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Waist circumference is a simple measure for estimating the degree of visceral fat that can be readily used in primary care settings. Because the presence of excess fat in the abdomen is associated with an increased risk of developing cardiovascular disease (Pennings et al., 2025), this measure can provide useful information about the health risks associated with someone’s weight.
Waist circumference should be measured with a tape measure at the highest point of the anterior iliac crest. (Some organizations suggest measuring at slightly different locations; it is important to be consistent in measurement technique to accurately track changes over time.) A high-risk waist circumference is defined as ≥40 inches (102 cm) for men and ≥35 inches (88 cm) for women (≥35.4 inches [90 cm] for Asian men; ≥31.5 inches [80 cm] for Asian women).
Kathryn N. Porter Starr, PhD, RDN, Associate Professor of Medicine – Geriatrics, Duke University School of Medicine, Research Health Scientist, Durham VA Health System
Beyond BMI and waist circumference, we need to consider body composition through methods like DEXA or bioelectric impedance analysis (BIA) when possible. Staging the disease by assessing complications such as metabolic or cardiovascular disease and functional decline helps identify individuals at greater risk for loss of independence and guides proactive treatment aligned with patient goals.
Measurements of body fat percentage may be particularly relevant for patients with extremes in muscle mass (e.g., very muscular individuals and those with sarcopenia) and may be a better measure than weight when assessing the impact of interventions intended to improve muscle mass.
Body composition assessment in older adults requires methods that capture age-related changes in muscle, fat, and bone while also being practical for this population. Dual-energy X-ray absorptiometry (DEXA) is especially valuable because it provides precise measures of lean mass, fat mass, and bone mineral density, making it the gold standard for studying sarcopenia and osteoporosis (Viswanathan et al., 2018).
If DEXA scan information is not available, low-cost and reasonably accurate substitutes for assessing body composition are available. Bioelectrical impedance analysis (BIA, using “smart” scales) is a practical alternative for clinical settings because it is inexpensive, quick, and noninvasive; however, hydration variability—common in aging—can limit accuracy. Air displacement plethysmography (ADP; e.g., BOD POD) is another reliable, radiation-free option. However, it may be difficult in practice for some older adults with mobility limitations or claustrophobia. Ultimately, DEXA is most often used in research settings due to its precision, while BIA is commonly applied in clinical practice for monitoring trends, and ADP can serve as a strong middle ground when equipment and participant feasibility allow. Emerging research suggests that visual body composition (VBC), which uses smartphone cameras to estimate percent body fat, may also provide useful information about body composition (Majmudar et al., 2022).
Overview | Assess BMI | Body Composition Assessments | Assess Function | Screen for Sarcopenic Obesity | Assess for Obesity-Related Complications | Take a Thorough Weight History | Assess Medications | Assess References