. 2025 Oct 1;8(10):e2537942.

doi: 10.1001/jamanetworkopen.2025.37942.

Cardiometabolic Outcomes Among Adults With Abdominal Obesity and Normal Body Mass Index

Kedir Y Ahmed^{1

2}, Setognal B Aychiluhm^{1

3}, Subash Thapa¹, Teketo Kassaw Tegegne⁴, Daniel Bekele Ketema^{5

6}, Zemenu Yohannes Kassa¹, Getiye Dejenu Kibret⁷, Bereket Duko^{8

9}, Desalegn Markos Shifti¹⁰, Meless G Bore¹, Zekariyas Sahile Nezenega¹, Asres Bedaso¹¹, Aklilu Habte Hailegebireal^{12

13}, Habtamu Mellie Bizuayehu¹⁴, Abel F Dadi^{15

16}, Tesfalidet Beyene¹⁷, Mohd Farooq Shaikh^{1

18}, Tahir A Hassen¹⁷, Abdulbasit Seid¹⁹, Feleke H Astawesegn¹, Sewunet Admasu Belachew¹⁴, Cheru Tesema Leshargie¹, Fentaw T Berhe^{20

21}, Utpal K Mondal¹, Damien Little¹, Kasuni Akalanka Hewa Marambage¹, Shakeel Mahmood¹, Allen G Ross^{1

22}

Affiliations

¹ Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
² Translational Health Research Institute, Western Sydney University, Campbelltown Campus, New South Wales, Australia.
³ Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁴ Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.
⁵ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁶ School of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
⁷ Center for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁸ Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia.
⁹ Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
¹⁰ Child Health Research Centre, The University of Queensland, Brisbane, Australia.
¹¹ The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council New South Wales, Sydney, Australia.
¹² School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
¹³ Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
¹⁴ First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
¹⁵ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹⁶ Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
¹⁷ Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
¹⁸ School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia.
¹⁹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
²⁰ Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
²¹ School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
²² Now with College of Medicine, Ajman University, Ajman, United Arab Emirates.

PMID: 41105408
PMCID: PMC12534855
DOI: 10.1001/jamanetworkopen.2025.37942

Cardiometabolic Outcomes Among Adults With Abdominal Obesity and Normal Body Mass Index

Kedir Y Ahmed et al. JAMA Netw Open. 2025.

. 2025 Oct 1;8(10):e2537942.

doi: 10.1001/jamanetworkopen.2025.37942.

Authors

Affiliations

¹ Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
² Translational Health Research Institute, Western Sydney University, Campbelltown Campus, New South Wales, Australia.
³ Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁴ Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.
⁵ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁶ School of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
⁷ Center for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁸ Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia.
⁹ Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
¹⁰ Child Health Research Centre, The University of Queensland, Brisbane, Australia.
¹¹ The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council New South Wales, Sydney, Australia.
¹² School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
¹³ Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
¹⁴ First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
¹⁵ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹⁶ Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
¹⁷ Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
¹⁸ School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia.
¹⁹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
²⁰ Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
²¹ School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
²² Now with College of Medicine, Ajman University, Ajman, United Arab Emirates.

PMID: 41105408
PMCID: PMC12534855
DOI: 10.1001/jamanetworkopen.2025.37942

Abstract

Importance: Cardiometabolic disorders are the leading causes of death and disability worldwide, with abdominal obesity being a major contributor to these conditions. Data on normal-weight abdominal obesity and its association with cardiometabolic outcomes are limited.

Objective: To investigate the global prevalence of normal-weight abdominal obesity and its association with cardiometabolic outcomes.

Design, setting, and participants: This cross-sectional study used data from the World Health Organization Stepwise Approach to Surveillance of Noncommunicable Disease Risk Factors survey datasets between 2000 and 2020. The surveys were from 91 countries across Africa, the Americas, the Eastern Mediterranean region, Europe, Southeast Asia, and the Western Pacific region. Adults aged 15 to 69 years or 18 to 69 years (based on participating countries' national definitions of adult) were included. The data were analyzed between April 2024 and January 2025.

Exposure: Normal-weight abdominal obesity, which is defined as a normal body mass index (BMI) of 18.5 to 24.9 (calculated as weight in kilograms divided by height in meters squared) but high waist circumference (female, ≥80 cm; male, ≥94 cm).

Main outcomes and measures: The main outcomes were hypertension, diabetes, cholesterol, and triglycerides. Associations with these cardiometabolic outcomes were quantified using multivariable binary logistic regression models.

Results: The study included 471 228 participants (mean [SD] age, 40.4 [15.9] years; 57.8% female). Globally, 21.7% (95% CI, 21.5%-21.8%) of participants with a normal BMI had abdominal obesity, ranging from 15.3% (95% CI, 15.0%-15.7%) in the Western Pacific region to 32.6% (95% CI, 31.9%-33.3%) in the Eastern Mediterranean region. Lebanon had the highest prevalence of normal-weight abdominal obesity (58.4%; 95% CI, 54.1%-62.6%), while Mozambique had the lowest (6.9%; 95% CI, 5.9%-8.1%). Factors associated with abdominal obesity included primary and secondary or higher education (odds ratio [OR], 1.53 [95% CI, 1.50-1.57] and 2.38 [95% CI, 2.33-2.43], respectively), unemployment (OR, 1.25 [95% CI, 1.23-1.27]), low fruits and vegetables intake (OR, 1.22 [95% CI, 1.20-1.24]), and physical inactivity (OR, 1.60 [95% CI, 1.57-1.63]). Additionally, having a normal BMI and abdominal obesity was consistently associated with hypertension (OR, 1.29 [95% CI, 1.25-1.33]), diabetes (OR, 1.81 [95% CI, 1.72-1.90]), high total cholesterol (OR, 1.39 [95% CI, 1.35-1.44]), and high triglycerides (OR, 1.56 [95% CI, 1.48-1.64]).

Conclusions and relevance: In this cross-sectional study, more than 1 in 5 adults worldwide with a normal BMI had abdominal obesity. Relying solely on BMI may be insufficient to identify these high-risk individuals and provide timely interventions. The findings have implications for the United Nations' Sustainable Development Goal targets 2.2 (ending all forms of malnutrition) and 3.4 (reducing premature mortality from noncommunicable diseases).

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

**Figure 1.. Associations Between Different Patterns of Obesity and Hypertension Across 6 World Health Organization (WHO) Regions, 2000 to 2020**
All associations between obesity patterns and hypertension were adjusted for age, sex, educational status, occupational status, smoking, alcohol use, fruits and vegetables consumption, and physical activity. Reference categories were normal body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), low waist circumference (WC), and low WC and normal BMI. Body mass index categories were 18.5 to 24.9 for normal weight, 25.0 to 29.9 for overweight, and 30.0 or higher for obesity. Abdominal obesity was considered as a waist circumference of 80 cm or higher for female individuals and 94 cm or higher for male individuals.

**Figure 2.. Associations Between Different Patterns of Obesity and Diabetes Across World Health Organization (WHO) Regions, 2000 to 2020**
All associations between obesity patterns and diabetes were adjusted for age, sex, educational status, occupational status, smoking, alcohol use, fruits and vegetables consumption, and physical activity. Reference categories were normal body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), low waist circumference (WC), and low WC and normal BMI. Body mass index categories were 18.5 to 24.9 for normal weight, 25.0 to 29.9 for overweight, and 30.0 or higher for obesity. Abdominal obesity was considered as a waist circumference of 80 cm or higher for female individuals and 94 cm or higher for male individuals.

**Figure 3.. Associations Between Different Patterns of Obesity and High Total Cholesterol Across World Health Organization (WHO) Regions, 2000 to 2020**
All associations between obesity patterns and total cholesterol were adjusted for age, sex, educational status, occupational status, smoking, alcohol use, fruits and vegetables consumption, and physical activity. Reference categories were normal body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), low waist circumference (WC), and low WC and normal BMI. Body mass index categories were 18.5 to 24.9 for normal weight, 25.0 to 29.9 for overweight, and 30.0 or higher for obesity. Abdominal obesity was considered as a waist circumference of 80 cm or higher for female individuals and 94 cm or higher for male individuals.

**Figure 4.. Associations Between Different Patterns of Obesity and High Triglycerides Across World Health Organization (WHO) Regions, 2000 to 2020**
All associations between obesity patterns and triglycerides were adjusted for age, sex, educational status, occupational status, smoking, alcohol use, fruits and vegetables consumption, and physical activity. Reference categories were normal body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), low waist circumference (WC), and low WC and normal BMI. Body mass index categories were 18.5 to 24.9 for normal weight, 25.0 to 29.9 for overweight, and 30.0 or higher for obesity. Abdominal obesity was considered as a waist circumference of 80 cm or higher for female individuals and 94 cm or higher for male individuals.

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References

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Cardiometabolic Outcomes Among Adults With Abdominal Obesity and Normal Body Mass Index

Affiliations

Cardiometabolic Outcomes Among Adults With Abdominal Obesity and Normal Body Mass Index

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous