Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Waist-to-height ratio: a simple option for determining excess central adiposity in young people


Waist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. In this study we examined the relation between sex- and age-specific waist circumference cut-points, the waist-to-height ratio (WHtR) cut-point of <0.5 and cardiovascular disease (CVD) risk clustering in 164 young people, mean age 14.9±0.2 years (mean±s.d.). In total 19 (11.6%) of the sample were identified as having CVD risk clustering. These young people were significantly (P<0.001) heavier and had higher body mass index (BMI) and waist circumference z-scores compared to those without CVD risk clustering. The WHtR cut-point of 0.5 estimated CVD risk clustering to a similar extent to sex- and age-adjusted cut-points for waist circumference and BMI. Young people with excess central adiposity (WHtR0.5) were 11 times (OR 11.4, P<0.001), more likely to have CVD risk clustering compared to those who did not have excess central adiposity. The WHtR has several advantages; it is easy to calculate, does not require sex- and age-specific centiles and as has been previously suggested, it is a simple message, easily understood by clinicians and families, to ‘keep your waist circumference to less than half your height’.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. Jolliffe CJ, Janssen I . Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol 2007; 49: 891–898.

    Article  Google Scholar 

  2. McCarthy HD, Ashwell M . A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message—'keep your waist circumference to less than half your height. Int J Obes (Lond) 2006; 30: 988–992.

    CAS  Article  Google Scholar 

  3. Kahn HS, Imperatore G, Cheng YJ . A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr 2005; 146: 482–488.

    Article  Google Scholar 

  4. Garnett SP, Cowell CT, Baur LA, Fay RA, Lee J, Coakley J et al. Abdominal fat and birth size in healthy prepubertal children. Int J Obes Relat Metab Disord 2001; 25: 1667–1673.

    CAS  Article  Google Scholar 

  5. Garnett SP, Baur LA, Srinivasan S, Lee JW, Cowell CT . Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence. Am J Clin Nutr 2007; 86: 549–555.

    CAS  Article  Google Scholar 

  6. Norton K, Olds T . Anthropometrica. University of NSW Press: Sydney, Australia, 1996.

    Google Scholar 

  7. (accessed November 2005).

  8. Eisenmann JC . Waist circumference percentiles for 7- to 15-year-old Australian children. Acta Paediatr 2005; 94: 1182–1185.

    Article  Google Scholar 

  9. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    CAS  Article  Google Scholar 

  10. Lambert M, Paradis G, O'loughlin J, Delvin EE, Hanley JA, Levy E . Insulin resistance syndrome in a representative sample of children and adolescents from Quebec, Canada. Int J Obes Relat Metab Disord 2004; 28: 833–841.

    CAS  Article  Google Scholar 

  11. Freedman DS, Kahn HS, Mei Z, Grummer-Strawn LM, Dietz WH, Srinivasan SR et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 2007; 86: 33–40.

    CAS  Article  Google Scholar 

Download references


This study was funded by a National Health and Medical Research Council (NHMRC) Project Grant no. 206501. Sarah Garnett is supported by an NHMRC Australian Clinical Research Fellowship no. 457225. We thank all the families that generously donated their time to participate in this study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to S P Garnett.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Garnett, S., Baur, L. & Cowell, C. Waist-to-height ratio: a simple option for determining excess central adiposity in young people. Int J Obes 32, 1028–1030 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • waist circumference
  • waist to height ratio
  • cardiovascular disease risk clustering
  • metabolic syndrome
  • body mass index
  • children

Further reading


Quick links