Can You Be Overweight and Healthy? Why Waist Size May Matter More Than Body Fatness

We live in a world that places a lot of emphasis on weight. And for better or worse (mostly for the worse) we often associate being thin or “normal” weight with having good health. But this isn’t always the case. 

After all, when it comes to your overall health and wellness, your weight is just one small part of the picture. Many other things are just as important — or even more important — in understanding your overall health, both now and in the future. 

Is BMI an accurate way to measure excess weight?

When you go to an appointment with a healthcare provider, they usually take your weight and height. These measurements can be used to determine your body mass index (BMI). Knowing your BMI can potentially help you understand your risk for certain types of medical problems. 

BMI is a good screening tool because it’s inexpensive and easy to do. But it has some problems, too. Let’s take a closer look at how BMI is calculated, and the pros and cons of using it as a screening tool. 

BMI is your weight in kilograms divided by your height in meters squared. This number corresponds with one of four weight categories:

• Underweight: BMI below 18.5 

• Healthy weight: BMI of 18.5-24.9 

• Overweight: BMI of 25-29.9

• Obesity: BMI of 30 and above

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On its own, BMI doesn’t say a lot about your body fatness or overall health. But knowing your weight category can help your healthcare provider understand your health risks. For example, a high BMI is linked to certain health problems like Type 2 diabetes, sleep apnea, and heart disease. A low BMI is also linked to health problems, such as osteoporosis. 

The problem with BMI and health

On its own, BMI doesn’t really say much about your overall health. It can give you a general idea about body fatness — but it’s only a rough estimate, at best. 

The main problem with BMI is that it's only based on two pieces of information: your height and your weight. It doesn’t account for other things that can affect your health, such as:

• Diet choices

• Lifestyle

• Medical history

• Family history

• Gender and sex

• Race and ethnicity

• Age

There’s also evidence that BMI isn’t very accurate for certain groups of people because it’s based on a white, male body. These include:

• Athletes

• People with a lot of muscle mass

• Older adults

• Women

• People of color

Because of these problems, the American Medical Association recommends that BMI should not be used on its own. It should only be used together with other measurements of health. 

Better alternatives to BMI?

There are other ways to measure your body fatness, and to predict your risk of having weight-related health problems. These include:

• Skinfold calipers

• Underwater weighing

• Whole-body CT or MRI scans

• DEXA scan for body fat

• Body fat scales

• Waist size (waist circumference)

• Waist-to-hip measurement

Some, like waist size, are quick and inexpensive, just like BMI. Others are more costly and time-consuming but may be more accurate. 

But, which one is best?

World health experts recommend using two tests together: BMI plus waist circumference. Putting these two together seems to be better at predicting your health risks than BMI on its own. And both are cheap, easy, and don’t require any special equipment.  

Let’s take a closer look at waist circumference, and why it’s important. 

Waist size (circumference) and health

Just like BMI, waist size is linked to potential health problems. Some experts believe it may be even more important than BMI. 

This is because your waist circumference is based on how much belly fat you have. Belly fat (also called “abdominal” or “visceral” fat) is linked to many different health conditions, including heart disease, diabetes, cancer, and dementia. 

Other types of body fat — like fat on your arms, hips, or thighs — don’t seem to carry the same risks. 

In other words: The more belly fat you have, the more likely it is to affect your health. 

How to measure waist circumference

To get your waist circumference, just measure all the way around your waist. Your waist is located halfway between your hips and your ribs.  

Here are some tips for getting an accurate measurement:

• Use a stretch-resistant measuring tape or string. 

• Breathe out naturally before measuring. 

• Wrap the measuring tape or strung snugly around your waist but not too tightly.  

• While measuring, be sure to keep the measuring tape parallel to the floor. 

If you’re having trouble, a friend or family member can help take your measurement. 

According to the National Heart, Lung, and Blood Institute, a large waist size increases your risk for certain health problems — even if your BMI is in the “normal” category. 

A large waist size is:

• More than 35 inches (88 cm) in women 

• More than 40 inches (102 cm) in men 

But keep in mind: Just like BMI, waist size recommendations may be different for certain groups of people, and for some health conditions. For example, your risk of getting diabetes may be higher if you’re are a South Asian, Chinese, or Japanese:

• Woman with a waist size of more than 80 cm

• Man with a waist size of more than 90 cm

Is your waist-to-hip ratio important, too?

Yes. When it comes to measuring health risks, there’s evidence that waist size and waist-to-hip ratio are equally good tools. But between the two, waist size is usually the top choice because it’s easier to do. 

Here’s how to find your waist-to-hip ratio:

1. Measure your waist size.

2. Measure your hips at the widest part.

3. Divide your waist size by your hip size. This number is your waist-to-hip ratio. 

According to the World Health Organization you have “abdominal obesity” if your waist-hip ratio is:

• Above 0.90 for men

• Above 0.85 for women

In research studies having a high waist-to-hip ratio is linked to health problems like diabetes, heart disease, and premature death. 

Cholesterol, blood pressure, and other measures of health

BMI, waist measurement, and waist-to-hip ratio can help you know whether body fat might be affecting your health. But when it comes to your overall health, body fatness is just one piece of the puzzle. 

There are many tests that can help you understand your overall health. Examples include:

• Cholesterol testing

• Blood pressure testing

• Blood sugar testing

• Liver function testing

• Bone density scan

• Mammogram

• Body imaging (such as X-ray, CT, or MRI)

• Colon cancer screening

• Heart stress test

• Cervical screening and Pap smear

Your healthcare provider may recommend some of these tests as part of regular preventive care. They might also recommend certain tests if you’re at risk for health problems, like heart disease or diabetes. 

Using this information together with measures of body fatness (like your BMI and waist size) is the best way for you and your healthcare provider to understand your overall health.

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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