What is a healthy waist circumference and why does it matter?
A larger waist circumference is associated with a higher risk of premature death, diabetes and cardiovascular disease, independent of body weight. If you also have other risk factors, it is wise to discuss this with your doctor.
Belly fat is biologically active: it secretes inflammatory substances that disrupt insulin function and damage blood vessels. The deep fat surrounding the organs is more harmful than the fat you can feel just beneath the skin. That deep abdominal fat disrupts metabolism more strongly, even when accounting for body weight or BMI.
Every 10 centimetres of extra waist circumference is associated with an 11% higher risk of premature death, independent of BMI. The ratio between waist and hips says even more: every 0.1 unit increase in that ratio is associated with a clearly higher risk of death. Notably, the opposite holds true for hip and thigh fat: 10 centimetres more hip circumference is associated with a 10% lower risk of death, and 5 centimetres more thigh circumference with as much as an 18% lower risk. Fat around the hips and thighs therefore appears considerably less harmful than abdominal fat.
A large waist increases the risk of type 2 diabetes, independent of body weight and blood values. Duration also plays a role: years of carrying a large waist accumulates the risk. For every 50 'waist circumference-years', the risk of diabetes increases by 38%. The longer you have a large belly, the more damage builds up.
Yet a large waist circumference alone does not automatically identify who is at greatest risk. It is only when other risk factors are also present, such as high blood pressure or diabetes, that the risk becomes truly concerning. In that case, the risk of cardiovascular disease or early death can more than triple compared to people without those risk factors. Moreover, 'metabolically healthy obesity' is often temporary: in approximately three quarters of people, that pattern eventually shifts to a less healthy picture with greater risks.
A specific threshold for what is 'healthy' does not appear in the studies underlying this answer. What they do show is this: the larger your waist circumference, the higher the risk, and the longer that circumference stays large, the more it increases. If you also have high blood pressure, elevated blood sugar or unfavourable cholesterol, discuss with your doctor what your waist circumference means for you.
This answer is based on large studies in which people were followed over longer periods, partly pooled across dozens of such studies with a combined total of more than 2.5 million participants. The associations are consistent and strong; however, cause and effect have not been proven with certainty, only made plausible. The evidence for the biological mechanism of abdominal fat is more robust: that mechanism is well established. The sources used say nothing about specific threshold values.
What is a healthy cholesterol level and when should I be concerned?
A normal LDL value does not give a complete picture of your cardiovascular risk. Ask your doctor about your remnant cholesterol as well, especially if cardiovascular disease or Alzheimer's disease runs in your family.
What is a healthy HDL (good cholesterol) level, and can I raise it?
Raising HDL through lifestyle is possible, but your genes set the ceiling. Lowering triglycerides through less sugar and alcohol, more exercise, and weight reduction has the greatest effect.
How healthy are my blood vessels / what is my vascular age?
For a first impression of your vascular health, an ApoB blood test is the simplest and most accessible step; a CAC scan adds the most value when your risk remains unclear after blood testing.
What is a healthy resting heart rate?
A resting heart rate between 60 and 80 beats per minute is considered generally normal, but lower is fine for active people, and above 78 the risk begins to rise measurably. Exercise regularly, stop smoking, and do not let your heart rate creep up over the years.
What is a healthy ApoB level?
There is no fixed 'healthy' ApoB value, but below 82 mg/dL the risk of a stroke already decreases measurably. ApoB offers better protection than LDL alone, but discuss your personal target with your doctor, as it depends on your overall risk profile and any medication you may be taking.
How healthy is olive oil and what is it good for?
Olive oil, and extra-virgin olive oil in particular, is well supported as protective for the heart and blood vessels, especially when used in place of butter and as part of a varied, plant-based diet.