Waist-to-height ratio
a numerical index for body fat distribution and related risks
The waist-to-height ratio (WHtR, or WSR: waist-to-stature ratio) is the waist circumference divided by body height, both measured in the same units.
WHtR is a measure of the distribution of body fat. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases, which are correlated with both total fat mass (adiposity) and abdominal obesity.
History
In 1996, WHtR was first suggested by Ashwell and Cole as a simple health risk assessment tool because "it was identified as a proxy for harmful central adiposity since WHtR was correlated with abdominal CT scan". A boundary value of 0.5 was proposed to indicate increased risk. A WHtR of over 0.5 signifies an increased risk; a 2010 systematic review of published studies concluded that "WHtR may be advantageous because it avoids the need for age-, sex- and ethnic-specific boundary values".
According to World Health Organization guidance, the waist circumference is usually measured midway between the lower rib and the iliac crest.
Guidelines
United Kingdom
The UK's National Institute for Health and Care Excellence (NICE):
All adults should "ensure their waist size is less than half their height in order to help stave off serious health problems".
Consensus statement on redefining obesity
As of 2024, the Lancet Commission on obesity and the European Association for the Study of Obesity recommended that obesity should no longer be diagnosed with BMI alone due to its several limitations, but confirmed by other surrogate measures such as WHtR of greater than 0.5. A strategic paradigm shift in obesity diagnosis, NICE provided this guideline in a 2025 advisory (graphs).
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