Editorial - Body Mass Index, Waist-to-Height Ratio, Cardiometabolic Risk Factors and Diseases in a New Obesity Classification Proposal

Ahmet Selçuk Can*
Division of Endocrinology and Metabolism, Department of Medicine, Private Gayrettepe Florence Nightingale Hospital, Gayrettepe, Beşiktaş, Istanbul, Turkey

© 2011 Ahmet Selçuk Can.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Division of Endocrinology and Metabolism, Department of Medicine, Private Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sok. No: 8, Gayrettepe, Beşiktaş, Istanbul, Turkey; Tel: (90) 212 2883400, ext. 4843; E-mail:


In this mini-hot topic issue, methods of body composition analysis are reviewed, a new shape chart based on waist-to-height ratio is presented and a new obesity classification system is proposed. Anthropometric indices are surrogate measures of body fat and are cost-free, practical and easy to interpret for health care providers and lay people. The answer to the question of “the best anthropometric index” varies according to study design, geographic area, characteristics of the study population and the outcome assessed. Recent studies suggest using measures of general obesity and abdominal obesity for assessment of excess body fat. The use of waist-to-height ratio as a global anthropometric index for children and adults is suggested in this mini-hot topic. Anthropometric indices have a good performance in predicting health risks in epidemiologic studies, but by themselves have limited use in treatment decisions of individual obese patients. Body mass index is strongly correlated with total body adipose tissue mass and is a measure of general obesity. Current classification of obesity is based on body mass index, an anthropometric index that does not inform about body fat distribution, is not a powerful discriminator of cardiometabolic risk factors and does not convey information about the presence of risk factors or co-morbidities. Therefore, a new obesity classification system is needed. I suggest this should be based on body mass index, waist-to-height ratio and obesity associated risk factors and diseases. Future studies should focus on seeing how the proposed obesity classification system works in different populations.

Keywords: Obesity, body weights and measures, body mass index, waist to height ratio, anthropometry, obesity classification.