A large proportion of the population has abdominal obesity despite a normal BMI, and these individuals are at increased cardiometabolic risk, two new studies found. 

In a global cross-sectional study published on October 17, 2025, in JAMA Network Open, more than 1 in 5 adults with a normal BMI had abdominal obesity. In these individuals, abdominal obesity was consistently associated with hypertension, diabetes, high total cholesterol, and high triglycerides, with some differences by global region. 

“Individuals with normal BMI but abdominal obesity are often overlooked for appropriate interventions…. We believe it is important to use both BMI and waist circumference together rather than in isolation to provide a more complete and accurate assessment of cardiometabolic risk in clinical settings,” lead author Kedir Y. Ahmed, MPH, PhD, research fellow of rural public health at the Rural Health Research Institute, Orange, New South Wales, Australia, told Medscape Medical News. 

Ahmed added that this recommendation aligns with a 2020 published consensus statement recommending that waist circumference be included as a vital sign in clinical settings. 

The other study, published on October 15, 2025, also in JAMA Network Open, aimed to examine the impact of the recent Lancet Commission obesity definition on obesity prevalence, using data from the US-based All of Us (AoU) cohort. Overall, more than one quarter of the AoU population did not have obesity by the traditional race-based BMI cutoffs but did have at least two elevated anthropomorphic measurements: waist circumference, waist-to-hip ratio, and/or waist-to-height ratio. The authors termed that phenomenon “anthropomorphic-only obesity.” 

Here again, “anthropometric-only obesity has significant morbidity associated with it, both for diabetes and cardiovascular disease,” lead researcher Steven K. Grinspoon, MD, professor of medicine at Harvard Medical School and chief of the Massachusetts General Hospital metabolism unit, Boston, told Medscape Medical News. 

Of note, Lancet Commission lead author Francesco Rubino, MD, told Medscape Medical News that the report did not advise defining obesity without regard for BMI. “The Commission’s framework allows the use of two additional anthropometric measures to confirm excess adiposity, but not at any BMI level. We emphasized that BMI should still be used as a screening tool, not alone as diagnostic of excess adiposity, unless the BMI is above 40. We said that confirmation of obesity requires clearer evidence of excess adiposity, particularly for those with BMI 30-40… [W]e are not recommending the classification of normal-BMI individuals as having obesity.” 

Worldwide, Over One Fifth With Normal BMI Have Abdominal Obesity

Ahmed and colleagues used data from the World Health Organization (WHO) Stepwise Approach to Surveillance of Noncommunicable Disease Risk Factors survey datasets from 2000 to 2020, with surveys from 91 countries in Africa, the Americas, the Eastern Mediterranean region, Europe, Southeast Asia, and the Western Pacific region. The survey population totaled 471,228 people aged 15-69 years, of whom 57.8% were female and 42.2% male. 

The global prevalence of abdominal obesity — defined as a waist circumference ≥ 80 cm for nonpregnant females and ≥ 94 cm for males — was 45.4%, ranging from 31.4% in Southeast Asia to 61.6% in Europe. 

Among those with a WHO-defined normal BMI of 18.5-24.9, 21.7% had abdominal obesity, ranging from 15.3% in the Western Pacific region to 32.6% in the Eastern Mediterranean. By country, the highest prevalence was 58.4% in Lebanon and the lowest was 6.9%, in Mozambique. 

Overall, abdominal obesity was associated with higher odds of hypertension across all regions (odds ratio [OR], 1.58 vs no abdominal obesity), while abdominal obesity with a normal BMI was also associated with significantly greater odds of hypertension globally (OR, 1.29). 

Similarly, both abdominal obesity overall and abdominal obesity with normal BMI were associated with diabetes across all regions (OR, 2.30 and 1.81, respectively), elevated total cholesterol (OR, 1.49 and 1.39, respectively), and elevated triglycerides (OR, 1.60 and 1.56, respectively), each with a few statistical exceptions by region. 

“Relying solely on BMI may be insufficient to identify those high-risk individuals and provide timely interventions,” Ahmed and colleagues concluded. 

Can Visceral Adiposity Be Treated Separately?

In their population-based longitudinal cohort study, Grinspoon, first author Lindsay T. Fourman, MD, and colleagues examined data from 301,026 individuals in the AoU database, of whom 61% were female and 39% male. They were racially mixed, with just over half (53.2%) being White. Using traditional BMI-only criteria, 42.9% had obesity, while another 25.9% had anthropomorphic-only obesity. The prevalence of the latter entity was significantly higher in males than in females (32.5% vs 21.7%) and in people older than 70 years (78.3%). 

Compared with individuals who had both BMI meeting traditional obesity criteria plus at least two elevated anthropomorphic measures, those with anthropometric-only obesity were older (median age 54 vs 60 years, respectively; P <.001), were more commonly male (34.7% vs 48.9%, respectively, P <.001), and had higher educational status and income. 

Anthropometric-only obesity increased with age, from 26.9% of the total group with obesity aged 18-29 years to 52.9% of those aged 70 or older. 

The risk for incident type 2 diabetes was highest among the individuals who had both BMI-defined obesity and anthropomorphic obesity (adjusted hazard ratio [AHR], 3.95) compared to those with neither of these condition, while that risk was still elevated in the anthropomorphic-only group (AHR, 2.12). The risks for cardiovascular events (AHR, 1.81 and 1.55, respectively) and all-cause mortality (AHR, 1.22 and 1.20) were similarly elevated in both groups. 

Grinspoon told Medscape Medical News that the findings suggest a role for medications that reduce visceral adiposity without significantly altering weight. One such agent is tesamorelin, a synthetic growth hormone analog approved for the treatment of HIV lipodystrophy. “Maybe there are types and categories of drugs that could be used more to move fat around than reduce it altogether in this now apparent sub population of people.” 

Ahmed’s study was funded by the Commonwealth of Australia, represented by the Department of Health. He has no further disclosures. Grinspoon reported receiving personal fees from Marathon Asset Management LP and Exavir Therapeutics during the conduct of the study and grant support from Kowa Pharmaceuticals America Inc,, Gilead Sciences, Inc,, and Viiv Healthcare. Rubino has received research grants from Ethicon (Johnson & Johnson), Novo Nordisk, and Medtronic; consulting fees from Morphic Medical; speaking honoraria from Medtronic, Ethicon, Novo Nordisk, Eli Lilly, and Amgen; has served (unpaid) as a member of the scientific advisory board for Keyron and a member of data safety and monitoring board for GI Metabolic Solutions; is president of the Metabolic Health Institute (nonprofit); and is sole director of Metabolic Health International and London Metabolic and Bariatric Surgery (private practice). Fourman has received grant support from Chiesi Farmaceutici SpA and personal fees from Chiesi Farmaceutici SpA and Theratechnologies. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social