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NICE recommends recording waist-to-height ratios alongside BMI for people with BMI < 35

Without seeing the rationale behind this, I instinctively wondered what would be the benefit of recording waist-to-height for those below a BMI of 35 in a Guideline to HCPs for overweight and obesity management. Surely the focus ought to be for those with a BMI above 35? Perhaps I'm just missing something.

From a Google search I found NG246,
Overweight and obesity management
NICE guideline [NG246] Published: 14 January 2025

But I couldn't find a mention of this in there. Also the consultation document was closed on 25 Feb

Consultation closed Consultation opened 16 January 2025, 12.00 pm and closed 25 February 2025, 5.00 pm

I don't use X (formerly Twitter) which seems to be discussing on 18 March 2025 the closed Consultation process. Judging by this tweet looking very "real", yet doubt in my mind whether this is for under or above BMI 35 - and thus confusion or uncertainty about what is really going on, I'm glad I don't use this social media platform.

However I can imagine considerable difficulty in finding due "sensitivity" for that conversation between patient and HCP during a 10 minute appointment. Never mind the actual practicalities of getting an accurate waist measurement. I'm considered slim, (bordering on gaunt by my family; they still relate to when I was moderately overweight, some 8-10 years ago.) Today my waist measurement is around 32-34", judging by the various pairs of shorts, jeans, tracksuit bottoms (with elastic waistband) and trousers in my wardrobe. At my heaviest the size of my backside governed what waist size of trousers I needed to wear - leading to a pretty vague actual waist measurement. Even then I don't think I was obese.

So setting aside whether this is really for those below or above a BMI of 35, measuring the waists of overweight folk is going to be somewhat subjective. My wife uses a pinchability scale. On me - no sensitivity applied either!
 
I read an article about this the other day, but only really skimmed it. It seemed to be saying that it’s very difficult to have a BMI of over 35 without carrying too much fat, but that under 35, you get a lot of fit, muscly athletes whose BMI is over 25 because of their muscle, but they normally have in proportion waist measurements.
 
Well those 2 comments, @Robin and @helli, helps me reconcile my initial instinctive contradiction about looking at those with a BMI under 35 rather than those above 35. But NG246 is about Overweight and Obesity management. Perhaps wrongly I'd assumed this would be those people with BMIs above 35. I'll have to read NG246 much more carefully than my rapid look early this am and see if it provides some indication of the defining parameters for obesity, thus who this Guideline is really for.

I'm still mildly frustrated that, even though there has been a consultation document, now closed, it's not in the public domain apparently. I suppose I don't need to know because I'm neither an HCP nor overweight. But I have an adult daughter who definitely is very overweight; her health is a constant concern to my wife and myself and it's a very sensitive topic. One never stops being a parent.
 
Proud to be erratic said:
Well those 2 comments, @Robin and @helli, helps me reconcile my initial instinctive contradiction about looking at those with a BMI under 35 rather than those above 35. But NG246 is about Overweight and Obesity management. Perhaps wrongly I'd assumed this would be those people with BMIs above 35. I'll have to read NG246 much more carefully than my rapid look early this am and see if it provides some indication of the defining parameters for obesity, thus who this Guideline is really for.

I'm still mildly frustrated that, even though there has been a consultation document, now closed, it's not in the public domain apparently. I suppose I don't need to know because I'm neither an HCP nor overweight. But I have an adult daughter who definitely is very overweight; her health is a constant concern to my wife and myself and it's a very sensitive topic. One never stops being a parent.
Click to expand...
I’m assuming the BMI classifications are what they’ve always been, 25-29.9, overweight; 30-34.9, Obese; 35-40 used to be morbidly obese, now seems to be Obese class 2; etc. see here

IMG_5388.png
 
Robin said:
I read an article about this the other day, but only really skimmed it. It seemed to be saying that it’s very difficult to have a BMI of over 35 without carrying too much fat, but that under 35, you get a lot of fit, muscly athletes whose BMI is over 25 because of their muscle, but they normally have in proportion waist measurements.
Click to expand...
Also a lot of serving soldiers fall into the Overweight or Obese category according to their BMI. They have to keep themselves fit and active as a requirement of the job.
 
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