Waist circumference should become a routine vital sign in clinical practice as it better predicts obesity-related outcomes than BMI, says an international consensus statement.

The International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity say the evidence on BMI shows it is insufficient to assess, evaluate or manage the cardiometabolic risk associated with increased adiposity.

Whereas waist circumference is associated with health outcomes in all BMI categories, independent of sex and age, note Dr Robert Ross of Queen’s University, in Kingston, Canada, and colleagues in Nature Reviews Endocrinology.

Furthermore, when BMI and waist circumference are considered in the same risk-prediction model, waist circumference remains a positive predictor of risk of death, whereas BMI is unrelated or negatively related to risk of death.