Question 1
What could be some potential limitations to using waist circumference as a measure of abdominal obesity?
posted by shelby @ 3:59 PM
14 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
Sunday, August 16, 2009
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14 Comments:
Studies that have analyzed the association of anthropometric measures and abdominal visceral fat have found waist circumference to be a better measure of central obesity because it is a better predictor of abdominal visceral fat. However, even though waist circumference is a good predictor of visceral fat, it does not distinguish abdominal subcutaneous fat, total abdominal fat and/or total body fat. Research indicates that waist circumference can help predict disease risks, especially for those with a BMI between 25 and 34.9. Therefore, to most effectively assess a patients' risk status, perhaps both measurements need to be considered.
One problem with using waist circumference as a measure of abdominal obesity is bone structure. Some lean women just have wider hips, which lead to a wider waist circumference. Therefore, the high waist circumference measurement could indicate more abdominal obesity when there is in reality.
Anna,
I agree that more than one measurement should be considered when assessing abdominal obesity because, like you said, visceral fat, subcutaneous fat, and total fat need to be distinguished in order to determine the true level of abdominal obesity. In addition, like most other measurement tools, not everyone can be evaluated under the same circumstances, so it's a good idea to incorporate multiple methods of measurement.
Jen, you are definitely right. A large waist circumference can reflect a greater amount of subcutaneous fat, more gluteal muscle mass, or a larger bone structure. As we have learned, central/abdominal obesity plays an important role in predicting an individual's risk of CHD. Just as waist circumference is a stronger predictor of CHD than BMI, perhaps; waist to hip ratio is a stronger predictor than waist circumference.
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One limitation to measuring waist circumference is the practical matter of getting it from a patient. BMI is something that can be calculated without much inconvenience for the patient or the physician. Not only does the waist circumference take time for both to be done, but either parties or both could feel uncomfortable that could possibly cause an error in the measurement.
A common limitation to using only waist circumference as a measurement of abdominal obesity is the chance for error. As with any anthropometric measurement, error can potentially occur, which is why it may be better to use multiple measurements to ensure that the measure of abdominal obesity is accurate.
Jenn -
I didn't think of bone structure! That can definitely play a role in waist circumference!
Melissa S.
An enormous limitation to using waist circumference as a measure of obesity is that the mainstream medical community just doesn't bother with it - no doctor's office I've ever been in has employed this method of anthropometric assessment; nor has any hospital I've observed. Nurses and doctors who routinely interact with patients just don't have this as part of their skill set in making patient assessments. If it were commonly used as an obesity measurement tool then maybe taking the waist measurement would be routinely done well (practitioners would have finessed how to do the assessment) but when waist measurement stays something that is only used or referred to in the research arena then this isn't a practical assessment tool simply due to unfamiliarity and tendency for error.
You ladies have such good limitations! I wanted to expand on Jen's original idea of bone structure. Waist circumference does not incorporate percent body fat around the abdominal. An elderly person can have a very small waist circumference due to the fact that their bones are weakening making their frame smaller. Their percent fat may be extremely high in the small mass they do have, however with a waist circumference test one would not be able to tell this. Although they are expensive, a body fat caliper may be the most accurate way to measure abdominal fat.
The only real drawback that I see to using waist circumference as an indicator of abdominal adiposity is that it is not easy to obtain an accurate waist measurement, with no standardized protocol practiced, and different studies using different locations to take the measurement (1). Even with a standard protocol, clinicians will differ in the measurement of an individual’s waist. In addition, the subject’s measurement of their own waists will commonly differ from the clinician’s measurement. It is because of this that other factors such as BMI are used in addition to waist circumference when determining whether or not one is at risk for disease.
1. Wang, Y. & Rimm, E. B. & Stampfer, M. J. & Willett, W. C. & Hu, F. B. (March, 2005). Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am. J. Clinical Nutrition, 81: 555-563.
Melissa -
I completely agree. It's just too hard to tell whether or not the individual is measuring at the same exact spot on a consistent basis. This goes for other measurements like height and weight too.
In this study, the initial waist circumference was obtained by someone trained whereas the follow-up circumferences were done at home. In order to make sure that the measurements are reliable, and thus able to be compared to each other, both the initial and follow-up measurements should be taken by the same person and hopefully by a trained professional at that.
Steph N -
That's a good observation about the initial measurements being taken by a trained professional vs the subsequent measurements being done at home by people who were not trained....this must have been frustrating for the study's authors...I bet if they'd had more funds they'd have gone for a pro in every case.
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