Waist circumference clarification

Medical Q&A [Moderated]
1

Hi docs,

Following your advice I made a lifestyle change and I’m happy and thankful for that.

I’m 34 years old, male, 5’8", 184lb, 91.5cm waist at the belly button.

I read / listened to one of your articles or podcasts and found out that my 103cm waist is quite a big deal. I thought it isn’t since I’m lifting relatively heavy weights and carry a lot of muscle mass, but you changed my opinion and I’m glad for that. At first, I read you’re saying that above 100cm is a bigger risk so I did my best to get to about 98cm successfully. Than, I read another article of yours that says that for men 100cm is a very high risk but over 94cm is high risk. So I did my best to go down to 90cm and for the last year or so I’m moving between 90cm to 93cm which is better than before.

Than, I listened to a recent podcast of yours and you’re saying that I should aim for a waist which is half my height - 86.5cm.

Of course, maybe you said it all along and I didn’t pay attention. My questions are:

  1. If half of my height is less than 94cm, shall I aim for the lower one or the higher one?
  2. After listening to one of the obesity podcasts about the willpower thing - I will admit that staying around 90cm-93cm is probably realistic to me and I keep that for about a year now on a “moderate RPE”. I make my decisions based on the question of whether I can sustain these decisions and whether I think I can make a specific decision for a lifetime (like avoiding a specific cake etc).
    I do think that going down to 86cm would make the “waist RPE” around 9-10 and I’m not sure I can make it for a lifetime, but it may be worth trying. If the answer to the first question is indeed 86cm and not 94cm, what would you recommend in my situation? “sign a contract” for a sustainable 90cm-93cm or trying a higher RPE for the desired 86cm? Or trying the 86cm route and maybe failing and going back to the next best option?
    Do you think that in terms of health - not looks - the drugs for losing weight worth considering in my case? (My default opinion would be to not go for that, I prefer a “natural” way, and I guess that these drugs are not originally meant for my situation, but I’m very open to any advice)

Thank you so much for everything you do in general, and for the reply on that topic :slight_smile: :folded_hands:

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2

Nice work on the weight loss so far. Very impressive stuff, to be clear. I think maybe it would help if I gave you a lay of the land when it comes to fat and health.

Fat becomes harmful when it is dysfunctional (cardiometabolic), excessive (force), or creates stigma due to other people’s perception of the individual. We collapse that all into obesity, which only describes the way a person looks. Maybe we should call it adipositis instead…but that’s another discussion.

The problem is, we can’t “know” that fat is becoming harmful until after it has already started causing harm, so various cut-offs and tools are mostly trying to do risk stratification by proxy. A waist of 40" or more in a man almost certainly (but not always) represents adipositis, 37" is probable (but not quite as strong), and a waist to height ratio of 0.5 is unlikely (but maybe).

I think this is an important question that you’re asking and it requires more information to know what, if any, medical conditions you may have that are related to body fat. If so, they may benefit from medication to assist you here. If not, the discussion becomes a bit more challenging. I’m a bit limited with what I can do through the forum, but this is how I think about it.

Maybe this helps?

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