Some research has shown that with fat loss in some people, there is a loss from the hips as well as the waist and therefore WHR can remain relatively constant. For this reason it is probably best used as an absolute measure of risk in the first instance of measurement, rather than a relative measure of change, and is best used in combination with other measures such as BMI.

Attempts are currently being made to incorporate WHR and BMI into a single formula, but so far these have not added to the individual predictive value of either single measure. Waist measurements suggested by the Laval group as indicative of disease risk are above 100cm for men and 90cm for women—irrespective of height. Researchers at Glasgow University8 have compared waist measurements with BMI and have come up with the following conclusions for health promotion:

• men with a waist size of > 102cm and women with a waist size of >92cm should be encouraged to lose weight

• men with a waist of between 94-102cm and women with a waist of 80-88cm should be encouraged not to put on any more weight

• men with a waist size of <92cm and women with a waist size of <80cm do not need weight management.

WHR has a relatively high validity in the measurement of abdominal fat distribution, particularly in men and post-meno-pausal women, however validity may be affected by changes in hip size that occur with changes in body fatness. Reliability and sensitivity of waist measures alone is quite high, particularly in the hands of an experienced measurer.

Correct sites for measurement of waist and hips can vary and although there are currently attempts to standardise these, there is still controversy about the correct locations. There is general agreement that hips should be measured at the widest part of the buttocks as determined from side-on. Protocols for waist measurement include measures at umbilicus (the navel), which has the particular advantage of being easy to find, but the disadvantage of being almost at hip level in some obese women. Another waist site is mid-way between the lowest rib and the top of the iliac crest (hip bone), which has the advantage of bony landmarks but does not always capture the large abdominal mass in very obese people. In lean people the waist is the narrowest part between the chest and the hips but in obese people it can be the widest, therefore this is not recommended as a definition. Each has its disadvantages, but provided the measure is used constantly, the actual site becomes less relevant.

WHR and waist circumference measures have the advantages of being quick, non-intrusive and useful for large scale population surveys. WHR has disadvantages in making comparisons between varying groups of people such as is often seen in different cultural groups. Asian women, for example, have small hips and WHR measures are much less valid as an indicator of health risk. Negroid women on the other hand have large hips and buttocks and their health risk may be misinterpreted from WHR measures. Overall WHR, or waist alone, may provide a quick and simple indication of health risk. Waist alone can then be used to examine the success of a fat loss program in those groups where abdominal fat is stored readily.

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How has she done it? By being choosy about her chocolate treats.

Ever since she was a child, Vicki, an administrative assistant from Indianapolis, has fought the battle of the bulge. In college, she reached 225 pounds, the most she has ever weighed.

These days, at age 42, Vicki is a fit 155 pounds. She says that she reached her goal weight by making smart food substitutions that save calories and still satisfy. For example, if she gets the urge to eat something salty, she chooses pretzels over potato chips. In restaurants, she orders baked potatoes instead of french fries.

Some of Vicki’s smartest substitutions happen when those chocolate cravings hit. “Instead of high-fat chocolate chip cookies, I eat a handful of chocolate animal crackers,” she says. They do the trick with far less calories and fat. Other favorites include fat-free chocolate pudding, Fudgsicles, and hot chocolate.

It took Vicki only a year to hit her goal weight. She feels that she succeeded because she feeds her cravings instead of starving them. But she feeds them with smart choices.

Who says you can’t outsmart a sweet tooth?

WINNING ACTION

Want chocolate? Then eat! If you crave chocolate, go ahead and indulge. After all, this sweet treat may actually be good for you. According to researchers at the University of California, Davis, chocolate contains flavonoids, compounds that may help protect against heart disease.But try to sticLwith something low-fat and low-calorie, as Vicki does. You may yearn for a huge bowl of triple-chocolate-chunk ice cream, but low-fat chocolate yogurt with a drizzle of chocolate syrup will probably do the trick.

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