Varying Sensitivity of Waist Action Levels to Identify Subjects with Overweight or Obesity in 19 Populations of The WHO MONICA Project

Molarius, Anu; Seidell, Jacob C.; Sans, Susana; Tuomilehto, Jaakko; Kuulasmaa, Kari; for the WHO MONICA Project
†
See for list of participants.,

« Previous Next »Journal of Clinical Epidemiology
Volume 52, Issue 12 , Pages 1213-1224, December 1999

Varying Sensitivity of Waist Action Levels to Identify Subjects with Overweight or Obesity in 19 Populations of The WHO MONICA Project

Anu Molarius
- MONICA Data Centre, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland
- The Netherlands Institute for Health Sciences, Erasmus University Medical School, Rotterdam, The Netherlands
- Address for correspondence: Dr. A. Molarius, Centre for Public Health Research, Karlstad University, 651 88 Karlstad, Sweden
Jacob C. Seidell
- Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Susana Sans
- Department of Health and Social Security, Institute of Health Studies, Barcelona, Spain
Jaakko Tuomilehto
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
Kari Kuulasmaa
- MONICA Data Centre, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland
for the WHO MONICA Project

Accepted 17 April 1999.

Abstract

It has been suggested in the literature that cut-off points based on waist circumference (waist action levels) should replace cut-off points based on body mass index (BMI) and waist-to-hip ratio in identifying subjects with overweight or obesity. In this article, we examine the sensitivity and specificity of the cut-off points when applied to 19 populations with widely different prevalences of overweight. Our design was a cross-sectional study based on random population samples. A total of 32,978 subjects aged 25–64 years from 19 male and 18 female populations participating in the second MONICA survey from 1987 to 1992 were included in this study. We found that at waist action level 1 (waist circumference ≥94 cm in men and ≥80 cm in women), sensitivity varied between 40% and 80% in men and between 51% and 86% in women between populations when compared with the cut-off points based on BMI (≥25 kg/m²) and waist-to-hip ratio (≥0.95 for men, ≥0.80 for women). Specificity was high (≥90%) in all populations. At waist action level 2 (waist circumference ≥102 cm and ≥88 cm in men and women, respectively, BMI ≥30 kg/m²), sensitivity varied from 22% to 64% in men and from 26% to 67% in women, whereas specificity was >95% in all populations. Sensitivity was in general lowest in populations in which overweight was relatively uncommon, whereas it was highest in populations with relatively high prevalence of overweight. We propose that cut-off points based on waist circumference as a replacement for cut-off points based on BMI and waist-to-hip ratio should be viewed with caution. Based on the proposed waist action levels, very few people would unnecessarily be advised to have weight management, but a varying proportion of those who would need it might be missed. The optimal screening cut-off points for waist circumference may be population specific.

Keywords: Abdominal obesity, waist circumference, cut-off points, WHO MONICA Project