News release

From: International Congress on Obesity 2026

Hidden risk of heart disease in seemingly healthy people who are living with overweight or obesity

·       Abdominal obesity is a better predictor of cardiac ill health and death than BMI, study of hundreds of thousands of middle-aged adults in UK finds.

·       Taking waist-based measurements along with BMI could prevent hundreds of thousands of deaths globally in just a decade, University of Glasgow researchers say.

Individuals with overweight or obesity can have a higher risk of heart disease despite appearing to be healthy, new research being presented at the International Congress on Obesity in Mexico City (15-17 July) shows.

Using waist-based measurements along with body mass index (BMI) to identify this hidden risk and intervene early could prevent hundreds of thousands from dying from heart attacks, strokes and other cardiac problems in the years to come, said the researchers from the University of Glasgow, Glasgow, UK.

“We know that excess weight, particularly around the waist, increases the risk of heart disease, says lead researcher Ms Estefania Fuentes Avalos. “In 2021, an estimated 1.9 million cardiovascular disease deaths – almost one in ten heart-related deaths worldwide – were attributed to high body mass index.

“The link between central, or abdominal, obesity and heart disease is especially strong because fat stored around the waist, known as visceral fat, is metabolically active and releases inflammatory substances into the bloodstream. Over time, this chronic inflammatory state can damage blood vessels and accelerate the build-up of arterial plaque, significantly increasing the risk of heart attacks.”

BMI, a measure of weight compared to height, is routinely used to assess people’s weight status, defining whether they have normal weight, overweight or obesity. However, it doesn’t factor in where fat is stored in the body.

To address this and other limitations of BMI, The Lancet Diabetes & Endocrinology Commission recently proposed a different way of assessing obesity status (1).

The Lancet Commission framework uses BMI and central adiposity markers (waist measurements) to determine if an individual has excess body fat. Individuals with excess body fat are then categorised as having pre-clinical obesity or clinical obesity, depending on whether they have long-term obesity-related conditions such as high blood pressure, joint pain and sleep apnoea.

The new study investigated whether this method is better at identifying individuals at high risk of cardiovascular disease than BMI alone.

“Detecting cardiovascular risk at an early stage is essential, particularly at the pre-clinical stage of obesity, as it provides a window of opportunity to implement timely, targeted interventions before obesity-related complications such as high blood pressure arise,” says Ms Fuentes Avalos. “This underpins our focus on risk stratification in this group, with the aim of detecting high-risk individuals who may otherwise be overlooked.”

Ms Fuentes Avalos examined data on 382,769 adults of white ethnicity in the UK Biobank study (age range 40-69 years, average age 56 years, 53% women).

According to the Lancet Commission framework, 285,190 (74%) of the participants had excess body fat, based on BMI and central adiposity markers*.

102,237 (26.7%) of this group were classified as having preclinical obesity (excess body fat without long-term obesity-related conditions) and 182,953 (47.8%) with clinical obesity (excess body fat and long-term obesity-related conditions).

The remainder did not have excess body fat and long-term obesity-related conditions. They were classified as not having obesity and acted as the reference group.

None of the participants had cardiovascular disease at the start of the study. Hospital and death records provided information about diagnoses of, and deaths from, heart attacks, strokes and other forms of cardiovascular disease over the next 12 years.

During this time, there were 41,742 new cases of, and 8,832 deaths from, cardiovascular disease.

Analysis of the data revealed that individuals with clinical obesity were much more likely to develop or die from cardiovascular disease than those without obesity.

Women with clinical obesity developed cardiovascular disease at a rate that was 2.5-fold higher than women without obesity. They also died from cardiovascular disease at an almost three-fold (2.8 fold) higher rate than women without obesity.

Similarly, men with clinical obesity developed cardiovascular disease at an almost two-fold higher rate (1.9-fold) and had a 2.6-fold higher rate of cardiovascular mortality than men without obesity.

However, the individuals with preclinical obesity were also at higher risk, despite not having any obesity-related conditions and so seeming to be in good health.

Women with preclinical obesity developed cardiovascular disease at a 38% higher rate, and died from cardiovascular disease at a 46% higher rate, than women without obesity.

For men, preclinical obesity was associated with an 18% higher rate of developing cardiovascular disease and 52% higher rate of cardiovascular disease mortality.

All of the results were adjusted for socioeconomic status and lifestyle factors including smoking and alcohol consumption.

Further analysis showed that the more “high-risk” central adiposity markers (waist measurements)* an individual had, the more likely they were to develop heart disease. For example, a woman with one high-risk marker (waist circumference, waist-to-hip ratio or waist-to-height ratio) was 17% more likely develop cardiovascular disease than a woman without any high-risk waist measurements. Having all three high-risk measurements increased the risk by 64%.

The study also found that that waist measurements were more accurate at predicting cardiovascular disease than BMI.

The researchers concluded that individuals with preclinical obesity are at higher risk of developing, and dying from, cardiovascular disease despite appearing to be healthy.

Ms Fuentes Avalos said: “Preclinical obesity is a critical window of opportunity to improve heart health. Routinely measuring waist circumference, waist-to-hip ratio and waist-to-height ratio along with BMI would identify high-risk individuals who might be overlooked by assessing BMI alone.

“They could then be offered intensive diet and exercise programmes to improve their cardiac and overall health.

“We have calculated that early intervention could prevent 45% of new cases of cardiovascular disease and 41% of cardiovascular disease deaths in similar populations.

“Given that cardiovascular disease remains a leading cause of ill health and death globally, routinely taking waist measurements along with BMI could prevent hundreds of thousands of deaths over a decade alone.”