About this Research Topic

Background

Obesity is recognized globally as a risk factor for chronic diseases and a priority for public health. It is universally assessed using BMI with many countries collecting data on a national and/or local level to monitor trends. Waist to height ratio (WHtR) has been proposed as a simpler measure of central obesity, which is more important than general obesity in terms of health risk. The critical boundary value of 0.5 is also easy to communicate to all: e.g. "keep your waist under half your height".

In the UK, the National Institute for Health and Care Excellence (NICE) has been reviewing the accuracy and suitability of various anthropometric measures and thresholds for assessing health risk. Therefore this Research Topic is especially timely. In regard to WHtR, further research is required on the cross-classification of WHtR with BMI, associations of WHtR with current and future health risks, and appropriate boundary levels for intervention. WHtR has the potential to be used as a universal indicator of central obesity/adiposity in primary care, and as a public health education tool. Even so, the evidence base needs to be strengthened in the following areas:

1) Value in estimating current health risk (diagnostic/cross-sectional studies)
2) Value in predicting future health risk and mortality (prognostic/prospective studies)
3) Correlation with direct measures of total and visceral obesity
4) Variability in 1) to 3) according to age, sex, ethnic group, country
5) Cut-offs to indicate risk: can we use values of 0.4, 0.5 and 0.6 for all groups?
6) Cross-classification of WHtR categories (0.4<0.5/ 0.5<0.6/0.6+) with BMI categories (normal, overweight, obese) to estimate prevalence of normal weight central obesity
7) Practicality of using WHtR in clinical and community settings
8) Potential for Policies to adopt WHtR in national surveillance, clinical, community and educational settings.

Prospective (prognostic) studies and also diagnostic (cross-sectional/case control) studies are needed to evaluate the validity of WHtR as a risk indicator for use in primary care. We especially call for secondary analyses of datasets from large population studies that collected anthropometric information but have not to date reported on indices such as WHtR.

The choice of appropriate WHtR boundary values for assessing risk, including differences within and between populations, are of interest in establishing the generalisability of cut offs such as 0.4, 0.5, and 0.6. Studies that compare anthropometric measures with direct measures of visceral obesity such as MRI are also important to establish if WHtR can be used in screening (e.g. for NAFLD). This issue also welcomes reports on practical and policy issues involved in anthropometric assessment of obesity that would inform future practice concerning use of WHtR.

We welcome contributors to submit original research, review, and perspective articles that address the goals above.

Keywords: Waist-to-height ratio (WHtR), Obesity, Assessment, Risk, Metabolic, Cardiovascular, Public health, Guidelines

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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