Estimating Chronic Health Risks in Africans: Is Waist Circumference Better Than BMI?

Author: Dr Temitope Oyetunji, MBBS, FWACP (Family Medicine). Medically reviewed by the DLHA Team.

A shirtless black man wearing blue jeans pants and standing against a blue background. He is measuring his waist with a tape measure. Image credit: Freepik

 

Highlights

• BMI is not always accurate for Africans. It does not reflect how fat is distributed, which is key in understanding health risks.

• Waist circumference is a better predictor of heart disease, diabetes, and other health risks, especially in African populations with higher abdominal fat.

• A healthy waist size is less than 94 cm for men and 80 cm for women. Higher values may indicate increased health risks.

• Use both BMI and waist circumference to get a clearer and more complete picture of your health status and risk.

• Other useful tools which provide more insight into your health risk include waist-to-hip ratio, waist-to-height ratio and body fat percentage.

• Your waist circumference and BMI measurements can guide your health choices. They help you understand your risks, track your progress and start meaningful conversations with your healthcare provider.

 

Introduction

Maintaining a healthy weight is important for reducing the risk of chronic conditions like diabetes, high blood pressure, and heart disease, which are becoming increasingly common in African communities. But how best can you assess your health risks with measurement of your body weight and fat?

For many years, Body Mass Index (BMI) has been the go-to tool in Africa and around the world. However, research has shown that waist circumference is a more reliable measure, especially in African populations, where body fat tends to accumulate around the abdomen. [1]

Tape measures are no longer just for tailors. Healthcare providers now use them to assess your risk for chronic diseases.

In this article, you will learn and be able to make informed decision on whether BMI or waist circumference measurement is better for assessing your weight and health risks.

 

What is BMI and How is it Calculated?

Body Mass Index (BMI) is a simple screening tool used to measure the relationship between your height and weight.

It is calculated by dividing a person’s weight (in kilograms) by their height squared - i.e. multiplied by itself (in metres). [2]

Based on the resulting number, you are categorised into underweight, normal weight, overweight, or obese, which helps flag possible health risks (see fig. 1).

Fig. 1: Cartoon illustration of BMI categoties

 

BMI was first developed by Adolphe Quetelet in the 19th century as a way to study body proportions across populations. It has since become a widely used obesity screening tool around the world, including in Africa. [3]

Although BMI has several advantages, it also has some limitations, especially among African populations.

Advantages of BMI

BMI remains widely used because it is easy to calculate, cost-effective, and well-known among both healthcare workers and the general public.

In many African communities, where resources may be limited, BMI offers a quick way to raise awareness of health risks linked to excess weight. [3, 4]

Limitations of BMI in African settings

Despite its advantages, BMI has important limitations. It does not directly measure body fat, nor does it account for the distribution of fat in the body. 

This matters because Africans are more likely to store fat around their abdomen (central or visceral obesity), which poses greater health risks. 

In addition, BMI does not consider differences in muscle mass or body composition common among African populations, which means it can sometimes misclassify people’s true health risk.

Because of these limitations of BMI, experts increasingly suggest combining BMI with other measures, like waist circumference, to better understand obesity and related health problems in African settings. [1, 5]

 

What is Waist Circumference?

Waist circumference is a simple measurement of the distance around your waist, usually taken at the narrowest point of your torso, which is between the bottom of your last rib and the top of your hip bone. 

It is an easy way to assess how much fat is stored around your abdomen, which is a key factor in determining central obesity in Africans.

How to Measure Waist Circumference

• Stand up straight
• Find the spot midway between your lowest rib and the top of your hip bone. This is usually above or at the level of your belly button.
• Wrap the tape measure at this point circling it around your back to the front of your waist.
• Breathe out normally, don’t suck in your stomach or hold your breath.
• Read the measurement where the tape measure meets. The number indicates your waist measurement.

Tips for an Accurate Waist Measurement:

• Make sure the tape is not compressing your skin or too tight. 
• Wear light or no clothing around your waist to avoid interference.
• Ensure the measuring tape is straight and not twisted anywhere, especially in the back.
• You can use a mirror to check that the tape is evenly wrapped around your waist
• For the best results, take the measurement more than once and use the average.

Interpreting Waist Circumference Measurement

A healthy waist size is less than 94 cm (37 inches) for men and less than 80 cm (31.5 inches) for women.

Measurements above these limits may increase your risk of serious health conditions like heart disease, stroke, type 2 diabetes, and even some types of cancer.

Although some studies suggest that Africans may need lower waist size cut-off points, the values above are still widely used to assess health risks in sub-Saharan Africa. [6, 7] More research may be needed to fine-tune these recommendations.

However, if your waist measurement falls outside the recommended range, you should discuss it with your healthcare provider to better understand your health risks and take appropriate action.

Advantages of Waist Circumference in Africans

In African settings, waist circumference is a practical and reliable tool for assessing health risks related to excess body fat. It offers several advantages, especially in environments where access to advanced health assessment tools may be limited.

• Simple, Quick, and Affordable

Measuring waist circumference requires only a flexible tape measure. It is inexpensive and easy to perform. It can be done in clinical and community settings, and even at home without any special equipment or training. This makes it particularly useful in low-resource areas.

• It is a direct indicator of abdominal (visceral) fat

Waist circumference specifically reflects abdominal fat, especially visceral fat which wraps around internal organs. Fat stored around the internal organs poses greater health risks than fat stored in other parts of the body.

• It is a better predictor of chronic disease risk in Africans

Research shows that waist circumference predicts the risk of heart disease, stroke, type 2 diabetes and other metabolic diseases better than BMI in African populations. [5, 8]

• It encourages early identification of risk and intervention

High waist circumference measurements can serve as an early warning sign. By identifying individuals at risk early, healthcare providers can recommend lifestyle changes like improved diet and increased physical activity before chronic illnesses fully develop.

 

BMI vs Waist Circumference: Which Works Better for Chronic Disease Estimation in Africans?

When it comes to body weight estimtion in Africa, both BMI and waist circumference have their roles.

BMI offers a simple way to estimate body fat using your height and weight. It is simple, cost-effective, and serves as a conversation starter between you and your healthcare provider. However, BMI does not account for where fat is distributed in the body, which matters because abdominal fat is linked to higher health risks.

Waist circumference, on the other hand, specifically measures central (abdominal) fat, which is strongly linked to metabolic diseases. This means waist circumference is better at picking up risk factors that BMI might miss.

Ultimately, for Africans wondering which is better: BMI or waist circumference, a combination of both may be best. While BMI provides a general overview, waist circumference draws more attention to dangerous abdominal fat, giving a clearer picture of true health risk.

 

Additional Tools for Monitoring Your Health Risks

In addition to BMI and waist circumference, there are other tools that can provide even more insight into your health risks. They include:

• Waist-to-Hip Ratio (WHR) 

This measures the size of your waist in relation to your hips.

It serves as another useful indicator of visceral fat or central (abdominal) obesity.

According to the World Health Organization, a healthy WHR is below 0.80 for women and below 1.0 for men. Ratios above these cutoffs may signal a higher risk of health problems related to excess abdominal fat. [9]

• Waist-to-Height Ratio (WHtR)

This is a simple way to assess how fat is distributed in your body. 

It is calculated by dividing your waist circumference by your height.

For both men and women, a WHtR of 0.5 or lower is considered healthy.

Because of its accuracy and simplicity, WHtR is becoming a more widely recommended tool in assessing health risk.

• Body Fat Percentage

This measures how much of your body is made up of fat compared to everything else like muscles, bones, and water.

It is considered one of the most accurate ways to assess body composition and health risk.

Body fat percentage can be measured in several ways:

• Simple methods like skinfold measurements and bioelectrical impedance analysis (BIA)
• Advanced techniques like DEXA (Dual-energy X-ray Absorptiometry) scans.

While advanced methods give more precise results, they often require expensive equipment and trained personnel which may not always be available in many African healthcare settings.

Still, even the simpler methods can offer useful insights when done correctly.

 

How to Use Your Waist Circumference and BMI Information

Both your waist circumference and BMI information can be useful for making better health choices. They can help you: 

Understand your risk

If your BMI falls within the overweight category (BMI 25–29.9), it increases your risk for conditions like type 2 diabetes, high blood pressure, and heart disease. The risk even increases more with BMI > 30.

Women with waist measurement above 31.5 inches (80 cm) and men with waist circumference above 37 inches (94 cm) also have an increased risk of health problems related to excess belly fat.

Knowing these numbers does not mean you are unhealthy, but it does mean it is time to take action.

Track Progress over Time

If you have been making changes to your lifestyle, you can easily track your progress by measuring your weight and tracking changes in your BMI.

Measuring your waist circumference can also signal progress. It is easy to measure at home and can help you track your health progress better than a weighing scale alone.

Even a small reduction in your waistline (2–5 cm) can significantly reduce your health risks sometimes even if your weight doesn’t change much.

Start a Conversation with Your Healthcare Provider

Once you have your BMI and waist circumference measurements, do not just stop there. Use them as a starting point to better understand your health.

Here are some helpful questions to ask your doctor or nurse:

• What do these numbers mean for my personal health risks?
• Should I consider other measures like waist-to-hip ratio or waist-to-height ratio?
• Are there other tests I need to get a fuller picture of my health?
• What can help me improve my numbers?
• What healthy targets should I aim for based on my age, sex, and health history?
• How often should I recheck these measurements?

These questions can help you make informed decisions and take proactive steps toward better health.

 

Conclusion

Measuring waist circumference alongside BMI is a more holistic and culturally relevant way to assess health risks in Africans. Waist circumference provides important clues about central obesity and its link to chronic diseases like diabetes, high blood pressure, and heart disease.

If you are concerned about your weight or overall health, take the first step by measuring both your BMI and waist circumference. Then, discuss these numbers with your healthcare provider so you can get a more complete evaluation of your health status.

Together, these tools will help you take practical action toward healthier living and informed decisions about your well-being. 

 

References

1. Sweatt K, Garvey WT, Martins C. Strengths and limitations of bmi in the diagnosis of obesity: what is the path forward? Curr Obes Rep [Internet]. 2024 Sep 1;13(3):584–95. Available from here 

2. Zierle-Ghosh A, Jan A. Physiology, body mass index. Updated 2023 Nov. 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Aug 1]. Available from here 

3. Muscogiuri G, Verde L, Colao A. Body mass index (Bmi): still be used? European Journal of Internal Medicine. 2023];117:50–1. Available from here 

4. Wu Y, Li D, Vermund SH. Advantages and limitations of the body mass index (BM) to assess adult obesity. Int J Environ Res Public Health. 2024 Jun 10;21(6):757. Available from here 

5. Olatunbosun ST, Kaufman JS, Bella AF. Central obesity in Africans: anthropometric assessment of abdominal adiposity and its predictors in urban Nigerians. Journal of the National Medical Association. 2018 Oct 1;110(5):519–27. Available from here 

6. Owolabi EO, Ter Goon D, Adeniyi OV, Ajayi AI. Optimal waist circumference cut-off points for predicting metabolic syndrome among low-income black South African adults. BMC Research Notes. 2018 Jan;11(1):22. Available from here 

7. Kabakambira JD, Baker Jr RL, Briker SM, Courville AB, Mabundo LS, DuBose CW, et al. Do current guidelines for waist circumference apply to black Africans? Prediction of insulin resistance by waist circumference among Africans living in America. BMJ Glob Health. 2018 Oct 15;3(5):e001057. Available from here 

8. Ekoru K, Murphy G a. V, Young EH, Delisle H, Jerome CS, Assah F, et al. Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa. Int J Obes. 2018 Mar;42(3):487–94. Available from here 

9. Piqueras P, Ballester A, Durá-Gil JV, Martinez-Hervas S, Redón J, Real JT. Anthropometric indicators as a tool for diagnosis of obesity and other health risk factors: a literature review. Front Psychol. 2021 Jul 9;12. Available from here

 

Related:

What BMI Tells You About Your Health Status as an African

Rising Obesity Rates Among African Women: A Growing Public Health Concern

 

 

Published: August 12, 2025

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