Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents

Public Health Nutr. 2010 Oct;13(10):1566-74. doi: 10.1017/S1368980009993053. Epub 2010 Jan 26.


Objective: The waist-to-height ratio (WHtR) assesses abdominal adiposity and has been proposed to be of greater value in predicting obesity-related cardiovascular health risks in children than BMI. The present study aims to develop WHtR cut-offs for overweight and obesity based on the 85th and 95th percentiles for the percentage body fat (%BF) in a cohort of children and adolescents.

Design: Waist circumference (WC), height, triceps and subscapular skinfolds were used to calculate WHtR and %BF. Correlations between WHtR and %BF and WHtR/mid-abdominal skinfold were made. Receiver-operating characteristic (ROC) curve analysis was used to select WHtR cut-offs to define overweight and obesity. Subjects were grouped by WHtR cut-offs, and mean values for anthropometry, blood lipids and blood pressure (BP) variables were compared.

Setting: Australian primary and secondary schools.

Subjects: A total of 2773 male (M) and female (F) subjects of the 1985 Australian Health and Fitness Survey, aged 8-16 years.

Results: Correlation coefficients between WHtR and %BF were M: r = 0.73, F: r = 0.60, P < 0.01 and WHtR/mid-abdominal skinfold were M: r = 0.78, F: r = 0.65, P < 0.01. WHtR of 0.46(M) and 0.45(F) best identified subjects with > or = 85th percentile for %BF and 0.48(M) and 0.47(F) identified subjects with > or = 95th percentile for %BF. When comparing the highest WHtR group to the lowest, both sexes had significantly higher means for weight, WC, %BF, TG (male subjects only), systolic BP (female subjects only) and lower means for HDL cholesterol (P < 0.05).

Conclusions: WHtR is useful in clinical and population health as it identifies children with higher %BF at greater risk of developing weight-related CVD at an earlier age.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Australia / epidemiology
  • Blood Pressure
  • Body Composition
  • Body Height*
  • Body Weight
  • Child
  • Cholesterol, HDL / blood
  • Female
  • Humans
  • Male
  • Obesity / diagnosis*
  • Obesity / epidemiology
  • Overweight / diagnosis*
  • Overweight / epidemiology
  • Prevalence
  • ROC Curve
  • Reference Values
  • Sex Factors
  • Skinfold Thickness
  • Triglycerides / blood
  • Waist Circumference*


  • Cholesterol, HDL
  • Triglycerides