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Dr. Kevin Soden serves as worldwide medical director for Texas Instruments. He worked 23 years as an emergency physician and has been a medical journalist for more than two decades. Dr. Soden recently won two Emmy awards from the National Capital Chesapeake Bay Chapter of the National Academy of Television Arts and Sciences, for his work on the Healthline medical program and a documentary on post-polio syndrome. Healthline appears on the Retirement Living TV network, available in the Dallas area on Verizon FIOS TV and in many other states on the Comcast cable network.
Q: What does waist size have to do with overall health?

A: If you have a doctor who measures your waist often, you are extremely fortunate. He or she is obviously keeping up with the latest research on which body measurements are the best predictors of future health problems.

Traditionally, most doctors measure a person's BMI, or body mass index, to determine if he or she is overweight. BMI is a common measure expressing the relationship (or ratio) of weight-to-height. Tables are available that you can use to determine your BMI. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese.

There is a growing common opinion in medical circles that waist circumference should be considered a "vital sign" and recorded in the medical chart of every patient, in the same manner as weight, height and blood pressure. Some investigators claim that waist circumference should replace BMI for determining which adults may have possible health risks due to obesity. In fact, there is a 20 percent higher risk of death if your waist size is over 40 inches for men and 35 inches for women, when compared to those with a normal waist size.

The bottom line: Fat around our middle dramatically increases our risks of coronary heart disease, diabetes and heart attacks. In other words, if you have a lot of fat around your middle, you are still at increased risk for a heart attack, even if your overall weight is in a good range.

Also, studies show that people with the waist measurements mentioned above or a BMI of 30 or more were between 3 and 8 times more likely to develop a medical condition called metabolic syndrome than those with a smaller waist circumference or a BMI less than 25.

Metabolic syndrome increases our risk of heart disease and diabetes. There are different criteria for diagnosing metabolic syndrome; here are the ones used by the American Heart Association:
  • Increased waist size (as stated above)
  • Elevated blood glucose, indicating diabetes (fasting glucose >100)
  • High cholesterol (>150) with low HDL and triglycerides
  • Elevated blood pressure (>130/85)
Metabolic syndrome requires three or more of the above and increases dramatically with age. At younger ages, about 15 percent of the population has it; over age 50, at least one out of three people have this condition.

What do you do if you have metabolic syndrome? As with most health risks, it's a matter of lifestyle. For managing both long- and short-term risk, the best first-line interventions would be:
  • Waist reduction to 40 inches for men or 35 inches for women.
  • Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
  • Healthy eating habits that include reduced intake of saturated fat, trans-fat and cholesterol.
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