Why Waist-to-Hip Ratio Is an Increasingly Important Health Metric for Midlife Women
You’re probably familiar with your waist-to-hip ratio (WHR) in the context of shopping for clothes, but a growing body of research finds this measurement is key for assessing future risk of developing health issues.
The measurement, which is the circumference of your waist divided by the circumference of your hips, paints a picture of how much fat someone carries in the midsection; higher waist-to-hip ratios point to more accumulated fat and have been linked to higher risks of metabolic issues like Type 2 diabetes and heart disease.
Flow Space spoke with two experts to learn more about why waist-to-hip ratio can be a helpful measurement of body composition and future health risk.
Why Waist-to-Hip Ratio Is a Better Metric Than BMI
Compared to body mass index (BMI), which measures height against weight, waist-to-hip ratio has been found to be a better predictor of future issues because it better reflects body composition. Research has found that BMI is less useful and broadly accurate than previously thought—it doesn’t say much about where and how someone carries excess fat.
The amount of fat stored in the abdomen is such an important measure for health risk because that’s where so many key organs, like the heart, intestines, liver and pancreas, are located.
“The place to store fat is really the subcutaneous area, meaning under the skin,” explained Dr. Lindsay Fourman, a board-certified physician in endocrinology, diabetes and metabolism, as well as the associate director of lipid and metabolism associates at Massachusetts General Hospital. When there’s not enough room under the skin, the body has to store fat elsewhere like deep in and around the organs.
“That’s not really where fat is supposed to be and not where energy belongs,” she said.
The kind of fat being stored matters, too. This tends to be visceral fat, which has been linked to a host of health issues.
“Think about it as active, angry fat. It’s not the healthy storage depot like the under-the-skin fat,” said Dr. Ava Port, a board-certified endocrinologist who specializes in diabetes, metabolism and weight management at MedStar Georgetown University Hospital. “The visceral fat causes a lot more inflammation and negative hormonal effects.”
A larger gap between the hip and waist measurement points to less visceral fat storage.
“It’s a good surrogate marker of visceral fat because there’s only so much [fat] you can store under the skin, so the bigger the waist circumference, the bigger the visceral fat quantity typically is,” said Port.
To be clear, this is not a measurement of thinness.
According to Dr. Rohit Soans, a board-certified general surgeon and medical director of bariatric surgery at Temple University Hospital, waist-to-hip ratio is important because it highlights where fat is distributed.
“The waist circumference and the fat there is more related to both visceral adiposity and central obesity, which is the key connection with cardiovascular disease and insulin resistance,” he said. “Everyone is different, but it’s that central obesity has a much higher link to the medical issues that we’re worried about.”
He added that compared to other measurements like BMI, waist-to-hip ratio seems to be more generalizable across large populations.
How to Find Your Waist-to-Hip Ratio
To measure your waist-to-hip ratio, take a soft tape measure and measure the circumferences of these two places: your natural waistline, which is typically near the belly button, and the widest part of your hips. Divide your waist size by your hip size.
“You’ve got to measure the waist part of it from under the last rib to the top of the iliac crest, which is that big bone that you can feel on your side,” advised Soans, who added that the hip measurement should be also be taken at the widest part.
It’s recommended to measure twice for accuracy and to average the two sets of measurements if they return differences within one centimeter.
According to the World Health Organization (WHO), a waist-to-hip ratio of 0.85 or higher points to abdominal obesity. A ratio above 1 means increased risk of health issues.
“Anything above 0.85 for women is when we can start linking this ratio to a higher risk of cardiovascular disease, conditions and insulin resistance,” he said.
WHR is also helpful because it’s a measurement you can keep an eye on yourself. Keeping track of your measurements can help surface patterns.
“If your starting number is 0.95, that’s fine. But then in a couple years, if that number has crept over 1.0, that’s a trend that patient may be able to think about,” said Soans.
How to Improve Your Waist to Hip Ratio
If your waist-to-hip ratio could use improvement, know that it’s a moveable metric. Speak with your health care provider for help.
However, Port said that those who are predisposed to carry more fat in midsection due to certain factors, like genetics and medications, can have a tougher time shrinking their WHR—but that doesn’t mean it’s impossible.
“It is a little bit tricky if you are predisposed to carry [fat] in a certain way to all-of-a-sudden overcome your nature… Sometimes, that’s where medications do become helpful or necessary,” she said. “Also, when somebody has pre-diabetes or metabolic health issues related to that visceral fat, it does get kind of tricky to lose that midsection fat without escalating to medical therapy or more intense interventions.”
Regular exercise will improve waist-to-hip ratio and provide overall health benefits, which can include body recomposition. But leave the crunches and ‘belly fat blasting’ exercises alone. While, you cannot target fat loss in specific parts of the body, you can improve your body composition overall by gaining muscle and losing fat.
“From a weight standpoint, they may not necessarily lose a lot of weight because they’re gaining muscle and losing fat, but from a body composition standpoint, they’re improving their body composition,” explained Fourman. “In any case, exercise is also just very healthy in terms of cardiovascular risk protection. So whether we’re improving the belly fat, which I think they are, it will have its own intrinsic benefits to reduce cardiovascular risk.”
Eating a nutritious diet can also help reduce health risks associated with a higher waist-to-hip ratio. Focus on incorporating plenty of nutrient-dense fruits, vegetables and lean proteins and reducing foods that are high in sugar, fat and salt.
Additionally, hormonal changes due to menopause can drive changes.
“During the menopausal transition, women become more androgenic so as estrogen levels are dropping, you have sometimes relatively more male hormones but also a big tendency to store fat in the midsection instead of in the hips, and that’s what really drives the metabolic risk,” said Port.
Fourman said that taking systemic hormone replacement therapy (HRT) can be helpful to address menopause symptoms like weight gain in the midsection and body composition changes. Speak with your doctor about whether this is a good option and, if so, which type is best suited for you. Getting treatment for other conditions that can cause weight gain around the midsection, like thyroid issues or PCOS, can also help.
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