---
title: "Waist circumference predicts mortality more than BMI in adults 65+: study findings"
id: "medical-news-today-0-bmi-vs-waist-size-study-finds-belly-fat-matters-more-than-weight-for-death-risk"
canonical_url: "https://medichelpline.com/clinical-feed/medical-news-today-0-bmi-vs-waist-size-study-finds-belly-fat-matters-more-than-weight-for-death-risk"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "Medical News Today"
source_url: "https://www.medicalnewstoday.com/articles/bmi-vs-waist-size-study-belly-fat-matters-more-weight-death-risk-longevity/"
published_at: "2026-09-01T09:00:00.000Z"
evidence_level: "Verified Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Waist circumference predicts mortality more than BMI in adults 65+: study findings
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/medical-news-today-0-bmi-vs-waist-size-study-finds-belly-fat-matters-more-than-weight-for-death-risk
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** Medical News Today
- **Source URL:** [Original Journal Publication](https://www.medicalnewstoday.com/articles/bmi-vs-waist-size-study-belly-fat-matters-more-weight-death-risk-longevity/)
- **Published At:** 2026-09-01T09:00:00.000Z
- **Evidence Rating:** Verified Feed
## Executive GIST (TL;DR)
- A cohort study of 6,905 adults aged 65 years and older (2011–2024) examined associations between **BMI**, **waist circumference**, and **all-cause mortality**. The study was published in the Journal of the American Geriatrics Society. - In men over 65, an **overweight BMI** was associated with a 46% lower risk of all-cause mortality versus healthy/underweight BMI; class I and II obesity were associated with a 51% lower risk. - A **high waist circumference** was linked to higher all-cause mortality for both sexes; in men it was associated with a 24% higher risk compared with healthy waist size, and a similar effect was observed in women. - Being **underweight** or having a normal BMI but a **high waist circumference** was associated with higher mortality risk in both men and women. - Experts note limitations of BMI: it does not differentiate muscle, bone, and fat, and can misclassify body fat distribution; loss of muscle and bone with age can lower BMI and hide frailty. - **Truncal (visceral) fat**—indicated by larger waist circumference—accumulates around organs (kidneys, liver, heart, pancreas, digestive organs) and is linked to cardiometabolic risk. - Waist circumference thresholds cited: 40 inches or more in men and 35 inches or more in women (NHLBI definitions). - Clinicians and commentators emphasize that BMI alone should not be the sole health metric in older adults, and that waist measurement adds prognostic value, especially for cardiometabolic risk in perimenopausal and menopausal women. - The report highlights potential clinical implications related to frailty, body-fat distribution, transplant eligibility, and concern about weight-loss medication misuse, but detailed clinical guidance was not provided in the source.
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Written by Robby Berman on September 1, 2026 — Fact checked by Jill Seladi-Schulman, Ph.D. ![An older adult male listens to a healthcare professional explain the importance of weight management for longevity while sitting on a couch](https://media.post.rvohealth.io/wp-content/uploads/sites/3/2026/09/getty_912072036_header_1296x728-1024x575.jpg)[Share on Pinterest](https://www.pinterest.com/pin/create/button/?url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2Fbmi-vs-waist-size-study-belly-fat-matters-more-weight-death-risk-longevity&media=https%3A%2F%2Fmedia.post.rvohealth.io%2Fwp-content%2Fuploads%2Fsites%2F3%2F2026%2F09%2Fgetty_912072036_header_1296x728-1024x575.jpg&description=Longevity%3A%20High%20waist%20circumference%20linked%20to%2024%25%20higher%20death%20risk "Share on Pinterest")Extra weight may protect older adults, but abdominal fat remains high risk, according to new research. DMP/Getty Images * **Having a higher body mass index (BMI) is linked to a lower risk of all-cause mortality in males over age 65, compared to people with healthy or underweight BMIs, a new study has found**. * **A high waist circumference, however, was linked to a greater risk of all-cause mortality in the same age group for both males and females.** * **Experts caution against using BMI as the only measure of health, as it cannot measure true body fat or overall health.** A new study explores the effect of both high BMI (body mass index) and greater waist circumference on all-cause mortality for people over 65 years of age. The study found that a BMI indicating overweight is associated with a 46% reduction in the risk of all-cause mortality for males and that class I and class II obesity are associated with a 51% lower risk. Having an underweight BMI or being a normal weight with a high waist circumference were linked to a higher risk of all-cause mortality in both men and women. **In addition, the study reported that a high waist circumference in men was associated with a 24% higher risk of all-cause mortality, compared to people with a healthy waist size. A similar effect was seen in women.** A higher waistline measurement often indicates problematic body fat around the kidneys, liver, heart, pancreas, and digestive organs. The study, published in the _[Journal of the American Geriatrics Society Trusted Source](https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70600),_ incorporated data from a cohort of 6,905 individuals ages 65 years and older from 2011 to 2024. ## The BMI and obesity paradox A person’s [BMI](https://www.medicalnewstoday.com/articles/323586) is a numerical value derived from their height and weight as a means of predicting their amount of body fat. Body fat, in general, is linked to health issues. BMI values are associated with body-type descriptors, including the class I and II categories of obesity cited in this study, as well as underweight, healthy, and overweight. However, BMI alone is not necessarily an indicator of health. For example, a short, muscular person may have a high BMI while being in excellent health. “It has long been recognized,” said [Mir Ali, MD](https://shared.outlook.inky.com/link?domain=www.memorialcare.org&t=h.eJxFjUsSgjAQRK9iZS2E_MUVVxnCiFMmhEqiLCzvrlm57H79ebNnDux6Yvda93Ll_DiOPmJMmSB4yNinvPI9pxctmAuPlLu5g0DsfGKPVtyw_iJWSqVHx2sGj1NI25p8ivG5kYdKaSv9T3IAY5xRN7NcZqvcxQojBfhBDIjzYCUXTmkjtHa6l6O0Quj2g-0nUIE4Q6GA0xqBQltsdGn073y-pUFCHw.MEUCIEnLKF8bslLOhi9OJje5r6b56S4eo4qRsP8VZC-1NgnlAiEAoqGm3C2kWQu8OUbpK6KNwkGnTt0svkSu_qMdnITZ6dc), “that BMI is not an ideal measure, and that a high waist circumference, which typically indicates truncal obesity, is a better predictor of mortality risk.” Ali is the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, and was not involved in the study. In addition, a loss of muscle mass and bone mineral density that may occur with age can result in a lower BMI. This means a higher BMI may indicate better muscle mass and bone density. Older people with illnesses or chronic conditions may also have lost weight, resulting in a lower BMI, which may be reflected in the study. > “Patients with class I or II obesity and a normal waist circumference typically carry most of their weight in their hips and thighs, maintaining a relatively normal torso. Individuals who carry their weight in the lower body likely experience less impact on their internal organs.” > — Mir Ali, MD ## Why being underweight may also be a risk Some of the study’s results are surprising, as they indicate other factors may be at play. “There are some surprises, especially with the paradox of the seemingly protective effect of class I and class II obesity on male mortality independent of waist circumference,” said [Jayne Morgan, MD](https://www.joinmidi.com/team/jayne-morgan), cardiologist and Vice President of Medical Affairs for Hello Heart, who was also not involved in the study. Morgan suggested, “In [older adults], some weight may actually be protective.” **“In fact,” she surmised, “this may actually be less of a healthy state and more of an indicator of less frailty, less debilitating illness, and lack of terminal illnesses that often portend severe weight loss.”** “More weight, therefore, seems to confer a survival advantage,” she said. Morgan also touched on the health risks associated with being underweight. “[The study] lends further evidence that being underweight, regardless of waist circumference, portends the highest mortality risk,” she added. Morgan considers this “especially important in the era of potential GLP-1 abuse and body dysmorphism, especially among women.” ## Why increasing waist size may be a concern The study’s finding of an association between high waistline measurements and increased mortality is less surprising. **Morgan warned that a waist increase of 2–3 inches in perimenopausal and menopausal women may be especially concerning.** It, she said, raises “the specter of increased cardiometabolic risk and all of its inherent health challenges, including increased insulin resistance, increased cholesterol, pro-inflammatory state, and increased cardiac and stroke risk.” Waistline circumference is derived by measuring the waist between the lower rib and the iliac crest, the upper border of the buttocks. **A high waistline circumference is defined as[40 inches or moreTrusted Source](https://www.nhlbi.nih.gov/health/heart-healthy-living/healthy-weight) in men and 35 inches or more in women.** ## Where BMI falls short, especially for women Morgan pointed out that the study found that class I and II obesity did not confer a significant mortality advantage in females. “However, interestingly, being overweight did.” **She said that BMI can be especially misleading as a marker of female health, noting that several high risk body types “fly under the radar” using BMI.** Morgan cited the “skinny fat” female: “This is the female with a normal weight, and normal BMI, but a fat redistribution from the hips to the abdomen. This increased visceral fat carries a higher metabolic burden and higher cardiovascular risk, but the woman is classified as normal despite the increased waist circumference.” She also reported that heart-transplant BMI guidelines often wind up excluding Black women. “Many of these women,” she said, “exhibit the healthier body fat distribution of a smaller waist circumference and rounder hips. This pear-shaped body for females, with weight being carried in the bottom and hips, is the healthier distribution, yet many have been denied heart transplants in part because of this metric.” * [Obesity / Weight Loss / Fitness](https://www.medicalnewstoday.com/categories/fitness-obesity) * [Seniors / Aging](https://www.medicalnewstoday.com/categories/seniors) * [antiaging](https://www.medicalnewstoday.com/categories/cat1-antiaging) ### How we reviewed this article: History Share this article [](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2Fbmi-vs-waist-size-study-belly-fat-matters-more-weight-death-risk-longevity%3Futm_medium%3Dsocial%26utm_source%3Dfacebook%26utm_campaign%3Dsocial-sharebar-referred-desktop "Share on Facebook") [](https://twitter.com/intent/tweet?via=mnt&text=Longevity%3A%20High%20waist%20circumference%20linked%20to%2024%25%20higher%20death%20risk&url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2Fbmi-vs-waist-size-study-belly-fat-matters-more-weight-death-risk-longevity%3Futm_medium%3Dsocial%26utm_source%3Dx%26utm_campaign%3Dsocial-sharebar-referred-desktop "Share on X") ![](https://i0.wp.com/post.medicalnewstoday.com/wp-content/uploads/sites/3/2021/04/Robby-Potrait-Trimmed-BW.png?w=105&h=105) Written by Robby Berman on September 1, 2026 — Fact checked by Jill Seladi-Schulman, Ph.D. ## Was this article helpful? 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