BMI May Not Be King
What Waist-to-Hip Ratio Says About Mortality
Research shows that a smaller waist-to-hip ratio increases mortality rates.
Dr. Justin Hoffman, ND, NMD 
When it comes to health and mortality, Body Mass Index (BMI) is one of the most widely touted figures. The general theory is that higher BMIs correlate to more health complications and the likelihood of premature death. But, new research shows that BMI is an antiquated measurement. Rather, waist-to-hip ratio offers a better look at an individual’s overall health and mortality.
BMI is Antiquated and Improperly Used
In 1830, a Belgian mathematician named Lambert Adolphe Jacques Quetelet produced the formula that would become the Body-Mass-Index (BMI). It was designed to measure how obese a population is in general. Quetelet’s intent was to give governments data points to assist with allocating resources.
The formula was never intended to indicate the ‘fatness’ of an individual. Rather, Quetelet had sent out to measure ‘the average man,’ by looking at a large sample of individuals.
During Quetelet’s study, he looked at white European males. Subsequent studies that break down a healthy BMI have similarly skewed racial profiles. As BMI has been used more and more to dictate someone’s level of health, there has been pushback as to the accuracy of this equation.
Asia Grace’s New York Post article ‘BMI standards are ‘racist’: American Medical Association’ ran on June 20, 2023. It took a hard look at the unequal standards set by BMI, especially in light of an individual’s genetic background.
But the pushback against BMI began more than 10 years earlier. Keith Devlin’s NPR article ‘Top 10 Reasons Why The BMI Is Bogus,’ was published on July 4, 2009. Devlin outlines his reasoning with hard-hitting facts, including BMI’s inability to make allowances for muscle versus fat.
Waist-to-Hip Ratio Is a Better Indicator of Health
At the European Association for the Study of Diabetes (EASD) annual meeting in 2022, the findings from a new study were presented, revealing that waist-to-hip ratio presented a better indicator of an individual’s mortality than BMI.
The results were presented by Irfan Khan, a second-year medical student at University College Cork. Khan conducted the study with Dr. Guillaume Paré.
As Khan explained:
…depending on an individual's body composition, someone might actually benefit from a higher or lower BMI. With our study, that's not necessarily the case with waist-to-hip ratio. Our study demonstrates that a lower waist-to-hip ratio will always result in a lower mortality risk without any nuance.
While the study doesn’t confirm that waist-to-hip ratio could replace BMI, Khan does recommend that clinicians consider using waist and hip circumference to indicate health.
Losing Weight Can Help Increase Waist-to-Hip Ratio
Throughout history, different body types have been praised. But it was in the 1930s - 1950s, the Hollywood era, that the hourglass figure reached its peak with curvy bombshells like Marilyn Monroe. Most recently, the Kardashian family has breathed new like into this idealized shape.
While we don’t recommend turning to Hollywood for your health goals, the recent findings do indicate that working to have a bigger waist-to-hip ratio could benefit you beyond just looks.
According to the World Health Organization (WHO), the following are healthy waist-to-hip ratios:
- 0.85 or less for women
- 0.9 or less for men
As with BMI, these ratios can (and do) fluctuate depending on an individual's genetic background and life experience.
For those who want to improve their waist-to-hip ratio, the best way to do so is to lose weight.
4 Simple Lifestyle Modifications to Lose Weight
1. Water First
Begin each meal with at least 8 ounces of water. This can help curb your appetite and reduce the chance of overeating.
2. Find Calorie-Free Motivation
A 2021 megatstudy published in Nature showed that offering as little as a 9-cent financial reward for showing up to the gym could increase gym visits by 16%! Calorie-free incentives can, and do, work. But it doesn’t have to be money.
There’s a wide variety of weight loss incentives that aren’t food-based. By utilizing them, you can help keep yourself motivated to lose weight and keep it off.
3. Stay Hydrated
In addition to drinking 8 ounces of water before each meal, staying well hydrated will also support your metabolism, reduce food cravings, increase overall energy, and more.
4. Get More Steps
The old adage of ‘parking at the back of the parking lot’ is still a good one. Take advantage of this sage advance and amplify it where you can. Folding laundry? Consider doing a slow march as you fold. Watching TV? Take five minutes to stand up and shuffle your feet from side-to-side. In a recent study, researchers found that with an “increase by 500 steps/day is associated with a 7% reduction in dying from cardiovascular disease.”
5. Medically Supervised Weight Loss
No matter how you slice it, losing weight is hard. Conquering the task alone can feel like an uphill battle you never win. Medically supervised weight loss offers the support and professional guidance to help you lose weight and keep it off for good.
