Belly Fat vs. BMI: Which Better Predicts Your Heart Disease Risk?

A new study suggests that belly fat may be a better indicator of heart disease risk than body mass index (BMI). The research, published in JACC on August 11, found that high waist circumference or waist-to-hip ratio could increase the risk of heart disease by up to 50%.

Dr. Michael J. Blaha, senior author of the study, explained that visceral fat, or belly fat located around the organs, is more metabolically active and can release chemicals that contribute to inflammation, inflammation in the bloodstream, and negatively impact blood sugar regulation, blood pressure control, and cholesterol levels. This, in turn, raises the risk of heart disease.

Although BMI has been widely used to assess weight-related health risks, Blaha emphasized that it is not a perfect measure, as it does not account for abdominal or visceral fat. He stated that waist circumference and waist-to-hip ratio are better measures of abdominal/visceral fat and provide a more accurate assessment of body composition.

Research included health data from nearly 260,000 individuals, with records of heart disease outcomes such as heart attack, stroke, heart failure, atrial fibrillation, coronary heart disease, cardiovascular disease, and overall mortality. The study discovered that people with a healthy weight or overweight and a high waist circumference or waist-to-hip ratio had a 15% to 50% increased risk of experiencing one of these heart disease events.

Dr. Cheng-Han Chen, an interventional cardiologist, explained that visceral fat around the internal organs is particularly metabolically active and releases chemicals that contribute to inflammation, interfering with blood sugar regulation, blood pressure control, and cholesterol levels, thereby increasing cardiovascular disease risk.

Experts are moving away from using BMI as the sole indicator of weight and body composition, with a growing recognition that abdominal fat can raise health risks even in individuals with normal weight or BMI. Blaha stressed that patients with normal weight or overweight can still have high metabolic and cardiovascular risk, highlighting the importance of optimizing lean body mass while reducing unhealthy abdominal or visceral fat.

To reduce visceral belly fat, bariatric surgeon Dr. Mir Ali recommended maintaining a heart-healthy, balanced diet low in saturated fat and sugar, getting regular physical activity, avoiding alcohol, ensuring adequate sleep, and limiting stress. He cautioned that spot reduction, such as performing sit-ups, is ineffective and that overall weight loss will result in abdominal fat loss as well.