Sunday, November 09, 2008
It's the new vital sign. Waisted fat (i.e. fat socked beneath the abdominal musculature and carried front and center like an unfolding pregnancy) is known to be a potent marker and cause of both cardiovascular and diabetic risk. While the ideal dimensions of a healthy waistline are in dispute, thus far 40 inches/102 cm. for men and 35 inches/88 cm. for women are cited as goal.
How to measure a waistline is a hot topic. In fact, the International Chair on Cardiometabolic Risk, an organization headquartered in Quebec City, established a sub-committee to review the existing medical literature on the subject and establish a waist circumference protocol. Let it never be said that we doctors don't take our tasks very seriously.
The expert panel reached two conclusions: 1) "It didn't matter" where you measured distended abdomens with respect to predicting mortality from diabetes, cardiovascular disease, or all other causes. If the silhouette looked apple-ish (think Tweedles Dee and Dum), that defined the problem, and the bigger the gut, the worse the risk. 2) They decided to establish a protocol nevertheless to put an end to the "mass confusion" that existed on the subject so that both providers and patients could measure midriffs and follow weight loss progress.
They concluded for purposes of simplicity that the top of the iliac crest (aka pelvic or hip bone located on the side of the body at roughly, well, the waistline!) was a good anatomic marker easily found by physicians and the public alike. And in a bit of good news, spokesman and sub-panel chair Dr. Robert Ross assures us that the bathroom scale may not be the first reporter of success in weight loss programs, but rather that waist circumference may fall in a reassuring and healthful sort of way before the pounds start to drop off.