Measuring Tape - The New Medical Instrument

In addition to measuring Body Mass Index (BMI), all doctors now measure waist circumference in overweight and obese adults to assess abdominal obesity. This helps in identifying adults at increased risk for morbidity and mortality

Dr KK Aggarwal | Feb 28, 2020

Being overweight or obese is no indication that you are well nourished, as it is a state of health due to consuming a diet consisting of food and drink that's high in fat and sugar but low in essential vitamins and minerals.

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. In addition to measuring Body Mass Index ( BMI), all doctors now measure waist circumference in overweight and obese adults to assess abdominal obesity.

This helps in identifying adults at increased risk for morbidity and mortality, particularly in the BMI range 23 to 35 kg/square meter (m2 ) . Patients with abdominal obesity (also called central adiposity, visceral, android, or male-type obesity) are at increased risk for heart disease, diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease, and have higher overall mortality rates.

The waist circumference is measured with a flexible tape placed on a horizontal plane at the level of the iliac crest as seen from the anterior view.

Measurement of the waist-to-hip ratio provides no advantage over waist circumference alone and is infrequently used by clinicians. It is not recommended as part of the routine obesity evaluation by the American Heart Association (AHA)/American College of Cardiology (ACC)/The Obesity Society (TOS) guideline, although it was in the previous version.

Until recently, a weight (in kg) of more than 25 x height (in metres) x height (in metres) was considered overweight and a weight of more than 30 x height (in metres) x height (in metres) was considered obese. However, these criteria have been changed for the Asian population including Indians and now the classification of obesity as per the weight is a weight more than 23 x height (in metres) x height (in metres) is overweight and a weight more than 25 x height (in metres) x height (in metres) is obese.

This classification has limitations. More than 50% of the cases of proven coronary artery disease have a normal body mass index {weight (in kg)/ height (in mtr.) x height (in mtr.).

A waist circumference of ≥ 90 cm for men and 80 cm for women is considered elevated and indicative of increased cardiometabolic risk.

Waist circumference measurement is unnecessary in patients with BMI ≥35 kg/m2 as almost all individuals with this BMI also have an abnormal waist circumference and are already at a high risk from their adiposity.

Worldwide obesity has nearly tripled since 1975. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese, according to World Health Organisation.

The problem is not restricted to adults. The WHO data shows that 40 million children under the age of 5 were overweight or obese in 2018.

The major cause of potbelly obesity is consumption of refined (bad) carbohydrates and animal (bad) fats. The refined carbohydrates include any item which is artificially whitened like white
sugar, white maida, white bread and white rice. They have high a glycemic index and raised blood sugar levels immediately after consumption and, over a period of time, cause higher levels of insulin in the blood and resultant insulin resistance state.

Once this situation has occurred, any bad fat that is consumed instead of getting converted into energy is converted into abdominal fat. This fat is deposited either in the ovaries leading to poly-cystic ovarian disease, in the liver leading to fatty liver and non-alcoholic fatty liver disease; or in the heart leading to coronary blockages.

(The writer is President of the Confederation of Medical Associations in Asia and Oceania (CMAAO), Heart Care Foundation Of India (HCFI) and past national president of Indian Medical Association (IMA))