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Body Composition Highlights Original Article

Is waist circumference per body mass index rising differentially across the United States, England, China and Mexico?



Little is known about whether waist circumference (WC) has increased disproportionately relative to body mass index (BMI) around the world.


Data came from the US National Health and Nutrition Examination Survey (1988–1994 and 2007–2010), Health Survey for England (1992–1993 and 2008–2009); the Mexican Nutrition Survey (1999) and the Mexican National Health and Nutrition Survey (NHNS 2012); and the China Health and Nutrition Survey (1993 and 2011). Country- and sex-stratified (for the United States, also race-/ethnicity-stratified) multivariable linear regressions were used to estimate mean difference in WC over time relative to BMI at specified overweight and obesity cutoff points, adjusting for age and survey year.


Although mean WC and BMI shifted upward over time in all age–sex subpopulations in all four countries, trends in overweight prevalence were less consistent. However, WC relative to BMI increased at varying magnitudes across all countries and subpopulations, except US Black men. The magnitude of increase was largest for women in the youngest age group (20–29 years), particularly for women in Mexico (+6.6 cm, P<0.0001) and China (+4.6 cm, P<0.0001) (holding BMI constant at 25 kg/m2). For men, the increase was primarily evident among Chinese men (+4.8 cm, P<0.0001).


WC has increased disproportionately over time relative to overall body mass across the United States, England, Mexico and China, particularly among young women, with the largest increases occurring in the middle-income countries of Mexico and China. These patterns are potentially a cause for concern especially for countries undergoing rapid economic and nutritional transitions.

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  1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 2011; 377: 557–567.

    Article  Google Scholar 

  2. Razak F, Corsi DJ, Subramanian SV . Change in the body mass index distribution for women: analysis of surveys from 37 low- and middle-income countries. PLoS Med 2013; 10: e1001367.

    Article  Google Scholar 

  3. Olds TS . One million skinfolds: secular trends in the fatness of young people 1951–2004. Eur J Clin Nutr 2009; 63: 934–946.

    CAS  Article  Google Scholar 

  4. Popkin BM, Slining MM . New dynamics in global obesity facing low- and middle-income countries. Obes Rev 2013; 14: 11–20.

    Article  Google Scholar 

  5. Stern D, Smith LP, Zhang B, Gordon-Larsen P, Popkin BM . Changes in waist circumference relative to body mass index in Chinese adults, 1993-2009. Int J Obes (Lond) 2014; 38: 1503–1510.

    CAS  Article  Google Scholar 

  6. Albrecht SS, Barquera S, Popkin BM . Exploring secular changes in the association between BMI and waist circumference in Mexican-origin and white women: a comparison of Mexico and the United States. Am J Hum Biol 2014; 26: 627–634.

    Article  Google Scholar 

  7. Despres JP . Abdominal obesity and cardiovascular disease: is inflammation the missing link? Can J Cardiol 2012; 28: 642–652.

    Article  Google Scholar 

  8. Despres JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 2008; 28: 1039–1049.

    CAS  Article  Google Scholar 

  9. World Cancer Research Fund/American Institute for Cancer Research Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. AICR: Washington, DC, USA, 2007.

  10. Deurenberg P, Deurenberg-Yap M, Guricci S . Asian are different from Caucasians and from each other in their body mass index/body fat percent relationship. Obes Rev 2002; 3: 141–146.

    CAS  Article  Google Scholar 

  11. World Health Organisation, International Association for the Study of Obesity, International Obesity TaskForce The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Health Communications: Sydney, NSW, Australia, 2000.

  12. Fernandez JR, Heo M, Heymsfield SB, Pierson RN Jr., Pi-Sunyer FX, Wang ZM et al. Is percentage body fat differentially related to body mass index in Hispanic Americans, African Americans, and European Americans? Am J Clin Nutr 2003; 77: 71–75.

    CAS  Article  Google Scholar 

  13. Aleman Mateo H, Lee SY, Javed F, Thornton J, Heymsfield SB, Pierson RN et al. Elderly mexicans have less muscle and greater total and truncal fat compared to African-Americans and Caucasians with the same BMI. J Nutr Health Aging 2009; 13: 919–923.

    CAS  Article  Google Scholar 

  14. Casas YG, Schiller BC, DeSouza CA, Seals DR . Total and regional body composition across age in healthy Hispanic and white women of similar socioeconomic status. Am J Clin Nutr 2001; 73: 13–18.

    CAS  Article  Google Scholar 

  15. Flegal KM, Shepherd JA, Looker AC, Graubard BI, Borrud LG, Ogden CL et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr 2009; 89: 500–508.

    CAS  Article  Google Scholar 

  16. Olivares J, Wang J, Yu W, Pereg V, Weil R, Kovacs B et al. Comparisons of body volumes and dimensions using three-dimensional photonic scanning in adult Hispanic-Americans and Caucasian-Americans. J Diabetes Sci Technol 2007; 1: 921–928.

    Article  Google Scholar 

  17. Wei M, Gaskill SP, Haffner SM, Stern MP . Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (niddm) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans–a 7-year prospective study. Obes Res 1997; 5: 16–23.

    CAS  Article  Google Scholar 

  18. Mamtani M, Kulkarni H, Dyer TD, Almasy L, Mahaney MC, Duggirala R et al. Waist circumference independently associates with the risk of insulin resistance and type 2 diabetes in Mexican American families. PLoS One 2013; 8: e59153.

    CAS  Article  Google Scholar 

  19. Centers for Disease Control and Prevention (CDC) 2014. National health and nutrition examination survey. Available at:

  20. Mindell J, Biddulph JP, Hirani V, Stamatakis E, Craig R, Nunn S et al. Cohort profile: the health survey for England. Int J Epidemiol 2012; 41: 1585–1593.

    Article  Google Scholar 

  21. National Bureau of Statistics of China. Available at Accessed 21 May 2009 (archived).

  22. Wang L . Summary Report of China Nutrition and Health Survey 2002. People’s Medical Publishing House: Beijing, China, 2002.

    Google Scholar 

  23. Ge K . The Dietary and Nutritional Status of Chinese Population (1992 National Nutrition Survey) vol. 1, People’s Medical Publishing House: Beijing, China:, 1995.

    Google Scholar 

  24. Popkin BM, Du S, Zhai F, Zhang B . Cohort profile: the China Health and Nutrition Survey—monitoring and understanding socio-economic and health change in China, 1989-2011. Int J Epidemiol 2010; 39: 1435–1440.

    Article  Google Scholar 

  25. Romero-Martínez M, Shamah-Levy T, Franco-Núñez A, Villalpando S, Cuevas-Nasu L, Gutiérrez JP et al. Encuesta nacional de salud y nutrición 2012: Diseño y cobertura. Salud Pública Mex 2013; 55: S332–S340.

    Article  Google Scholar 

  26. Resano-Pérez E, Méndez-Ramírez I, Shamah-Levy T, Rivera JA, Sepúlveda-Amor J . Methods of the national nutrition survey 1999. Salud Pública Mex 2003; 45: 558–564.

    Article  Google Scholar 

  27. National Health and Family Planning Commission of the People’s Republic of China Health Standard of the People’s Republic of China. No. WS/T 428-2013: Criteria of Weight for Adults. National Health and Family Planning Commission of the People’ s Republic of China: Beijing, China, 2013.

  28. Janssen I, Shields M, Craig CL, Tremblay MS . Changes in the obesity phenotype within Canadian children and adults, 1981 to 2007-2009. Obesity (Silver Spring) 2012; 20: 916–919.

    Article  Google Scholar 

  29. Li C, Ford ES, McGuire LC, Mokdad AH . Increasing trends in waist circumference and abdominal obesity among us adults. Obesity (Silver Spring) 2007; 15: 216–224.

    Article  Google Scholar 

  30. Romaguera D, Angquist L, Du H, Jakobsen MU, Forouhi NG, Halkjaer J et al. Dietary determinants of changes in waist circumference adjusted for body mass index - a proxy measure of visceral adiposity. PLoS One 2010; 5: e11588.

    Article  Google Scholar 

  31. Tchernof A, Despres JP . Pathophysiology of human visceral obesity: an update. Physiol Rev 2013; 93: 359–404.

    CAS  Article  Google Scholar 

  32. Ismail I, Keating SE, Baker MK, Johnson NA . A systematic review and meta-analysis of the effect of aerobic vs resistance exercise training on visceral fat. Obes Rev 2012; 13: 68–91.

    CAS  Article  Google Scholar 

  33. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B . Ultra-processed products are becoming dominant in the global food system. Obes Rev 2013; 14: 21–28.

    Article  Google Scholar 

  34. Ng SW, Popkin BM . Time use and physical activity: a shift away from movement across the globe. Obes Rev 2012; 13: 659–680.

    CAS  Article  Google Scholar 

  35. Popkin BM . Synthesis and implications: China's nutrition transition in the context of changes across other low- and middle-income countries. Obes Rev 2014; 15: 60–67.

    Article  Google Scholar 

  36. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 2008; 117: 605–613.

    Article  Google Scholar 

  37. Després JP . Cardiovascular disease under the influence of excess visceral fat. Crit Pathw Cardiol 2007; 6: 51–59.

    Article  Google Scholar 

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This work was supported by NIH: NICHD (R01-HD30880) and NHLBI (R01-HL108427). NIH had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data, and preparation, review or approval of the manuscript. We thank our colleagues at the National Institute of Public Health, Cuernevaca Mexico, particularly Juan Rivera, for providing access to the Mexican data. We also thank our collaborators at the Chinese National Institute of Nutrition and Food Safety for collaboration in collection of the China Health and Nutrition Survey. We also wish to thank Ms Frances Dancy for administrative support and Mr Tom Swasey for graphics support in this effort.

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Correspondence to S S Albrecht.

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Albrecht, S., Gordon-Larsen, P., Stern, D. et al. Is waist circumference per body mass index rising differentially across the United States, England, China and Mexico?. Eur J Clin Nutr 69, 1306–1312 (2015).

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