April 8, 2022

expert reaction to updated NICE draft guideline on weight management, including the suggestion for people to keep their waist measurement to less than half their height

The National Institute for Health and Care Excellence (NICE) have published an updated draft guideline recommending people keep their waist measurement to less than half their height.

Dr Katarina Kos, Consultant Physician and Senior Lecturer in Obesity and Diabetes Research, University of Exeter, said:

“There is increasing concern about unhealthy fat distribution rather than just obesity per se.  Being concerned about the waist measurement is more than justified and part of the cardiovascular risk assessment.  As a researcher of fat tissue, I understand that the inner body fat within and around organs and inside our abdomen is crucial to our health.  The waist is a good representation in what happens inside.

“However, whilst some of us have a ‘ballooning’, others do have an apron-like abdomen, which makes measurements trickier.  These are not recommended or needed in those who have higher BMIs.

“Being more practical, in case of a protruding tummy or if one can make a considerable roll with the skin below the navel, there is time for adjusting one’s lifestyle and as for adults, a tape measure may not be needed.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“Rising waist girths are upstream of many chronic conditions that are on the rise in today’s population, but it is hard to see how the UK will start to reverse such trends.  To being with, however, we need to help people better understand when their excess fat-related risks are starting to escalate and then to provide simple evidence based interventions to slow, stop or reverse weight gain.

“Body mass index is not easily understood by many people and for this reason waist circumference thresholds were proposed over a decade ago.  The present NICE draft recommendation for people to measure their waist levels and compare to their height (aiming to keeping it less than half) may be an additionally useful message as most people should be able to understand how to do this.  It is also known people of shorter stature tend to be at higher risk for risks for diabetes and heart disease so comparing waist to height does have some evidence base.

“Whether this new message gets taken up is uncertain but it never harms to try new ways to get people to consider their health status.  However, in the end, we need better interventions to help people change behaviour and also a less obesogenic environment to improve the health of the nation.  There is much to do to tackle the UK’s rising waist girths.”

Prof Tom Sanders, Professor Emeritus of Nutrition and Dietetics, King’s College London, said:

“As a rule of thumb, it  is generally OK to set a target waist circumference as half your height particularly for younger and middle-aged adults.  However, it does not work for people who are very short in stature e.g. achondroplasia (dwarfism) and there are limitations on its application to older adults.

“The risks associated with increased waist circumference differ between men and women, with the risk of diabetes being much greater in men than women.  The International Diabetes Federation (IDF) guidelines suggest waist circumference should not exceed 94 cm for men and 80 cm for women, and 90 cm and 80 cm for Asian men and women respectively (because they tend to be in shorter stature).  The average height for men and women has increased over decades and is now 175 and 162 cm – this would give values of 87.5 cm for men and 81 cm for women.  So these cut off are close to the IDF guidelines for women but  much tougher for men.  Many older adults are shorter in height, mainly due to shorter femur length which reflect poorer growth in childhood, so that their waist/height ratios are higher than in adults with longer legs (most of the body weight is in the trunk).  Furthermore, over the age of 60 (in some even younger) people tend to lose height which ranges from 2.5 – 7.5 cm (or more if there is osteoporosis).  Consequently, this simplistic classification is likely to classify far more older adults being at risk of diabetes than the current IDF guidelines.”

‘Guideline: Obesity: identification and classification of overweight and obesity; Draft for consultation, April 2022’ was published by NICE on Friday 8 April 2022.

Declared interests

Dr Katarina Kos: “I have no conflict of interest.”

Prof Naveed Sattar: “Consulted for Novo Nordisk, Pfizer, Eli-Lilly, in the area of weight loss.  Also involved in several lifestyle trials.”

No others received.