Is a large waist circumference a problem no matter what your BMI?

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Body mass index (BMI) has been used for some time to characterize adiposity in children and adolescents. It has several limitations, but a major one is that it does not provide a characterization of the distribution of body fat. This has led some to recommend the waist circumference as a way of estimating visceral fat. In this issue of The Journal, Sellers et al evaluated a number of approaches to evaluating adiposity including BMI, waist circumference, skin fold thickness, and body fat percentage in children age 9-14 years in the Darwin Health Region, Northern Territory, Australia.

The authors found that cardiometabolic risk factors are frequent in this cohort of Australian Aboriginal children even though there was a low prevalence of obesity. The waist circumference was significantly associated with insulin resistance. This suggests that these children may be developing central adiposity despite normal weight. Measuring the waist circumference may be helpful in detecting children at cardiometabolic risk.

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