What Is Waist-to-Hip Ratio?

Waist-to-hip ratio (WHR) is an alternative to body mass index (BMI) that may do a better job of identifying the risk of weight-related health outcomes. A higher WHR suggests that you also have higher levels of visceral fat, a dangerous type of belly fat that contributes to high blood pressure, heart disease, and type 2 diabetes.

In fact, new research published in the Journal of the American College of Cardiology shows that the size of your waist and your waist-to-hip ratio are better indicators of your heart disease risk than your BMI. Researchers also found that people who had obesity, but had a smaller waist-to-hip ratio, actually had similar rates of heart disease risk to people who didn't have obesity.

And our experts agree. “Essentially, the wider the waist is and the closer in circumference to the hips, the more at risk one is for metabolic disease,” says Meghan Garcia-Webb, MD, a triple board-certified internal medicine, lifestyle medicine, and obesity medicine doctor in Wellesley, Massachusetts.

A lower WHR is associated with a lower risk of health conditions. “It typically means that a person carries less weight in their midsection relative to their hips,” says Nina Crowley, PhD, RDN, a nutritionist in Mount Pleasant, South Carolina. “Some people naturally carry more of their body fat in the lower body (hips and thighs), which isn’t associated with the same health risks as excess abdominal fat.” The reason lower body fat doesn’t have the same health risks is that the hips and thighs don’t contain vital organs, and fat in the lower body usually accumulates just below the skin.

Both Dr. Crowley and Dr. Garcia-Webb agree that having a smaller waist-to-hip ratio isn’t usually a cause for concern.

Health Risks Associated With a Higher Waist-to-Hip Ratio

• High blood pressure
• High cholesterol
• High uric acid levels, which can contribute to gout, a type of inflammatory arthritis
• Metabolic syndrome, a group of conditions that indicate a higher risk of diabetes, stroke, and heart disease

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• Colon cancer

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It’s a good idea to speak with a healthcare provider about ways to reduce your risk of these conditions if you have a WHR at or above 0.85 (for women) or 0.90 (for men).

The World Health Organization provides a simple cutoff for healthy and unhealthy waist-to-hip ratios:

When it comes to determining risk, it’s important to consider other factors, too. “Health is more than just a number,” Crowley says. “WHR accounts for gender differences, but it does not take into account age or ethnicity, both of which influence metabolic health risks.”

Follow these steps for measuring and calculating your waist-to-hip ratio, Crowley says.

1. Make sure you have a flexible tape measure handy. Stand up tall and breathe out.
2. Use the tape measure to measure your waist at the narrowest part, typically just above the belly button, and your hips at the widest part, around the fullest point of your butt.
3. To calculate your WHR, divide your waist circumference by your hip circumference. For example, if your waist is 30 inches and your hips are 40 inches, your WHR is 0.75 (30 ÷ 40 = 0.75).

If you have a higher WHR, it doesn’t necessarily mean that you also have high levels of visceral fat, as the measurement doesn’t indicate what kind of fat is being stored around your abdomen, Garcia-Webb says. To assess your risk of certain health conditions, speak with your healthcare provider, who can order additional testing to help you better understand your health risk.

“If you’re not sure if you have more subcutaneous (surface level) or visceral fat (deep fat next to your internal organs), a DEXA (bone density) scan will give you a more accurate assessment of body composition. But usually if people have abdominal obesity, they have more visceral fat than is healthy, regardless of how much subcutaneous fat there is,” Garcia-Webb says.

Some health experts are promoting the use of WHR because it addresses one of the major flaws with body mass index, the biomarker that has traditionally been used to define if a person is overweight or has obesity.

While both BMI and WHR can be useful tools, they’re best when used together and discussed with a doctor. “A patient who has both an obese BMI and abdominal obesity is going to be at higher risk of weight-related health issues,” Garcia-Webb says.

“Ethnicity, genetics, and body type all influence fat storage and health risks,” says Crowley. “For the best understanding of health, body composition analysis — which assesses fat mass, muscle mass, and key metabolic markers — is far more useful than relying on either WHR or BMI alone.”

If you’re concerned about your health risks or any other variables that may contribute to your disease risk, it’s important to talk with your healthcare provider.

Your healthcare provider may also be able to recommend lifestyle changes or other treatments to improve your overall health, so it’s a good idea to be in contact with them if you’re trying to manage your weight or make adjustments to your WHR.

Making dietary changes and exercising are always good first steps toward adjusting your WHR, Crowley says. “Including healthy fats, such as omega-3s from fish and nuts, may reduce inflammation linked to metabolic dysfunction. Exercise plays a crucial role, with strength training helping to build muscle and boost metabolism, and moderate to high-intensity cardio may help reduce visceral fat.”

Your mental health can play a role in how your body stores visceral fat too. “Chronic stress increases cortisol levels, which can promote fat storage in the abdomen, making mindfulness, deep breathing, and relaxation techniques valuable strategies,” Crowley says.

In some cases, an underlying health condition can be the cause of excess weight around the abdomen. “Certain medical issues may present with a higher waist-to-hip ratio, such as Cushing syndrome,” Garcia-Webb says. “Postmenopausal women will generally have a slightly higher waist-to-hip ratio than premenopausal women, due to hormonal changes, but the goal is still to keep it below 0.85.”

If you’re having difficulty reducing your WHR, reach out to your healthcare provider for support. They may ask about any other symptoms you’re experiencing and suggest testing to get to the root of what may be contributing to excess weight.

• Waist-to-hip ratio, or WHR, measures the ratio of your waist size to your hip size, which does a better job of estimating how much visceral fat you carry in your midsection than traditional measurements like BMI.
• A higher WHR is associated with an increased risk of chronic diseases such as metabolic syndrome, heart disease, and diabetes.
• For women, a WHR at or above 0.85 indicates a higher risk, while for men, a WHR at or above 0.90 may indicate increased risks.
• You can’t change your body shape, and it’s not easy to target weight loss in your belly, but a healthier diet, exercise, and lifestyle choices can reduce your risk of chronic conditions.