Abdominal fat distribution — predicts cardiometabolic risk.
Source: WHO expert consultation (2008).
What does waist-to-hip ratio mean?
Waist-to-hip ratio (WHR) is simply your waist circumference divided by your hip circumference. It quantifies fat distribution, whether you carry weight predominantly around the abdomen (associated with higher visceral fat) or the hips and thighs (associated with lower cardiometabolic risk).
Visceral fat, the fat stored deep within the abdominal cavity around the organs, is metabolically active and releases inflammatory cytokines and free fatty acids that impair insulin signalling, raise blood pressure, and promote atherosclerosis. Subcutaneous fat on the hips and thighs, while still fat, has a more benign metabolic profile and some researchers argue it may even be somewhat protective.
WHR has been validated as a predictor of type 2 diabetes, coronary artery disease, stroke, and all-cause mortality in multiple large prospective cohort studies, including INTERHEART (52 countries, 27,000 participants). Its predictive power is comparable to and sometimes exceeds that of BMI, particularly in older adults who have lost muscle mass but gained abdominal fat.
The WHO defines high-risk WHR as ≥ 0.90 for men and ≥ 0.85 for women, based on their 2008 expert consultation on waist circumference and waist-hip ratio. These thresholds may not be optimal for all ethnic groups, some Asian guidelines use lower cut-points.
Reference ranges (WHO 2008)
| Risk category | Men (WHR) | Women (WHR) |
|---|---|---|
| Low risk | < 0.90 | < 0.85 |
| Moderate risk | 0.90 – 0.99 | 0.85 – 0.89 |
| High risk | ≥ 1.00 | ≥ 0.90 |
When should you see a doctor?
If your WHR falls in the moderate or high-risk range, it is worth discussing with your doctor, particularly if you also have other risk factors such as elevated blood pressure, high blood sugar, or an unfavourable lipid profile. Waist-to-hip ratio is most informative when combined with a full metabolic assessment rather than viewed in isolation.