27 Apr To Your Health: Beyond BMI, Waist Size/ Body Shape Matter More Than Weight!
Welcome back to the series which offers a deep dive into the world of health, wellness, and disease prevention with Telluride local Dr. Alan Safdi.
Dr. Alan is a board-certified physician in Internal Medicine and Gastroenterology, a Fellow of the American College of Gastroenterology, and a respected leader in healthcare. His blogs have featured and will continue to showcase the most current information in his fields: health, wellness and longevity.
In this installment of “To Your Heath, Dr. Alan updates notions about BMI and why waist size and body shape matter more than weight.
Scroll down to read the salient details and listen to the podcast to find out more.
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Most people have been told for years that body mass index, or BMI, is the standard way to define whether they are at a healthy weight. It is simple and easy to calculate, but that simplicity hides a major problem.
BMI does not measure fat, it does not distinguish fat from muscle, and it tells us nothing about where fat is stored. Two individuals can have the exact same BMI, yet one may be metabolically healthy while the other is at high risk for diabetes and cardiovascular disease. In clinical practice, this shows up frequently, particularly in patients who appear lean, but carry excess visceral fat, the type of fat that is most strongly linked to disease.
What truly drives risk is not just how much fat a person has, but where that fat resides.
Visceral fat, which accumulates deep within the abdomen and around organs such as the liver and pancreas, behaves very differently from subcutaneous fat. It is metabolically active, contributing to insulin resistance, systemic inflammation, and downstream effects that increase the risk of cardiovascular disease, diabetes, and possibly neurodegeneration. The challenge is that visceral fat is not visible on exam and is not captured by BMI. Imaging such as MRI, CT, or advanced DEXA can quantify it, but these are not routinely used or consistently reported, which is why better clinical surrogates are so important.
That is where newer approaches become far more useful.
Body Roundness Index is calculated using just two measurements, height and waist circumference, and reflects how much fat is concentrated centrally rather than total body weight. In practical terms, a clinician or even an AI tool can estimate BRI quickly if those two numbers are available. Waist circumference should be measured at the level of the iliac crest for consistency rather than at the navel, and then interpreted relative to height. As waist size increases relative to height, BRI rises, tracking closely with visceral fat and cardiometabolic risk.
An even simpler and highly actionable approach is the waist to height ratio, calculated by dividing waist circumference by height.
The key clinical rule is straightforward: keep your waist less than half your height. This single metric performs remarkably well in predicting diabetes, cardiovascular disease, and overall mortality, and in many cases provides more useful information than BMI.
The broader implication is that we need to rethink how we define and assess obesity.
BMI was never designed to guide individual health decisions, yet it remains deeply embedded in medicine. A more accurate approach focuses on central fat distribution rather than total body weight alone, giving patients a clearer and far more actionable picture of their true metabolic health.
In this podcast, Dr. Alan explains why he has not relied on BMI for over a decade, and how advances in our understanding of visceral fat have fundamentally changed the way we should assess risk.
With more meaningful tools now available, the focus has shifted from simply measuring weight to understanding fat distribution and metabolic health.
This is a critical shift in thinking that has implications for prevention, diagnosis, and long-term outcomes.
Listen to the full discussion to explore how these insights can be applied in everyday clinical practice and personal health decisions.
Dr. Alan, more:
Dr. Alan Safdi is board-certified in Internal Medicine and in Gastroenterology and a Fellow of the American College of Gastroenterology. A proven leader in the healthcare arena, he has been featured on the national program, “Medical Crossfire” and authored or co-authored numerous medical articles and abstracts.
Dr. Alan is a long-time Telluride local, has been involved in grant-based and clinical research for four decades. He is passionate about disease prevention and wellness, not just fixing what has gone wrong.
He is also Chief Medical Officer Quadrant Health, partnered with and co-owned by Stanford University and Mayo Clinic.
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