Don't throw the baby out with the bath water

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Abstract
The article by Janssen et al (1) in this issue of the Journal examined whether body mass index (BMI; in kg/m2) adds to the risk associated with waist circumference (WC). The authors made several important points. On the basis of data from the National Health and Nutrition Examination Survey conducted between 1988 and 1994, they showed that the BMI is related to cardiovascular disease (CVD) risk factors in a graded fashion—ie, as the BMI increases, the CVD risk increases. However, other conditions, such as diabetes, sleep apnea, cancer, and osteoarthritis, were not included in the risks evaluated in their analysis, which limits their overall conclusions about the relation of BMI and WC to CVD risk. Moreover, they showed that most of the information about CVD risks that is obtained from BMI can also be obtained from WC. Finally, Janssen et al showed that, when WC was used as a continuous variable, it accounted for the risk of CVD better than it did when it was dichotomized with the use of the risk algorithm published by the National Institutes of Health (2). These are important findings, and they led me to propose a new way of classifying WC (Table 1).