Obesity Matters: How do You Know if You are Overweight and Why Jumping on the Scales May be a Bad Idea?

The Role of Body Weight in Lymphatic Insufficiency

For individuals living with lymphatic insufficiency, maintaining a healthy weight is crucial. Excess body weight increases lymphatic pressure, worsening swelling and exacerbating symptoms.

Body weight plays a significant role in chronic lymphedema. Studies have shown that obesity and poor health increase the risk of lymphedema and related symptoms in breast cancer survivors (1).

Additionally, abdominal obesity is linked to metabolic disorders such as diabetes and cardiovascular disease, highlighting the importance of accurate weight assessment (2, 3).

As many of us resolve to lose weight this year, it’s vital to consider how success is measured to avoid unrealistic goals and setbacks.

Limitations of BMI in Measuring Obesity

While Body Mass Index (BMI) is widely used to assess obesity and is calculated using the formula weight (kg) / height (m)2. Using BMI as a measure for obesity has notable limitations, especially for individuals with lymphatic insufficiency. For instance, the weight of swollen limbs can elevate the BMI, even if the person is underweight in the upper body. Similarly, BMI is not an ideal measure for bodybuilders, certain indigenous populations, or for older adults whose body composition has changed over time.

For adults, a BMI under 19 is considered underweight, 20-25 a healthy weight, over 25 is considered Overweight, and over 30 Obese.

Why Waist-to-Hip Ratio (WHR) Is a Better Metric

To find your Waist-to-Hip Ratio (WHR), simply divide your waist size by your hip size. Hold the tape at the narrowest part of your torso and the widest part of your hips.

The World Health Organization (WHO) defines abdominal obesity as a WHR of at least 0.85 or more for women and 0.90 for men. A ratio higher than 1.0 indicates and increased risk of health problems

How does your BMI compare to your WHR?

Advantages of WHR

Waist-to-hip ratio offers several advantages over BMI:

• Accurate Fat Proportion Assessment: By including the waist circumference measure, WHR provides insight into abdominal fat distribution, thereby mitigating the effect of excess muscle development on BMI measures. Body builders may have a very low WHR if they have worked towards eliminating all abdominal fat.

• Disease Risk Prediction: WHR has been shown to predict risks of cardiovascular disease, diabetes, and premature death more effectively than BMI. A 2015 study found that a high WHR was associated with increased risk of early death, even in individuals with moderate BMI (4).

• Hypertension and Heart Disease: Studies in 2021 and 2018 revealed that WHR is a reliable predictor of hypertension and heart failure-related mortality, particularly in women (5, 6).

Moreover, reducing WHR by just 5% has been linked to significant health benefits, including a lower risk of chronic kidney disease (7).

Disadvantages of WHR

Despite its benefits, WHR has some drawbacks:

• Measurement Challenges: Accurate measurement of both the waist and hips can be difficult and prone to error.

• Interpreting Results: Like all measures, there will be outliers and people who have excess abdominal skin after weight loss, or low muscle mass around the hips may have issues interpreting the results.

• Unsuitable for Certain Groups: WHR is not recommended for children, individuals under 150cm tall, or those with a BMI over 35.

Comparing WHR with Other Metrics

Waist Circumference

While WHR considers the ratio of the waist to the hips, waist circumference alone is also a valuable measure.

A waist circumference above 80 cm for women and 94 cm for men is associated with an increased risk of chronic conditions, and studies suggest it may outperform WHR in predicting cardiovascular risks and diabetes, particularly when adjusted for height (8).

Waist-to-Height Ratio

The waist-to-height ratio is another promising metric. It accounts for variations in body structure, offering a straightforward way to assess obesity and health risks.

This method is particularly relevant for individuals whose height impacts interpretation of other measures.

Simply divide your waist measurement by your height (in cm). The general guidance is that a waist-to-height ratio between 0.4 and 0.5 is considered healthy, while values exceeding 0.5 indicate a greater probability of health issues related to excess body weight.

WHR and Lymphatic Health

For people with lymphatic insufficiency, including a waist measure in the assessment of your healthy, overweight or obese status may provide a more accurate base line, than other measures of weight. And focussing on waist and hip circumferences as a measure of success may give a more stable long term goal, rather than stepping on the scales every day and hoping for a miracle.

Focusing on abdominal fat rather than overall weight will also help to identify and mitigate risk factors impacting lower limb oedema and related complications. Furthermore, it aligns with the broader understanding that abdominal obesity is a key driver of metabolic and cardiovascular issues.

Broader Implications of WHR

Stress and Cortisol

Abdominal fat, is associated with elevated cortisol levels, a stress hormone linked to further weight gain, poor healing, muscle weakness and mood swings.

This relationship underscores the importance of managing abdominal fat to reduce stress-related health risks (9).

Fertility and Reproductive Health

WHR also has implications for fertility. Studies suggest that women with lower WHR tend to have higher fertility rates and earlier pubertal development. Men with optimal WHR exhibit better reproductive health and lower risks of prostate and testicular cancer (10), indicating WHR’s broader significance beyond individual health (11).

Setting Realistic Goals for Weight Management

While losing weight is a common resolution, it’s crucial to focus on achievable and meaningful goals.

For individuals with lymphatic insufficiency, this means prioritising health over arbitrary numbers on a scale.

Practical Tips for Measuring Success

1. Choose the Right Metrics: Use WHR, waist circumference, or waist-to-height ratio to monitor your progress.

2. Celebrate Non-Scale Victories: Improved mobility, reduced swelling, and better overall health are significant achievements. Keep a record of your level of pain or immobility. Score your experience of each symptom on a scale of 1 - 10 before you begin your weight loss program, and revisit the scores weekly.

3. Seek Professional Guidance: Work with healthcare providers to develop a personalised plan that considers your unique needs. Extreme diets may make lymphatic disorders worse through the yo-yo effect, so care should be take to develop a weight loss plan with sustainability in mind.

Conclusion

Maintaining a healthy weight is a modern day challenge that affects nearly everyone. Given the relationship with overweight and obesity to poorer health outcomes and higher public health costs, how we measure the progression or reversal of obesity matters. For people affected by chronic oedema, WHR and waist circumference stand out as a superior metrics to weight (body mass) or BMI measures. By adopting realistic goals and focusing on health improvements, we can make sustainable strides toward better well-being.

References

1. Ahmed RL, Schmitz KH, Prizment AE, Folsom AR: Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Research and Treatment 2011.

2. Mallick A, Ahsan M, Das B, Rai S: A correlation study of lipid profile with body mass index and waist hip ratio in Rohilkhand region. Int J Med Res Rev 2018.

3. Aghaei M, Joukar F, Hasanipour S, et al.: The association between waist-to-hip ratio (WHR) with diabetes in the PERSIAN Guilan cohort study population. BMC Endocrine Disorders 2024.

4. Healthline. Waist-to-Hip Ratio: Advantages and Disadvantages.

5. Wikipedia. Waist-to-Hip Ratio and Health Risks.

6. WHO Guidelines on Abdominal Obesity.

7. American Diabetes Association Studies on WHR.

8. Stress and Cortisol: Implications of High WHR. American Journal of Physiology 2020.

9. Fertility Studies and WHR: A Dutch Perspective. Reproductive Health Journal 2015.

10. Cognitive Outcomes and Maternal WHR. Journal of Developmental Neuroscience 2018.