A new obesity measure based on relative waist circumference – how useful is it?

Background The Krakauer (2012) obesity measure, the ABSI, is based on waist circumference relative to its predicted value from known height and weight. It is based on novel logic designed to identify excess waist size irrespective of BMI and appears to work well in a USA sample. We aim to explore the effectiveness of the ABSI in North American and United Kingdom populations and against standard measures, and consider the case for its general use. Methods The ABSI was originally developed from regression of log transforms of waist on height and weight in the NHANES survey 1999–2004. Waist ratio, based on un-transformed regression, is introduced here for further exploration of the concept. ABSI-UK is obtained from parameters from the Health Survey for England (2010). Comparisons are made in the prediction of mortality hazard in the 23 year follow-up of the 9003 participants in the UK Health and Lifestyle Survey. Results In women, the rank ordering by hazard ratio for one sd increase, with 95% CI was: ABSI-UK 1.257 (1.179 to 1.341), ABSI 1.245 (1.167 to 1.327), waist ratio 1.231 (1.153 to 1.314), waist to height ratio 1.186 (1.108 to 1.268), waist alone 1.160 (1.087 to 1.238), BMI 1.038 (0.971 to 1.109). The ordering was identical for men. Conclusions ABSI appears to be the preferred choice of obesity measure using waist, height and weight. The concept underlying the new measure has considerable potential although the particular form adopted for the ABSI can perhaps be improved for convenience of general users. Key messages A new obesity measure, the ABSI (Krakauer, 2012), is a significantly more effective predictor of premature mortality than any other combination of weight, waist and height. A new obesity measure, the ABSI (Krakauer 2012), is based on novel logic designed to identify excess waist size irrespective of BMI. It is effective as predictor of mortality in UK population sample.