to state that BMI is a flawed measure, as it doesn't take body composition into account. BMI will wrongly imply that a superfit, muscled athlete is at high risk of diabetes.

Genuinely high-risk individuals with stick arms and legs, but an expanded potbelly, are slipping through the net because their BMI is normal. Waist circumference is far from perfect, but gives a much more accurate indication of cardiometabolic risk, is easily performed by the patient, needs no calculation, and is a tangible figure which means something to everyone.

There is arguably nothing wrong with using BMI to track improvements in someone who has already been identified as suffering from abdominal obesity, but measuring waist circumference should become part of routine practice.

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