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Keywords:

  • nutrition surveys;
  • sex;
  • trends

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

Objective: Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S.

Research Methods and Procedures: We used data from 15, 454 participants ≥20 years old in National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994) and 4024 participants ≥20 years old from National Health and Nutrition Examination Survey 1999 to 2000.

Results: The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and ≥70 years old, and women who were Mexican American or of “other” race or ethnicity.

Discussion: These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesity-associated morbidity and mortality in the U.S. can be expected to increase substantially in future years.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

The epidemic of obesity, defined using BMI, that has swept through the U.S. during the past 2 decades has been well documented (1, 2). BMI provides a measure of overall adiposity, but the distribution of adipose tissue in predicting health risks associated with obesity is also important. Abdominal fat deposition is generally considered to be a key component of obesity (3). Waist circumference is a convenient way of measuring abdominal fat deposition and may be an equally or more useful measure of obesity than BMI is for several reasons. First, waist circumference is associated as strongly or more strongly with risk factors for cardiovascular disease (4, 5, 6, 7) and is as good or better predictor of future risk of the metabolic syndrome, type 2 diabetes, cardiovascular disease, and all-cause mortality (8, 9, 10, 11). Second, waist circumference provides information about health risks—such as diabetes, hypertension, and dyslipidemias—in addition to BMI (12). Third, waist circumference may be a better predictor of medical care costs than BMI (13). Fourth, waist circumference is conceptually easy to measure, although it does require some training and standardization (14). Fifth, the public may understand waist circumference more easily than BMI. Finally, measurements of waist circumference are needed to diagnose the metabolic syndrome (15). Recognizing the importance of waist circumference, the NIH recommended in 1998 that waist circumference be measured, especially in people with a BMI of 25 to 34.9 kg/m2 (16).

Waist circumference data for National Health and Nutrition Examination Survey (NHANES)1 III have been described for participants ≥17 years old (17). In this analysis, we provide additional detail about the distribution of waist circumference in NHANES III and examine changes in waist circumference among U.S. adults from 1988 to 1994 through 1999 to 2000.

Research Methods and Procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

We used data from two cross-sectional surveys of the U.S. population in this analysis.

NHANES III (1988 to 1994)

NHANES III was conducted from 1988 through 1994 (18, 19). Participants were selected using a multistage, stratified sampling design and are considered representative of the civilian, noninstitutionalized U.S. population. Persons ≥60 years old, African Americans, and Mexican Americans were over-sampled. After an interview in the home, participants were invited to attend one of three examination sessions in the mobile examination center: morning, afternoon, or evening. Body measurements were performed using standardized methods and equipment. The waist circumference was measured with a steel measuring tape to the nearest 0.1 cm at the high point of the iliac crest at minimal respiration (19). BMI was calculated from measured weight and height. Weight was measured on a Toledo self-zeroing weight scale. Participants wore underwear, disposable paper gowns, paper pants, and foam rubber slippers. Height was measured with a stadiometer to the nearest millimeter.

NHANES (1999 to 2000)

In 1999, NHANES became a continuously operating survey (20). We used data obtained during 1999 to 2000. A representative sample of the civilian, noninstitutionalized U.S. population was selected using a stratified multistage sampling design. Persons with low income, persons ≥60 years old, African Americans, and Mexican Americans were over-sampled. Using a computer-assisted personal interview system, trained interviewers talked with participants at home. Participants were asked to attend the mobile examination center, where they completed additional questionnaires, underwent various examinations, and provided a blood sample. Using standardized methods and equipment, body measurements were performed similarly to those in NHANES III (21).

Covariates

Other variables included in the analyses were age, sex, and race or ethnicity (white, African American, Mexican American, and other).

Data Analysis

Analyses were limited to participants ≥20 years old. Pregnant women were excluded. “High-risk” waist circumference was defined as a waist circumference of >102 cm in men and >88 cm in women (16). Differences in estimates between the two surveys were tested by dividing the difference in the means or proportions by the pooled SE of the two estimates, which was calculated as the square root of the sum of the squares of the two SEs. Analyses were done by using Software for the Statistical Analysis of Correlated Data to obtain proper variance estimates for the complex sampling design (22). Sampling weights were used to correct for the over-sampling in the surveys. Pearson correlation coefficients between waist circumference and BMI were calculated by using SAS software (SAS Institute, Cary, NC) and the examination sampling weight.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

Among participants who attended the mobile examination center, 15, 454 of 16, 285 participants in NHANES III and 4024 of 4185 in NHANES 1999 to 2000 had a waist circumference measurement. The waist circumference percentiles for both surveys are shown in Tables 1 and 2. The median circumference increased from 94.4 to 97.1 cm among men and from 86.6 to 90.3 cm among women. The percentiles suggest that much of the waist circumference distribution has shifted.

Table 1.  Distribution of waist circumferences (in centimeters) among U.S. adults ≥20 years, by selected demographic variables, NHANES III (1988 to 1994)
 Percentile
 01510152025405060758085909599100
Men                 
 Total58.970.876.079.181.684.186.291.394.497.4102.9105.4108.0111.7118.6131.0174.1
 Age (years)                 
  20 to 2961.168.872.374.676.378.079.182.985.888.494.196.599.7103.4111.5127.5162.2
  30 to 3965.371.476.479.281.683.485.789.892.494.599.9101.2103.5108.0115.0134.5168.8
  40 to 4966.671.479.183.385.388.389.593.496.599.2104.2106.1109.5112.7121.0135.9174.1
  50 to 5967.276.383.285.888.690.792.396.599.5103.0107.2108.6111.9116.7121.6132.1151.2
  60 to 6958.974.583.387.290.492.294.498.4101.9104.2108.9110.9112.2116.2120.7129.8147.6
  70+68.275.080.685.288.690.792.196.699.5102.0106.2108.0110.1112.8119.0125.5150.5
 Race or ethnicity                 
  White66.372.377.480.383.385.687.592.595.498.6103.7106.0108.8112.3119.4131.0174.1
  African American58.968.372.074.677.279.180.586.790.694.4100.4102.7105.9110.5118.2135.4163.0
  Mexican American66.671.475.478.781.082.985.189.592.495.4101.0103.2105.7109.4114.6128.8154.5
  Other69.069.472.074.978.080.081.586.789.591.797.9102.5105.2108.6111.9121.2157.0
Women                 
 Total57.564.268.070.772.975.076.782.886.690.898.6101.7105.0109.3116.4130.2170.4
 Age (years)                 
  20 to 2958.662.365.667.268.970.070.974.576.680.087.189.893.999.4106.9119.8140.3
  30 to 3959.463.067.069.271.573.174.879.383.687.195.099.8103.9108.9116.3130.6154.8
  40 to 4961.965.469.572.775.077.078.383.586.691.198.8102.4105.6109.5116.7137.3160.0
  50 to 5957.567.572.676.779.181.483.788.492.597.4104.3107.0109.8113.6121.4135.5144.6
  60 to 6964.768.272.776.079.482.484.890.494.097.1102.8105.2109.3112.3119.1130.4150.8
  70+58.068.073.876.979.782.283.889.492.295.9101.6103.2105.4108.5113.5127.8170.4
 Race or ethnicity                 
  White57.564.668.070.472.474.576.182.186.090.198.0101.1104.7108.7115.3128.4170.4
  African American58.664.469.572.975.177.880.587.091.295.7103.2106.4110.4115.6122.6139.4160.0
  Mexican American60.265.069.873.275.578.280.586.690.494.3100.0102.9105.2110.0116.1128.8157.1
  Other61.862.767.171.373.475.176.782.285.389.095.799.9103.5105.4113.3124.8135.6
Table 2.  Distribution of waist circumferences (in centimeters) among U.S. adults ≥20 years, by selected demographic variables, NHANES 1999 to 2000
 Percentile
 01510152025405060758085909599100
Men                 
 Total62.470.776.280.383.486.188.393.897.1100.6107.3110.2113.7117.9125.8142.8173.4
 Age (years)                 
  20 to 2962.468.272.375.277.078.981.085.089.293.9100.1103.2105.4113.2119.0145.9145.9
  30 to 3964.469.275.678.780.883.786.291.594.097.2103.4106.6110.4114.2124.0141.9173.4
  40 to 4970.772.780.284.086.688.589.794.097.1100.5107.8110.5115.7119.0129.4147.7156.0
  50 to 5970.074.383.586.689.491.894.398.0101.6104.6111.4113.8117.1120.7128.2151.9157.0
  60 to 6969.779.885.490.091.494.596.1100.4104.5107.4113.7116.3120.1122.7130.6139.0140.0
  70+68.176.086.088.590.893.295.098.6101.5104.4108.8111.0114.0117.3123.4135.0144.8
 Race or ethnicity                 
  White66.471.878.281.685.488.089.795.098.2101.7108.3111.3114.4118.5127.4144.7173.4
  African American62.468.072.074.577.880.082.387.492.396.9104.2107.7111.5116.6123.5141.2156.0
  Mexican American65.171.576.580.183.486.588.093.096.298.9105.7107.7109.5114.0119.0136.5166.0
  Other70.370.370.772.374.276.681.389.793.896.0105.4113.2119.4124.0131.5139.4139.4
Women                 
 Total58.564.470.573.376.178.080.386.090.394.6102.4105.5108.8113.6120.8136.6155.9
 Age (years)                 
  20 to 2960.862.865.769.770.874.075.580.282.487.295.798.6102.0106.7115.5127.2137.1
  30 to 3961.265.969.972.174.276.477.783.687.090.499.7103.0108.0114.8121.4139.6146.2
  40 to 4965.766.471.172.475.776.979.985.190.994.0103.0105.7108.3113.0122.2138.0155.9
  50 to 5963.569.275.977.481.384.085.791.493.999.9107.0109.2113.1118.0121.2141.8146.1
  60 to 6959.465.276.780.081.384.486.093.197.2100.1106.3109.4113.6118.3123.3136.8140.3
  70+58.566.074.377.580.482.585.290.094.498.4103.3106.0108.7110.5115.3128.0142.7
 Race or ethnicity                 
  White59.463.469.972.375.377.079.585.289.793.9102.0105.4108.5112.8120.4134.6146.2
  African American62.067.072.977.480.984.086.291.996.7100.5109.5112.5117.5120.9128.6143.3155.9
  Mexican American58.567.072.476.678.280.081.686.790.794.8101.3103.7107.1110.8116.4132.6142.7
  Other67.467.467.470.670.876.576.982.986.387.0101.5107.1117.6127.2136.0138.0138.0

Between the two surveys, the age-adjusted mean waist circumference increased by 3.0 cm among men and 3.2 cm among women (Table 3). Among men, an increase occurred among all demographic subgroups but was of borderline significance among men 30 to 59 years old. The greatest increase occurred among men 20 to 29 years old. Among women, an increase occurred among all demographic groups but was not significant among women 40 to 59 or ≥70 years old, Mexican-American women, or women of other race or ethnicity. Women 20 to 29 years old showed the largest increase in waist circumference.

Table 3.  Trends in mean waist circumference (in centimeters) among U.S. adults ≥20 years, NHANES III (1988 to 1994) and NHANES 1999 to 2000
 NHANES IIINHANES 1999 to 2000  
 NMeanSENMeanSEIncreasep
  • *

    Age-adjusted results.

Men        
 Total        
 Unadjusted740395.30.3200898.60.63.3<0.001
 Age-adjusted740396.00.2200898.90.53.0<0.001
 Age (years)        
  20 to 29158987.80.432392.00.94.2<0.001
  30 to 39141793.60.633696.31.22.70.051
  40 to 49116897.70.533299.81.12.10.077
  50 to 59819100.50.5252103.01.32.50.070
  60 to 691106101.70.5369105.40.83.70.001
  70+130499.30.5396102.40.83.10.001
 Race or ethnicity        
  White*302396.60.293899.80.63.1<0.001
  African American*196893.00.336995.10.92.10.030
  Mexican American*213996.20.353198.60.72.40.003
  Other*27392.01.417096.61.84.50.056
Women        
 Total        
 Unadjusted805188.70.4201692.20.83.5<0.001
 Age-adjusted805188.90.4201692.10.83.2<0.001
 Age (years)        
  20 to 29162080.50.529286.11.15.6<0.001
  30 to 39170386.50.832790.51.34.00.012
  40 to 49128489.70.836092.01.42.30.141
  50 to 5996194.40.728396.81.92.40.235
  60 to 69107694.50.436797.41.02.80.011
  70+140793.10.538794.30.91.20.255
 Race or ethnicity        
  White*339387.90.486891.20.93.30.002
  African American*229394.00.440698.51.04.5<0.001
  Mexican American*201592.90.455893.21.20.40.778
  Other*35087.91.018490.92.13.00.200

The prevalence of a “high-risk” waist circumference (>102 cm in men and >88 cm in women) increased between the two surveys in all subgroups except Mexican-American women (Table 4). The increase was not significant among men 40 to 69 years old, men of other race or ethnicity, women ≥40 years old, and women of other race or ethnicity. Among both men and women, the greatest increases in waist circumference occurred among those 20 to 39 years old.

Table 4.  Trends in the prevalence of high-risk* waist circumference among U.S. adults ≥20 years, NHANES III (1988 to 1994) and NHANES 1999 to 2000
 NHANES IIINHANES 1999 to 2000  
 N%SEN%SEChangep
  • *

    High-risk waist circumference: >102 cm in men and >88 cm in women.

  • Age-adjusted results.

Men        
 Total        
 Unadjusted740327.70.8200836.02.18.3<0.001
 Age-adjusted740329.50.8200836.92.09.60.003
 Age (years)        
  20 to 29158912.11.132321.72.89.60.003
  30 to 39141717.31.633627.63.210.30.005
  40 to 49116830.42.333236.14.05.70.220
  50 to 5981945.12.625248.44.23.30.508
  60 to 69110649.62.536955.63.46.00.159
  70+130439.62.039648.33.58.70.037
 Race or ethnicity        
  White302330.40.993838.62.18.20.001
  African American196823.70.936931.42.57.60.006
  Mexican American213930.11.253135.72.05.60.022
  Other27324.05.717028.15.94.00.624
Women        
 Total        
 Unadjusted805146.31.1201655.42.19.1<0.001
 Age-adjusted805146.71.0201655.12.18.40.001
 Age (years)        
  20 to 29162022.81.629238.13.715.3<0.001
  30 to 39170337.32.732747.43.610.20.028
  40 to 49128447.02.236055.14.28.10.094
  50 to 5996161.22.428367.74.16.50.180
  60 to 69107667.31.536770.72.73.50.269
  70+140764.01.938766.23.32.10.578
 Race or ethnicity        
  White339343.61.386852.82.59.20.002
  African American229361.41.340669.92.58.50.004
  Mexican American201562.61.155859.93.3−2.60.455
  Other35044.53.418452.94.68.40.150

Among all participants, significant increases in mean waist circumference and percentage high-risk waist circumference occurred among all educational groups and smoking groups (Table 5). Among male participants who were current smokers, neither the increase in mean waist circumference nor the increase in the percentage with a high-risk waist circumference was statistically significant. The increase in mean waist circumference among women with <12 years of education and the increase in the percentage of women with 12 years of education who had a high-risk waist circumference were not significant.

Table 5.  Trends in the age-adjusted prevalence of mean waist circumference and high-risk* waist circumference among U.S. adults ≥20 years, by educational status and smoking status, NHANES III (1988 to 1994) and NHANES 1999 to 2000
 NHANES IIINHANES 1999 to 2000    
 NMean (cm)SEHigh-risk waist (%)SENMean (cm)SEHigh-risk waist (%)SEChange in means (cm)pChange in %p
  • *

    High-risk waist circumference: >102 cm in men and >88 cm in women.

Total              
 Education (years)              
  <12617493.80.443.21.2157696.50.850.61.92.70.0037.30.002
  12473293.00.342.70.991296.20.748.92.13.2<0.0016.20.010
  >12445390.80.332.31.1152594.40.642.02.43.6<0.0019.70.001
 Smoking status              
  Current405691.30.234.41.185393.80.640.82.22.40.0016.30.014
  Former384994.20.438.61.3108398.30.851.22.64.1<0.00112.6<0.001
  Never754891.40.340.11.2208095.00.847.62.43.6<0.0017.50.007
Men              
 Education (years)              
  <12313896.00.530.91.480499.20.938.72.63.20.0037.80.012
  12203696.80.432.91.8431100.30.742.12.23.5<0.0019.20.002
  >12217795.40.326.31.276698.10.733.32.72.80.0017.00.023
 Smoking status              
  Current229894.00.425.41.449895.60.930.03.11.70.0834.70.178
  Former245697.50.533.11.6684101.20.943.92.93.8<0.00110.80.002
  Never264896.00.327.71.382199.80.837.22.93.8<0.0019.40.004
Women              
 Education (years)              
  <12303691.50.656.11.977293.41.063.12.91.90.1007.00.049
  12269690.20.550.11.548192.91.155.33.32.70.0335.30.150
  >12227686.10.438.41.475990.70.950.83.04.6<0.00112.4<0.001
 Smoking status              
  Current175888.20.544.91.735591.41.253.73.53.10.0168.70.028
  Former139389.60.746.71.839994.31.660.64.84.70.00813.90.009
  Never490088.60.546.71.5125991.80.954.22.63.20.0037.50.016

Pearson correlation coefficients between waist circumference and BMI were high in both surveys, and the magnitude of the correlation coefficients increased slightly between the two surveys (Table 6). In NHANES III, the correlation coefficients ranged from 0.88 to 0.93 among men and from 0.86 to 0.92 among women. In NHANES 1999 to 2000, the correlation coefficients ranged from 0.91 to 0.94 among men and from 0.88 to 0.94 among women.

Table 6.  Unadjusted Pearson correlation coefficients between waist circumference and BMI among U.S. adults ≥20 years, NHANES III (1988 to 1994) and NHANES 1999 to 2000
 NHANES IIINHANES 1999 to 2000
 NrNr
Men    
 Total74020.9020050.92
 Age (years)    
  20 to 2915880.923230.94
  30 to 3914170.923360.94
  40 to 4911680.933310.94
  50 to 598190.912520.91
  60 to 6911060.913690.93
  70+13040.883940.92
 Race or ethnicity    
  White30230.919370.92
  African American19680.923680.93
  Mexican American21380.925300.93
  Other2730.901700.92
Women    
 Total80420.8920130.91
 Age (years)    
  20 to 2916180.912920.93
  30 to 3917010.923270.94
  40 to 4912840.913590.92
  50 to 599600.902820.91
  60 to 6910740.893660.91
  70+14050.863870.88
 Race or ethnicity    
  White33930.898670.91
  African American22930.914050.91
  Mexican American20060.905570.90
  Other3500.881840.91

To examine whether the increase in waist circumference reflected a general increase in body weight rather than a specific increase in abdominal adiposity, we examined the change in mean waist circumference and prevalence of high-risk waist circumference by three categories of BMI (Table 7). Only among obese participants was the increase in the prevalence of high-risk waist circumference significant. However, the median BMI for the three categories of BMI increased over time, complicating the interpretation of the data.

Table 7.  Age-adjusted percentage of participants ≥20 years with a high-risk* waist circumference, by BMI category, NHANES III (1988 to 1994) and NHANES 1999 to 2000
 Median BMI (kg/m2)Percentage of participants with a high-risk waist circumferenceMean waist circumference (cm)
 NHANES IIINHANES 1999 to 2000NHANES IIINHANES 1999 to 2000pNHANES IIINHANES 1999 to 2000p
  • *

    High-risk waist circumference: >102 cm in men and >88 cm in women.

BMI (kg/m2)        
 18.5 to <2522.422.77.4 (0.5)7.9 (1.0)0.05482.1 (0.2)82.7 (0.3)0.680
 25 to <3027.027.441.0 (0.9)43.0 (1.6)0.45894.9 (0.1)95.2 (0.3)0.296
 ≥3033.234.293.1 (0.9)96.4 (0.7)<0.001109.7 (0.3)112.3 (0.6)0.005

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

We have described the distribution of waist circumference among U.S. adults in two national surveys and the changes that occurred between 1988 to 1994 and 1999 to 2000. As the epidemic of obesity increases unabatedly, not surprisingly, a corresponding increase in the nation's waistline is occurring. For men, the largest mean waist circumference was among whites; for women, it was among African Americans in both surveys. The unadjusted mean waist circumference increased by 3.3 cm in men and 3.5 cm in women. Among the three major racial or ethnic groups, the largest increase occurred among white men and African-American women. In addition, the percentiles from both surveys suggest that much of the waist circumference distribution shifted, especially among women. Using age-specific rates of high-risk waist circumference and the year 2000 U.S. population, we estimate that ∼35 million men and 58 million women had a large waist.

The largest increases in the prevalence of high risk waist circumference occurred among men and women 20 to 39 years old. This finding is consistent with data from the Behavioral Risk Factor Surveillance System, which showed that between 1991 and 1998 the greatest increase in the prevalence of obesity was among people 18 to 29 years old (23). These trends are worrisome because they bode ill for the future health of young adults. For example, because of the epidemic of obesity among youth, the prevalence of type 2 diabetes has reached historic dimensions (24). Data from the Behavioral Risk Factor Surveillance System showed that people 30 to 39 years old experienced the largest increase in the prevalence of diabetes (25). The large increases in obesity among young adults suggest that they should receive high priority for intervention efforts to reduce obesity.

On the basis of a study of Dutch participants, Han et al. and Lean et al. suggested that waist measurements of 94 cm in men and 80 cm in women corresponded to a BMI of 25 kg/m2 (26, 27). The authors termed these cut-points “action level 1.” By examining the relation between waist circumference and risk factors for cardiovascular disease, these authors also established an “action level 2” (waist circumference >102 cm in men and >88 cm in women) and recommended that people in this category seek medical attention and attempt weight loss. This action level 2 later was adopted by the NIH as their high-risk waist circumference (16).

The prevalence of obesity, as measured by a BMI ≥ 30 kg/m2, increased between NHANES III and NHANES 1999 to 2000 from 20.2% to 27.5% among men and from 25.4% to 33.4% among women (1). The corresponding percentages of the age-adjusted prevalence of high risk waist circumference were 29.5% and 36.9% among men and 46.7% and 55.1% among women. Thus, the percentage of the U.S. adults who have a high-risk waist circumference is considerably larger than the percentage of participants with a BMI ≥ 30 kg/m2.

Although increases in BMI have been described in many populations, relatively few studies have described temporal changes in waist circumference. Increases in waist circumference were noted among Mauritian men and women 25 to 74 years old between 1987 and 1992 (29), Finish men and women 25 to 64 years old between 1987 and 1997 (30), German men and women 25 to 74 years old between 1989 to 1990 and 1994 to 1995 (31), and Indian women but not men ≥20 years old between 1989 and 2000 (32).

The results from our analyses provide another look at the obesity epidemic from the viewpoint of waist circumference. The rapid increase in the prevalence of obesity among U.S. adults portends ominously for the future health of the nation. To slow the rate of increase in obesity, let alone reverse it, will require the concerted efforts of many health care professionals and public health professionals. How commonly waist circumference is measured by clinicians is unclear. Anecdotal evidence suggests that it is not practiced routinely. However, more studies are demonstrating the value of measuring waist circumference. Although measuring waist circumference correctly requires some practice, we urge health care professionals to incorporate waist circumference along with measuring weight and height in their routine practice.

Footnotes
  • 1

    Nonstandard abbreviations: NHANES, National Health and Nutrition Examination Survey.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References
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