Do you have metabolic syndrome?

Why the Indian thresholds are different

Metabolic syndrome is a cluster: too much fat around the middle, blood pressure creeping up, triglycerides up, HDL down, sugar drifting. Having three of them roughly doubles cardiovascular risk and multiplies the risk of type 2 diabetes several times over.

The waist thresholds used here are 90 cm for men and 80 cm for women. Those are the South Asian values, adopted in the harmonised 2009 international definition and in the Indian consensus statement published the same year. The unmodified American criteria use 102 and 88, which for an Indian population misses a great deal.

One further detail that matters here more than elsewhere: the harmonised definition removed the older requirement that a raised waist must be one of the three. Any three of the five will do. That change was important for Indian practice, because the lean but metabolically unwell pattern is common here and the older rule missed it.

How to measure your waist properly

1. Stand up straight, feet together, arms relaxedLook straight ahead. Do not hold your breath and do not pull your stomach in.
2. Find the top of your hip boneThe tape goes just above it, horizontally all the way round. Not at the navel, which is a different place on different people and moves with weight.
3. Breathe out normally, then read the tapeAt the end of an ordinary breath out, not a forced one.
4. Snug, not tightThe tape should sit against the skin without denting it. Over bare skin or one thin layer, never over a jumper.
5. Same place, same way, every timeThe single commonest error in self-measurement is that the tape slopes down at the back where you cannot see it. Get someone to check, or use a mirror.

Fasting, in the morning, gives the most comparable readings between visits.

What to do with three or more

Everything in this cluster moves in the same direction with weight loss, and it moves faster than the weight does. Waist usually improves first. Triglycerides fall quickly. Blood pressure often needs its tablet reduced within a few months. The what it buys tool puts published numbers on each of those.

Criteria: Alberti KGMM and colleagues, Harmonizing the Metabolic Syndrome, a Joint Interim Statement, Circulation 2009;120:1640-1645, using the South Asian waist values. Cross-checked against Misra A and colleagues, Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians, JAPI 2009;57:163-170, which gives the same five criteria and the same thresholds. Waist protocol from the same consensus. Self-measurement reliability: Barrios P and colleagues, BMC Medical Research Methodology 2016;16:49.