Measuring waist. Credit: Andres Ayrton, Pexels
A growing body of research says the Body Mass Index (BMI) method is outdated. Here’s why waist-to-height ratio is gaining traction in global obesity diagnosis.
Researchers in Sweden and Finland say the waist-to-height ratio offers a better prediction of serious health conditions like heart failure and liver disease – sparking renewed debate over whether BMI is still fit for purpose in modern healthcare.
What is BMI and is it still useful?
BMI is calculated by dividing a person’s weight by their height squared. But critics argue that it doesn’t distinguish between fat and muscle, or where the fat is stored in the body.
As Dr Amra Jujic from Lund University in Malmö explained to Europa Press,
“BMI is the most common measure of obesity, but it’s influenced by factors such as sex and ethnicity, and doesn’t take into account body fat distribution.”
For example, a body builder with average height but high muscle mass could quite easily be labelled as obese by using the BMI method. Crazy, right?
A recent study presented at the European Society of Cardiology’s Heart Failure 2025 congress tracked 1,792 people aged 45–73 over 12.6 years. Those with a waist circumference greater than half their height were far more likely to suffer heart failure, regardless of BMI.
“Having a waist measurement less than half your height is ideal.” – Dr John Molvin.
Waist-to-height ratio also beats BMI for liver damage risk
Over in Finland, researchers came to a similar conclusion about liver damage. Analysing over 6,000 people across age groups and ethnicities, they found that a waist-to-height ratio was a far stronger predictor of liver steatosis and fibrosis than BMI.
The study, published in the Journal of the Endocrine Society, stated:
‘Waist-to-height ratio is a cheap and universally accessible tool to detect the risk of fatty liver disease both in the young and adult population.’
It found that people with a waist-to-height ratio over 0.53 had four times the odds of developing liver fat and 61 per cent higher odds of liver scarring.
While many experts argue that it’s time for more precise metrics like the waist-to-height ratio, others defend BMI’s simplicity and effectiveness at a population level.
Dr Mir Ali told Medical News Today:
“Adopting more clinically relevant criteria… will allow for treatment of a larger group of patients. Unfortunately, changing long standing parameters will take some time.”
Should healthcare systems finally retire BMI, or does it still serve a useful purpose in diagnosing obesity? Have you ever been misdiagnosed as obese by a BMI calculation?
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