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Importance Of Waist Hip Ratio And Insulin Resistance In Diabetes

Updated on February 14, 2016

Above normal Waist-Hip Ratio increases the risk of diabetes, stroke and heart problems


Diabetes is a disease of the endocrine system. Overweight people, especially those with an increased waist-hip ratio, are at risk of developing insulin resistance, and later on diabetes as a long-term consequence. Diabetes presents as abnormally high blood sugar levels increased thirst, an increased frequency of urination and increased infections. In diabetes, either there is a deficiency or total lack of hormone insulin, or the body resists actions of this hormone.

Link between obesity and diabetes

  • Upper body obesity is a greater health hazard than lower body obesity.
  • Overweight individuals with a Waist Circumference >102 cm in men and >88 cm in women; or a Waist Hip Ratio >1.0 in men and >.85 in women, have an increased risk of diabetes, stroke and heart problems.
  • Obesity is a common cause of insulin resistance.
  • Excess insulin hormone can lead to an increase in harmful fats, high blood pressure and hardening of arteries.

Obesity - a risk factor for diabetes

Obesity is defined as an excess of body fat. Overweight people are at an increased risk of high blood pressure, type-2 diabetes, increased blood cholesterol, heart problems, arthritis, gallbladder stones and certain cancers. Excess body fat can be measured by a standard parameter, the Body Mass Index (BMI). The BMI is calculated by dividing body weight by height of a person. According to the National Institutes of Health (NIH) -

  • Normal weight is BMI = 18.5 - 24.9 kg/square meters
  • Overweight is BMI = 25 - 29.9 kg/square meters
  • Class I obesity is BMI = 30 - 34.9 kg/square meters
  • Class II obesity is BMI = 35 - 39.9 kg/square meters
  • Class III or extreme obesity is BMI = >40 kg/square meters

Excess fat around the waist and flank is more dangerous than that in the hips and buttocks


Waist Hip Ratio

It is an accurate tool for disease risk assessment. Most people think of the fat that is easily seen collecting under the skin, or the subcutaneous fat to be extremely dangerous. But contrary to this, it is the fat deep inside the belly, or the visceral fat (the fat that accumulates around structures in the abdomen), which is the major source of risk.

Upper body obesity, with an excess fat around the waist and flank, is a greater health hazard than lower body obesity, or fat in the thighs and buttocks. Overweight individuals with a Waist Circumference (WC) > 102 cm in men; and >88 cm in women, or with a high Waist Hip Ratio of >1.0 in men; and >.85 in women, are at a greater risk of suffering from diabetes, stroke and heart problems, as compared to their counterparts having same body weight, but lower waist-hip ratio.

This is because, the visceral fat is not merely accumulated weight, but is metabolically active, just like an endocrine gland, but in a toxic manner. It secretes a number of molecules that increase inflammation and cause insulin resistance. In doing so, it promotes diseases associated with inflammation and increases the blood clotting tendency. In women, a high waist-hip ratio is associated with increased chances of getting breast cancer and developing gall bladder problems.

Weightlifting helps reduce belly fat


Measurement of Waist Hip Ratio

Using a standard tape, measure your waist at the midpoint between the lower edge to the ribs and the upper edge to the hips (iliac crest); measure the hips at their widest circumference.

The best way to improve this Waist-Hip Ratio is through regular exercises for 30 - 60 minutes every day. Weight lifting or resistance training have a unique benefit in reducing this deep belly fat.

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Acanthosis nigricans - a velvety, brownish-black patch of thickened skin- is an indicator of insulin resistance

Insulin Resistance

This is a decrease in the normal biological response to a given amount of insulin hormone that keeps blood sugar levels within the normal range.

Causes of Insulin Resistance:

  • Obesity
  • Severe infections
  • Trauma
  • Surgery
  • Hormonal imbalance - Excess Growth Hormone (acromegaly); excess Cortisol (Cushing's syndrome)
  • Autoimmunity

Middle-aged women in whom insulin resistance occurs, most often along with other autoimmune conditions, have antibodies against insulin receptors in the body. They also suffer from other autoimmune disorders such as systemic lupus erythematosus (SLE), Sjogren's syndrome, vitiligo (white spot disease), alopecia, Raynaud's phenomenon (pale, white fingers) and rheumatoid arthritis.

Acanthosis nigricans, a velvety, brownish-black patch of thickened skin that is prominent around the neck, on skin folds in the underarms or groin, often brings this condition into notice.

Parameters of harmful belly fat

Waist circumference
>102 cm
>88 cm
Waist Hip Ratio

Regular exercise reduces risk of Insulin Resistance and Syndrome - X


Syndrome - X or CHAOS

In an overweight individual with type-2 diabetes, increased blood glucose levels, increased insulin hormone, increased blood cholesterol and high blood pressure coexist. A combination of these can put the person at risk of coronary artery disease and stroke. Resistance to actions of insulin hormone leads to an abnormal increase in blood glucose levels. this in turn causes more insulin to be released from the pancreas, that may or may not be of sufficient magnitude to balance blood sugar. This excess of insulin hormone contributes to an increase in the levels of "bad fats" VLDL (very low-density lipoproteins ) and triglycerides. It also causes salt retention in the body that increases blood pressure. Excess of insulin hormone may also initiate hardening of arteries (atherosclerosis). This combination that has obesity as its root cause is named as syndrome X or CHAOS (Coronary artery disease, High blood pressure, Arterial hardening, Obesity and Stroke).


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