Most of us rely on the scale to judge our health. Few of us reach for a tape measure. But, research indicates one simple body measurement may reveal early warning signs of heart disease risk, even in those who appear healthy and have a normal body mass index (BMI).
It may help explain why some people who are not visibly overweight still develop cardiovascular disease.
For South Africans indulging this festive season and emerging expanding waistlines, the findings may serve as a timely wake-up call.
How the waist-to-hip ratio links to heart disease risk
Researchers presented the findings at the annual meeting of the Radiological Society of North America, meaning the results have not yet been published in a peer-reviewed journal. It focused on the waist-to-hip ratio, a measure of body fat distribution.
Rather than overall weight, the waist‑to‑hip ratio reflects how much fat you carry around your abdomen.
Abdominal fat includes visceral fat, which surrounds internal organs and is known to place strain on the heart and blood vessels, leading to an increased risk for heart disease. In simple terms, it’s not just about how much fat you carry, but where your body puts it.
The study analysed 2 244 adults aged 46 to 78 with no diagnosed heart disease. Each participant underwent detailed cardiac MRI scans to examine heart size, shape, and function.
People with a higher waist-to-hip ratio tended to have thicker heart muscle walls and smaller heart chambers, particularly among men. This pattern, known as concentric hypertrophy, can reduce the heart’s ability to relax and fill properly. They recognise these structural changes as an early warning sign of heart disease, and they may precede heart failure and other forms of cardiovascular disease.
This association remained even after accounting for traditional heart disease risks such as high blood pressure, diabetes, cholesterol levels and smoking.
Why belly fat matters for heart disease risk
While BMI shows general body size, it cannot identify visceral fat, the deep belly fat around organs and intestines. This is the fat most strongly linked with inflammation, metabolic disease and heart damage, or cardiovascular disease.
The study suggests that abdominal fat may place unique mechanical and metabolic stress on the heart, contributing to early remodelling even in people without obvious obesity.
This helps explain why someone can have a normal BMI yet still face elevated heart disease risk.
How to Check Waist-to-Hip Ratio to Assess Heart Disease Risk
You only need a tape measure.
- Measure your waist at its narrowest point.
- Measure your hip circumference at its widest point.
- Divide the waist measurement by the hip measurement.
According to the World Health Organization, a waist‑to‑hip ratio above 0.90 for men and 0.85 for women indicates abdominal obesity associated with an increased risk of heart disease.
While this measurement cannot diagnose heart disease or predict symptoms, it can provide useful early insight and encourage conversations about lifestyle changes and medical screening.
Ways to lower your heart disease risk
1. Move more, more often
Regular movement can improve cardiovascular health and help reduce visceral fat. You do not need an expensive gym membership. Nature-based activities boost heart health and mental well-being in many ways.
2. Eat to support your heart
Limiting ultra-processed foods and focusing on whole foods can help reduce inflammation and metabolic stress. Diets high in sugary drinks, refined snacks and excessive alcohol are associated with greater accumulation of abdominal fat and increased heart disease risks.
3. Prioritise sleep and manage stress
Poor sleep and chronic stress are linked to hormonal changes that promote abdominal fat storage. Establishing calming evening routines and making time to switch off can support both cardiovascular disease prevention and overall well-being.
Why this matters for South Africans
Cardiovascular disease accounts for one in six deaths in South Africa. Combined with high alcohol intake, rising processed food consumption, limited physical activity and increased obesity, the beer belly has become more than a cosmetic concern.
Health experts say regularly checking the waist-to-hip ratio could help South Africans catch silent heart health risks earlier and make necessary lifestyle changes, such as walking more, reducing sugar intake and moderating alcohol. Small changes made early can have a meaningful impact on long-term heart health.
