This will have obviously been considered but if you could clarify for me, why do you use waist circumference as a metric when some people carry a lot of muscle mass in the midsection compared to others, which may result in high measurements but not necessarily unhealthy?
Can you give many examples of individuals with waist measurements well into the 40"+ range who also have low bodyfat levels?
Those bodybuilders with the bubble guts come to mind though I assume you would recommend different health interventions for them
That is typically the result of the abuse of multiple anabolic substances, and does not tend to happen with otherwise “normal” training individuals.
I would also be curious to see what their actual waist measurements are when measured as we describe, as they are still likely to be below the same cutoffs we typically recommend. Recall that a small waist is still favored as part of the “bodybuilding aesthetic”.