This Simple Waist-To-Hip Ratio Test Could Predict Heart Disease Risk Better Than BMI

You’ve likely heard about the importance of keeping your weight in a healthy range to protect your heart. But the number on the scale may not be telling the full story. Your waist-to-hip ratio (WHR) could be an even more revealing measure when it comes to cardiovascular risk, especially for women over 50. But what exactly is WHR, how do you calculate it and what numbers should you be aiming for? We spoke with healthcare experts to break it all down, including what your WHR says about your heart health and what to do if your number is high.

The link between waist-to-hip ratio and heart health

Waist-to-hip ratio is a measurement comparing the circumference of your waist to that of your hips. “It’s a simple way of looking at how fat is distributed on your body,” explains Hussain Ahmad, MUDr/MD, consultant practitioner for Click2Pharmacy. More specifically, it determines whether a person carries more fat around the abdomen or the lower body. While body mass index (BMI) estimates overall body fat, WHR provides insight into where that fat is stored. 

So, how does this relate to your heart? “People with more fat around the waist tend to be at higher risk of cardiovascular disease compared to those who carry more weight around their hips and thighs,” says Dr. Ahmad. “That’s because belly fat, especially the kind that builds up around internal organs (visceral fat) is more strongly linked to heart issues.” 

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Increased visceral fat surrounds vital organs, producing inflammatory compounds that negatively impact heart function. This, Dr. Ahmad continues, can lead to an increased risk of developing high blood pressure, high cholesterol and insulin resistance. 

According to the American Heart Association, carrying more abdominal fat, even with a healthy BMI, can increase your risk of cardiovascular issues. Moreover, a 2023 study in JAMA Network Open found that WHR may be a better predictor of future health issues, including cardiovascular health, than BMI. This is especially important for postmenopausal women, who tend to shift fat storage to the abdomen due to hormonal changes. WHR offers a more targeted look at your metabolic health risk. 

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How to measure your waist-to-hip ratio

The good news is you don’t need any fancy tools to calculate your WHR. “You can take a measuring tape horizontally around the abdomen,” says Richard Frank, MD, MHSA, chief medical officer at Vida Health. “The tape must be snug, but not so tight that it compresses the skin, and parallel to the floor.” Here’s how to do it:

1. Measure your waist at its narrowest point, usually just above your belly button.
2. Measure your hips at their widest point, typically around the fullest part of your buttocks. 
3. Divide your waist measurement by your hip measurement. For example: 32” waist ÷ 40” hips = 0.80 WHR.

“A WHR greater than 0.85 for women and 0.90 for men increases metabolic risk,” says Dr. Frank. “Women naturally have higher fat storage around the hips, so the threshold for a high WHR is lower for women.”

WHR should be used in conjunction with other screening tools 

While WHR is helpful, it’s not the only number that matters. “It does provide a better insight into fat distribution than using BMI alone, however, it should not be used in isolation,” says Pamela Walters, MD, medical director at Eulas Clinics. “Other critical risk factors include blood pressure, blood sugar levels, whether you smoke, how active you are, cholesterol levels and so on.” 

Dr. Walters also notes that stress and mental health conditions, such as depression, are also associated with heart disease. “Addressing both physical and mental health together leads to better outcomes across the board,” she says. (You can see more risk factors for heart disease in women here.)

Additionally, WHR has its limitations. First, it doesn’t account for overall body composition or muscle mass. This means two people with the same ratio and similar body shapes could have very different health profiles. It also can’t distinguish between visceral fat and subcutaneous fat (the kind just under the skin). “WHR is a useful tool, but like BMI, it’s just one part of the picture,” says Dr. Ahmad. 

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How to improve your waist-to-hip ratio

If your WHR is higher than ideal, don’t panic. There are small, sustainable lifestyle changes that can help reduce abdominal fat and improve your heart health overall. 

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What you eat and when can play a big role. “Increasing fiber intake and balanced macronutrients, staying hydrated and decreasing late-night eating can improve WHR and help decrease visceral fat,” advises Dr. Frank. Other tips he shares include adding strength training to your workout routine, managing stress and getting proper sleep.

“Overall, consistency with dietary and lifestyle changes is crucial,” says Dr. Frank. He cites several medical conditions that can affect your WHR, including thyroid conditions, PCOS, menopause and Cushing’s disease. “However, management is the same with or without these conditions as well as treating underlying conditions,” he adds.

While WHR may not be a perfect predictor, it does offer important insight into how your body stores fat and how that might impact your cardiovascular system.