The Waist-to-Hip Ratio as an Index of Central Obesity

To the Editor.  —Drs Young and Gelskey¹ have offered persuasive evidence that the waist-to-hip ratio (WHR), a traditional index of central obesity, is a weak predictor of metabolic risk. However, it does not necessarily follow that noncentral obesity is a strong predictor of cardiovascular disease.Despite its historical role in focusing attention on abdominal (central) adipose tissue, the WHR may not be an effective anthropometric method for defining central obesity. Cross-sectional studies^2-4 have repeatedly demonstrated that alternative indexes of central obesity (eg, waist-to-thigh ratio, waist circumference alone, sagittal abdominal diameter) are more strongly associated than the WHR with blood pressure and metabolic variables. Beyond correlations with cardiovascular risk factors, it remains to be seen which index of central obesity best predicts cardiovascular disease outcomes.⁵Young and Gelskey have struggled possibly with a straw man of WHR, but they did not confront newer ways of looking at central