Waist-Hip Ratio vs. BMI

[Grateful]

So I'm one of the so-called "thin" diabetics. My BMI never went above 22 and is now 19. My doctor never had anything to say about my weight, and indeed when I lost 10KG on the (doctor-prescribed) low-carb diet in the few months after T2 diagnosis, he warned me not to lose any more or "you will just disappear"!

But here's the rub. In the past seven years or so, my waistline went from 34 inches to 40 inches at the time of my T2 diagnosis earlier this year (post-diagnosis and after 8 months of low-carb, it is back down to 36 inches). I have seen in the medical literature a number of statements to the effect that BMI is flawed. Indeed I saw a number of opinions to the effect that what really matters is the "waist-to-hip ratio":

Wikipedia: "Waist–hip ratio or waist-to-hip ratio (WHR) is the dimensionless ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement ( W ÷ H ). ... The WHR has been used as an indicator or measure of health, and the risk of developing serious health conditions."

Full article: https://en.wikipedia.org/wiki/Waist–hip_ratio.

So what I considered to be just a benign "beer belly" was (perhaps) a lot more sinister than it seemed. It is already the case that the conventional BMI definitions of "overweight" and "obese" are regarded as unreliable (too lenient) for certain groups (such as Asians).

Edited to add my own waist-hip ratio:
--At time of diagnosis in February 2017: 1.02 (and according to DGSP that is officially "obese" for a man!!).
--Today: 0.92 (which is still defined as marginally "overweight" for a man!!)

On the other hand, my diabetes (and that of other thin or non-thin people) could just as easily have been related to genetic or other causation factors. However I do think it might help if doctors and other specialists paid more attention to a broader range of risk factors, including (for instance) the waist-to-hip ratio as well as BMI.

 

[Bluetit1802]

The NHS, or at least my own GP surgery, looks more at the waist to height ratio, although still uses the BMI alongside it.

Measured in inches, the waist should be no more than half your height. Apparently.

 

[CherryAA]

The NHS, or at least my own GP surgery, looks more at the waist to height ratio, although still uses the BMI alongside it.

Measured in inches, the waist should be no more than half your height. Apparently.

I agree wholeheartedly. Basically all the evidence is that the weight that goes onto your waist is the malevolent stuff that also hits the internal organs and leas to untold problems.

I am currently eating real foods, just once a day and the effect on my waistline has been astonishing ( see the diet thread below ) 8cm off my waist in 15 days! my own doctor has never measured my waist once.

 

[Guzzler]

Sorry to sound cynical but I've done the BMI calculation, the Waist/Height ratio calculation and the Waist/Hip ratio calculation and all give varying readings of the risk factors. It reminds me of when, pregnant with my second child, I was asked my shoe size. I queried this and was told that it helped doctors assess risk factors for difficult births. By the time I had my third child they had dropped the question. Oh, I wonder why!

 

[Mr_Pot]

Measured in inches, the waist should be no more than half your height. A

Or measured in cm

 

[carol43]

It's not good measuring my weight as I have so much loose skin now. It looks horrible. I've got huge bingo wings and the skin at the top of my legs hangs in folds.

 

[Bluetit1802]

Sorry to sound cynical but I've done the BMI calculation, the Waist/Height ratio calculation and the Waist/Hip ratio calculation and all give varying readings of the risk factors. It reminds me of when, pregnant with my second child, I was asked my shoe size. I queried this and was told that it helped doctors assess risk factors for difficult births. By the time I had my third child they had dropped the question. Oh, I wonder why!

They did this with my daughter. At the time her shoe size was a 3 and a half. They said foot size and pelvic gap are related, so the smaller the feet the more difficult for baby to squeeze through. She has 2 children, and neither was a difficult birth.

 

[Guzzler]

They did this with my daughter. At the time her shoe size was a 3 and a half. They said foot size and pelvic gap are related, so the smaller the feet the more difficult for baby to squeeze through. She has 2 children, and neither was a difficult birth.

That's the explanation I got, too. My younger sister is the same shoe size as I am and two of her three births were difficult. Sometimes the parameters are just too wide but we are all supposed to be 'by the book'.

 

[Grateful]

Sorry to sound cynical but I've done the BMI calculation, the Waist/Height ratio calculation and the Waist/Hip ratio calculation and all give varying readings of the risk factors. It reminds me of when, pregnant with my second child, I was asked my shoe size. I queried this and was told that it helped doctors assess risk factors for difficult births. By the time I had my third child they had dropped the question. Oh, I wonder why!

I see what you mean! On the other hand, we have to start somewhere. Once upon a time, the mantra was "what you can measure, you can manage." Although that is now discredited as a fix-all philosophy, it has its place in a scientific framework. After all, as diabetics we spend a lot of time looking at blood numbers, trying to interpret them, and working to improve them.

The trick is to figure out which measurements are meaningful, and to put them into context with other relevant measurements. Reliance on the BMI (which seems to be widespread here in the USA) can, clearly, miss other stuff. My doctor never measured my waist or asked for my waist size.

 

[Mbaker]

My BMI is 27 point something so I am over weight, yet my fat percentage is 15 and of my circa 90 kilos 71 is muscle. On the waist to height ratio I come out as normal.

When my wife was in the British Judo squard in her teens she was told by Doctor she was obese, yet I have seen her pictures and she was no bigger than a floor gymnast (at the time she was also a personal trainer and warned the HCP that this type of assessment could cause body image issues).

I think BMI follows the 80 / 20 rules like type 2 diabetes alternative protocols.

 

[Guzzler]

I see what you mean! On the other hand, we have to start somewhere. Once upon a time, the mantra was "what you can measure, you can manage." Although that is now discredited as a fix-all philosophy, it has its place in a scientific framework. After all, as diabetics we spend a lot of time looking at blood numbers, trying to interpret them, and working to improve them.

The trick is to figure out which measurements are meaningful, and to put them into context with other relevant measurements. Reliance on the BMI (which seems to be widespread here in the USA) can, clearly, miss other stuff. My doctor never measured my waist or asked for my waist size.

Other than when I was pregnant my weight was never measured. Since dx with T2 it and my height have been measured at all appointments (though why they measured my height twice within one month just baffles me). No one has measured my waist, ever.

I know that these numbers are only a guide but what I object to is that some HCPs use them as a stick to beat you with. And the fact that some people get into sort of mindset that these numbers equate to a competition with others or even themselves.

 

[DCUKMod]

My BMI is 27 point something so I am over weight, yet my fat percentage is 15 and of my circa 90 kilos 71 is muscle. On the waist to height ratio I come out as normal.

When my wife was in the British Judo squard in her teens she was told by Doctor she was obese, yet I have seen her pictures and she was no bigger than a floor gymnast (at the time she was also a personal trainer and warned the HCP that this type of assessment could cause body image issues).

I think BMI follows the 80 / 20 rules like type 2 diabetes alternative protocols.

MBaker, I think there may be a typo in your post somewhere. You say in the post I just quoted that your BMI is 27, weighing 90 kilos, with 15% body fat, which equates to 13.5KG fat. You then go on to say you have 71 kilos of muscle? That only leaves you with 5.5kg for bone, water and so on?

It's just a bit confusing; for me anyway. Of course, I may have completely misinterpreted your post.

 

[Mbaker]

MBaker, I think there may be a typo in your post somewhere. You say in the post I just quoted that your BMI
is 27, weighing 90 kilos, with 15% body fat, which equates to 13.5KG fat. You then go on to say you have 71 kilos of muscle? That only leaves you with 5.5kg for bone, water and so on?

It's just a bit confusing; for me anyway. Of course, I may have completely misinterpreted your post.

I use 3 scales, Fitbit Aria, Withings Body Cardio and Tanita Innerscan V, not sure how the attachments come out but the results of the scales are:

Fitbit:
Weight 89.2 kg
12.6% Fat
BMI 27.4

Withings:
Weight 88.8 kg
13.2% Fat (August reading, for some reason extended readings haven't worked since)
BMI 27

Tanita:
Weight 89 kg
15.6% Fat
BMI 27.5
Visceral Fat 7.5%
Body Water 63%
Muscle Mass 71.4 kg
Bone Mass 3.7 kg
BMR 2169
Body Type 6 (muscular)
Metabolic Age 34

I think the confusion is that I rounded my weight up 90 kg, body fat I took at the higher reading and BMI I rounded down. In addition the muscle figure is muscle mass.


Withings Body Cardio:
Tanita Scales

 

[Fleegle]

My BMI is 27 point something so I am over weight, yet my fat percentage is 15 and of my circa 90 kilos 71 is muscle. On the waist to height ratio I come out as normal.

When my wife was in the British Judo squard in her teens she was told by Doctor she was obese, yet I have seen her pictures and she was no bigger than a floor gymnast (at the time she was also a personal trainer and warned the HCP that this type of assessment could cause body image issues).

I think BMI follows the 80 / 20 rules like type 2 diabetes alternative protocols.

I don't understand the math here - and I am interested so I can work my own stats out more accurately
As a massive generalisation, shouldn't you have about 51% water? So shouldn't at least 45kilos be water.
71kilos of muscle is pretty impressive as is your fat %. But I don't really understand how it all adds up.

Really interested to know.
Because my scales tell me I am about 52% water, and I weigh about 80kgs I think. Then the say I am 24% fat (still!) which equates to 76% of my body.

 

[DCUKMod]

I use 3 scales, Fitbit Aria, Withings Body Cardio and Tanita Innerscan V, not sure how the attachments come out but the results of the scales are:

Fitbit:
Weight 89.2 kg
12.6% Fat
BMI 27.4

Withings:
Weight 88.8 kg
13.2% Fat (August reading, for some reason extended readings haven't worked since)
BMI 27

Tanita:
Weight 89 kg
15.6% Fat
BMI 27.5
Visceral Fat 7.5%
Body Water 63%
Muscle Mass 71.4 kg
Bone Mass 3.7 kg
BMR 2169
Body Type 6 (muscular)
Metabolic Age 34

I think the confusion is that I rounded my weight up 90 kg, body fat I took at the higher reading and BMI I rounded down. In addition the muscle figure is muscle mass.View attachment 24195
View attachment 24206

Withings Body Cardio:
View attachment 24197 Tanita Scales
View attachment 24207

Thanks for posting all that MBaker. I'll have a better look at it tomorrow. I do agree though it's probably a rounding, coupled with mixed metric data befuddling me.

How did you end up with such a wide stable of scales at home? Are they lined up in a row?

I'm a data monster, but I've managed to limit myself to one set of scales, albeit I have their twin at our home from home. When did I develop that sort of self-control?

((When I acquired the second set, I was delighted to find then exceptionally well aligned to the originals. Phew.)

 

[Mr_Pot]

Muscle mass is defined as body weight after subtracting fat so it includes water and bone.

 

[Guzzler]

Thanks for posting all that MBaker. I'll have a better look at it tomorrow. I do agree though it's probably a rounding, coupled with mixed metric data befuddling me.

How did you end up with such a wide stable of scales at home? Are they lined up in a row?

I'm a data monster, but I've managed to limit myself to one set of scales, albeit I have their twin at our home from home. When did I develop that sort of self-control?

((When I acquired the second set, I was delighted to find then exceptionally well aligned to the originals. Phew.)

I thought I'd gone overboard on a new tape measure for 89p after I bought my first ever set of box standard scales. I must be meaner than I thought!

 

[Mbaker]

Thanks for posting all that MBaker. I'll have a better look at it tomorrow. I do agree though it's probably a rounding, coupled with mixed metric data befuddling me.

How did you end up with such a wide stable of scales at home? Are they lined up in a row?

I'm a data monster, but I've managed to limit myself to one set of scales, albeit I have their twin at our home from home. When did I develop that sort of self-control?

((When I acquired the second set, I was delighted to find then exceptionally well aligned to the originals. Phew.)

I like Fitbit as I find this brand stands up to my heavy handed behaviour and I like the openness of the platform, so I got the Aria scales at first, as the Fitbit dashboards I found excellent. I then got the Withings as a control. During part of my diabetes education I was sold that my diabetes was due to visceral fat as my overall fat percentage was relatively low, so I wanted a way to measure this cheaply compared to going into a body composition pod, so it was a choice between Omron and Tanita for me.

The Fitbit and the Withings are in a row for easy use by the family.

 

[DCUKMod]

I like Fitbit as I find this brand stands up to my heavy handed behaviour and I like the openness of the platform, so I got the Aria scales at first, as the Fitbit dashboards I found excellent. I then got the Withings as a control. During part of my diabetes education I was sold that my diabetes was due to visceral fat as my overall fat percentage was relatively low, so I wanted a way to measure this cheaply compared to going into a body composition pod, so it was a choice between Omron and Tanita for me.

The Fitbit and the Withings are in a row for easy use by the family.

When I chose, I chose the Omrons, with the hand grasps. Like lots of things T2 related, for me, I'm as much concerned with trends than the absolute number.

I do believe you may be more of a data monster than me.

To keep to the thread, I'm not too wedded to BMI. I still look at BMI on my scales, but also refer to waist/height measurement (because it's easy). plus my VF reading.

Sorry for my derailing @Grateful .

 

[Mbaker]

I don't understand the math here - and I am interested so I can work my own stats out more accurately
As a massive generalisation, shouldn't you have about 51% water? So shouldn't at least 45kilos be water.
71kilos of muscle is pretty impressive as is your fat %. But I don't really understand how it all adds up.

Really interested to know.
Because my scales tell me I am about 52% water, and I weigh about 80kgs I think. Then the say I am 24% fat (still!) which equates to 76% of my body.

This is one of those areas that I try and understand as much as possible, but have been mainly interested just is body fat percentage and visceral fat. This is because I don't think that I can ever get my bodyweight down from close to 90 kg to 70 something I saw on my doctors notes, my bone density is too high as one metric. I have got into the 85's on 2 occasions with less muscle but have been experimenting with additional muscle, so know my weight will go up. I use https://tanita.eu/help-guides.