Belly Weight Predicts Heart Health Better Than BMI, Study Indicates
Key Takeaways:
- Fat stored around the waist is a stronger predictor of heart disease than body mass index alone.
- People with preclinical obesity face a raised cardiovascular risk despite appearing healthy.
- Researchers estimate early intervention could prevent 45% of new cardiovascular disease cases.
Why waist size matters more than the scales
People living with overweight or obesity can carry a higher risk of heart disease even when they appear to be perfectly healthy, according to new research presented at the International Congress on Obesity in Mexico City (15–17 July). Combining waist-based measurements with body mass index (BMI) to detect this hidden risk and act early could, over the years ahead, prevent hundreds of thousands of people from dying from heart attacks, strokes and other cardiac problems, researchers from the University of Glasgow, Glasgow, UK, said.
“We know that excess weight, particularly around the waist, increases the risk of heart disease,” said lead researcher Estefania Fuentes Avalos. “In 2021, an estimated 1.9 million cardiovascular disease deaths – almost one in 10 heart-related deaths worldwide – were attributed to high body mass index.
“The link between central, or abdominal, obesity and heart disease is especially strong because fat stored around the waist, known as visceral fat, is metabolically active and releases inflammatory substances into the bloodstream. Over time, this chronic inflammatory state can damage blood vessels and accelerate the buildup of arterial plaque, significantly increasing the risk of heart attacks.”
The limits of BMI
BMI, a measure of weight compared with height, is routinely used to assess a person’s weight status, defining whether they have a normal weight, overweight or obesity. However, it does not take into account where fat is stored in the body.
To address this and other shortcomings of BMI, The Lancet Diabetes & Endocrinology Commission recently proposed a different way of assessing obesity status. The Lancet Commission framework uses BMI together with central adiposity markers – waist measurements – to determine whether a person has excess body fat. People with excess body fat are then categorised as having either preclinical obesity or clinical obesity, depending on whether they also have long-term obesity-related conditions such as high blood pressure, joint pain and sleep apnoea.
The new study set out to establish whether this method is better at identifying people at high risk of cardiovascular disease than BMI alone.
“Detecting cardiovascular risk at an early stage is essential, particularly at the preclinical stage of obesity, as it provides a window of opportunity to implement timely, targeted interventions before obesity-related complications such as high blood pressure arise,” Fuentes Avalos said.
“This underpins our focus on risk stratification in this group, with the aim of detecting high-risk individuals who may otherwise be overlooked.”
What the study looked at
Fuentes Avalos examined data on 382,769 adults of white ethnicity in the UK Biobank study (age range 40–69 years, average age 56 years, 53% women).
Under The Lancet Commission framework, 285,190 (74%) of the participants had excess body fat, based on BMI and central adiposity markers. Within this group, 102,237 (26.7%) were classified as having preclinical obesity – excess body fat without long-term obesity-related conditions – and 182,953 (47.8%) as having clinical obesity, meaning excess body fat alongside long-term obesity-related conditions. The remainder had neither excess body fat nor long-term obesity-related conditions; they were classified as not having obesity and served as the reference group.
None of the participants had cardiovascular disease at the start of the study. Hospital and death records provided information about diagnoses of, and deaths from, heart attacks, strokes and other forms of cardiovascular disease over the following 12 years. During this time, there were 41,742 new cases of, and 8,832 deaths from, cardiovascular disease. Studies of this scale underline how much practical assessment skill clinicians need when supporting patients with excess weight – a competency CCH’s Obesity Essentials short course is designed to build.
Clinical obesity carried the sharpest risk
Analysis of the data showed that people with clinical obesity were far more likely to develop, or die from, cardiovascular disease than those without obesity.
Women with clinical obesity developed cardiovascular disease at a rate 2.5-fold higher than women without obesity, and died from it at an almost threefold (2.8-fold) higher rate. Men with clinical obesity developed cardiovascular disease at an almost twofold higher rate (1.9-fold) and had a 2.6-fold higher rate of cardiovascular death than men without obesity.
The hidden risk in preclinical obesity
People with preclinical obesity were also at greater risk, despite having no obesity-related conditions and appearing to be in good health.
Women with preclinical obesity developed cardiovascular disease at a 38% higher rate and died from it at a 46% higher rate than women without obesity. For men, preclinical obesity was associated with an 18% higher rate of developing cardiovascular disease and a 52% higher rate of cardiovascular death.
All of the results were adjusted for socioeconomic status and lifestyle factors, including smoking and alcohol consumption.
More waist markers, more risk
Further analysis showed that the more high-risk central adiposity markers a person had, the more likely they were to develop heart disease. For example, a woman with one high-risk marker – waist circumference, waist-to-hip ratio or waist-to-height ratio – was 17% more likely to develop cardiovascular disease than a woman with no high-risk waist measurements. Having all three high-risk measurements increased the risk by 64%. The study also found that waist measurements were more accurate at predicting cardiovascular disease than BMI.
A window of opportunity
The researchers concluded that people with preclinical obesity are at higher risk of developing, and dying from, cardiovascular disease despite appearing to be healthy.
“Preclinical obesity is a critical window of opportunity to improve heart health. Routinely measuring waist circumference, waist-to-hip ratio and waist-to-height ratio along with BMI would identify high-risk individuals who might be overlooked by assessing BMI alone,” Fuentes Avalos said.
“They could then be offered intensive diet and exercise programs to improve their cardiac and overall health.
“We have calculated that early intervention could prevent 45% of new cases of cardiovascular disease and 41% of cardiovascular disease deaths in similar populations.
“Given that cardiovascular disease remains a leading cause of ill health and death globally, routinely taking waist measurements along with BMI could prevent hundreds of thousands of deaths over a decade alone.”
CCH insight
This is very important work on two levels. Firstly, it not only re-enforces the importance of waist circumference measures as superior indicators of disease risk compared to the traditional BMI measure, but also suggests that calculating three waist circumference markers gives a more accurate indication of CV risk than just one. And secondly, it feeds into the current debate around the terms ‘clinical’ and ‘pre-clinical’ obesity coined by The Lancet Diabetes & Endocrinology Commission. The results indicate that, while people with clinical obesity have a far higher risk of cardiovascular disease or death, those with pre-clinical obesity are still at risk and still therefore warrant intervention. Depending on your perspective, you could argue this supports the Commission’s findings or contradicts them!
Findings like these are only useful in practice if clinicians feel confident assessing excess weight and having sensitive, evidence-based conversations with patients about it. CCH’s Obesity Essentials – an online CPD short course offering 10 CPD hours – equips healthcare professionals with the practical skills to assess and manage patients living with overweight and obesity, from measurement through to compassionate communication.
Explore Obesity Essentials and strengthen your day-to-day weight-management practice.
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Year-Long Trial Finds Rapid Weight Loss Outperforms a Gradual Approach, Overturning a Long-Held Assumption
Key Takeaways:
- In a 52-week randomised trial, adults living with obesity who followed a rapid weight loss programme lost significantly more weight at one year than those on a gradual programme (14.4% versus 10.5% of total body weight), and the gap held throughout the study.
- Rapid weight loss was not associated with greater weight regain, directly contradicting the widespread belief that losing weight slowly is necessary to keep it off.
- A larger share of people in the rapid weight loss group reached clinically meaningful BMI and waist-to-height targets linked to a lower 10-year risk of obesity-related conditions.
A long-held belief comes under scrutiny
New research presented at the European Congress on Obesity (ECO 2026) in Istanbul, Turkey, indicates that rapid weight loss (RWL) is considerably more effective than gradual weight loss (GWL), both in the amount of weight people lose and in how well that loss is sustained at one year.
For years, conventional thinking has held that rapid weight loss is unhealthy and that shedding weight very quickly raises the chance of regaining it. Yet these concerns rest largely on observational data, historical assumptions, or small studies with methodological limitations. The scientific evidence directly supporting them is limited and inconsistent, and high-quality randomised controlled trial evidence remains relatively sparse.
The study was led by Dr Line Kristin Johnson of the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust in Tønsberg, Norway, together with colleagues. The centre is a collaborating centre with the European Association for the Study of Obesity (EASO-COM-Centre); EASO leads obesity advocacy and education across Europe and organises ECO.
Setting the treatment targets
A recent large, population-based cohort study concluded that, after weight loss, a body-mass index (BMI) of 27 kg/m² or below and a waist-to-height ratio (WHtR) of 0.53 or below may represent clinically meaningful treatment targets for lowering the 10-year risk of obesity-related complications, namely type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, and hip and knee osteoarthritis.
In this new study, the researchers set out to compare how effectively a rapid weight loss programme and a gradual weight loss programme helped people reach those targets.
How the trial was designed
The 52-week, investigator-initiated, randomised clinical trial was run as a collaboration between the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust and Roede AS, one of Norway’s leading and most established providers of commercial weight loss programmes.
In total, 284 adults living with obesity (BMI of 30 or above), of whom 257 (90%) were women, were randomised on a one-to-one basis to one of two 16-week, food-based programmes. The rapid weight loss programme reduced energy intake in stages: under 1,000 kcal per day in weeks 1 to 8, under 1,300 kcal per day in weeks 9 to 12, and under 1,500 kcal per day in weeks 13 to 16. The gradual weight loss programme set intake at 800 to 1,000 kcal per day below each participant’s estimated total energy expenditure, with a mean self-reported intake in this group of roughly 1,400 kcal per day.
Estimated energy expenditure was calculated from each participant’s estimated resting energy expenditure and then adjusted according to whether they had low, medium, or high physical activity.
The food composition in both programmes followed current Norwegian dietary recommendations from the Norwegian Directorate of Health. Core advice included eating healthy foods such as vegetables, fruits, whole grains, low-fat dairy products, fish, eggs, lean meat, and other protein-rich foods, while limiting saturated fats and added sugars.
Maintaining the results
After the initial weight loss phase, participants in both groups moved into an identical 36-week weight-regain prevention programme.
Throughout the study, the interventions included weekly in-person group sessions from week 1 to week 16. After that, in-person group meetings took place every 14 days for the first three months, followed by monthly meetings or individual contact via webinars, video, or telephone for the remaining five months.
In these sessions, participants were advised to raise their daily energy intake by 100 to 300 kcal during the first month, until their weight stabilised. From then on, daily intake was adjusted as needed in response to any weight changes across the eight-month maintenance phase. Participants could decide for themselves whether to maintain their weight or aim for further loss, and the majority chose to keep losing weight after the initial 16-week period.
What the trial found
Of the 284 participants, 142 were randomised to the rapid weight loss programme and 142 to the gradual weight loss programme. At baseline, the rapid weight loss group had a mean age of 48.5 years, body weight of 102.4 kg, height of 169 cm, BMI of 35.8 kg/m², waist circumference of 112.5 cm, and WHtR of 0.67. The corresponding figures in the gradual weight loss group were 47.7 years, 103.0 kg, 168 cm, 36.5 kg/m², 112.8 cm, and 0.67.
The primary outcome was one-year percentage total body weight loss (%TBWL). The proportion of participants reaching a BMI of 27 kg/m² or below, or a WHtR of 0.53 or below, after one year were exploratory outcomes.
During the first 16 weeks, the rapid weight loss group lost significantly more weight than the gradual weight loss group, with a mean %TBWL of -12.9% compared with -8.1%, a between-group difference of -4.8%.
At one year, that significant difference was maintained: the mean %TBWL was -14.4% in the rapid weight loss group and -10.5% in the gradual weight loss group, a between-group difference of -3.9 percentage points.
The share of participants achieving a BMI of 27 kg/m² or below was significantly higher in the rapid weight loss group than in the gradual weight loss group at both 16 weeks (13.8% versus 0.8%) and one year (28.3% versus 9.7%). A higher proportion also reached a WHtR of 0.53 or below in the rapid weight loss group, both at 16 weeks (24.2% versus 8.9%) and at one year (33.0% versus 18.4%).
What the researchers say
The authors conclude, “Among adults with obesity, participation in a structured rapid weight loss program resulted in significantly greater weight loss at one year, and higher rates of achieving clinically meaningful BMI and WHtR targets compared with a gradual weight loss approach.
“These findings indicate that, when provided within a controlled and professionally supervised setting, rapid weight loss may represent a more effective method than gradual weight loss for reaching key body weight targets associated with reduced obesity-related health risks.”
Dr Johnson adds, “Our results clearly challenge the prevailing belief that slow and steady gradual weight loss is necessary to prevent weight regain and reduce obesity-related complications.
“By contrast, we show that rapid weight loss is not associated with weight regain, and, more importantly, that a larger proportion of participants undergoing rapid weight loss – compared with gradual weight loss – achieved clinically meaningful treatment targets for reducing the 10-year risk of type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, and hip/knee osteoarthritis.
“These findings are particularly relevant given the urgent need for effective weight-loss and weight-maintenance strategies. As many individuals with obesity cannot access or afford medical or surgical treatments, our results support the potential of effective, commercially available weight-reduction programs to help reduce the growing burden on public health care systems.”
Why it matters
With obesity placing a rising strain on health systems, and with medical and surgical treatments out of reach for many, the trial points to professionally supervised commercial programmes as a potential route to meaningful, lasting results. Its central message reframes a long-standing assumption: under proper supervision, losing weight quickly did not undermine maintenance, and it helped more people reach the targets tied to lower long-term health risks.
CCH insights:
These are impressive results for a diet and lifestyle intervention, with both groups achieving greater than 10% total body weight loss over a period of a year. However, participants received fairly intensive support throughout the entire year of the trial. The important thing is what happens in the next 12 months, after the intervention has stopped – are they able to sustain behavioural changes and weight loss without the support from the programme?
Source: Medical Xpress
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