Measures used to estimate body fat and quan- tify the associated health risks include BMI, waist CLINICAL STATEMENTS AND GUIDELINES circumference, waist hip ratio, bioimpedance, and dual-energy X-ray absorptiometry (DXA).S4.1-18 BMI, waist circumference, and waist hip ratio are easily measured and therefore are the most widely used in clinical practice. A USPSTF document found good evi- dence supporting the use of BMI to identify adults at increased risk of future morbidity and mortality.S4.1-18 Because obesity/overweight defined by BMI is the most studied and standardized approach, we rec- ommend its measurement for primary screening of individuals needing weight loss. BMI should be inter- preted with caution in persons of Asian ancestry, older adults, and muscular adults.S4.1-19,S4.1-20 4. Increased waist circumference has been associ- ated with increased cardiometabolic and ASCVD Central adiposity, captured by using waist circumference, has been associated with ASCVD risk and may be missed when BMI is used as the only measure of obesity.S4.1-21,S4.1-22 Waist cir- cumference measurement is recommended in all patients with BMI <35 kg/m2 Ethnic differences in waist circumference thresholds associated with cardiometabolic risk have been reported. Waist circumference may be more useful than BMI in persons with abdominal obesity (cen- Definitions of elevated waist cir- cumference as 40 inches ( 102 cm) in men and 35 inches ( 88 cm) in women were recommended by the 1998 National Heart, Lung, and Blood Institute Obesity Initiative Expert PanelS4.1-25 and were adopted by the 2013 AHA/ACC/TOS writing Furthermore, waist circumference assessment is needed for the diagnosis of metabolic syndrome. Thus, combining waist circumference and BMI may be the best approach for assessing obesity-related risk. 