Tape measure helps gauge heart risk

Atape measure around the waist helps show who is at risk for heart disease beyond standard body-mass-index measurements, but not all family doctors are routinely using it.

Scientists are learning more about how the deep abdominal fat that surrounds vital organs is worse than fat just beneath the skin in terms ofrisk of developingheart disease, Type 2 diabetes and other obesity-related illnesses. That'swhy waist circumference is important to watch for the 65 per cent of Canadians adults who are overweight or obese.

"When your waist circumference is bigger, all that fat is around all your organs," said Grant Barber, who is participating in a study on weight loss through exercise at Queen's University in Kingston, Ont."For some reason, I never thought of it that way before, and it kind of gave me a visual as to 'That can't be good.'"

Using waist circumference alongside BMI helps doctors, nurses, dietitians, kinesiologists and psychologiststo tease out who is in greater need ofweight-loss counselling, said Prof. Robert Ross, an exercise physiologist at Queen's.

A healthy waistline is:

• 94 centimetres (37 inches) for most men.
• 80 centimetres (31.5 inches) for women.

Research suggests that if the waist circumference climbs to more than 102 centimetres(40 inches) for most men or more than 88 centimetres(35 inches) for women then the risk ofType 2 diabetes, coronary heart disease, and other obesity-related illness also rises.

Watchful on waist

Those risks explain why Canadian family doctors are encouraged to watch their patients' waistlines.

"It would put people potentially in a different risk category if their waist circumference was above the cutoff," said Dr. Karl Iglar, an associate professor of family medicine at the University of Toronto. "It might lead to lifestyle interventions at an earlier stage than with BMI alone."

In 2007, waist circumference became part of a preventive care list for family doctors in Canada a checklist for physicians to use during checkups for adults that also includes measures like colonoscopy and hepatitis B screening.

While it's simple for doctors to wielda tape measure alongside their prescription pads, there is room to improveon their use of the tool, said Iglar, who developed the checklist. Impediments to greater use mayincludethe time required, uncertainty about who should take the measurements, and a lack of familiarity with methods, Iglar suggested.

Since a healthy diet and exercise can shrink the waist while weight stays the same, a smaller waist circumference may reflect health improvements from lifestyle changes that might otherwise be abandoned by those discouraged bynumbers on the scale that barely budge, Ross said.