A study released at the Mayo Medical Center at the European Society of Cardiology annual meeting showed that normal weight people with excess abdominal fat will have a higher risk of death than those who are simply obese. People with a normal body mass index (BMI) but who also have central obesity or a high waist-to-hip ratio have the highest risk of death from cardiovascular disease and a variety of other causes. Dr. Francisco Lopez-Jimenez, a cardiologist at Mayo Medical Center in Rochester and lead author of the study, explained, “While previous studies have told us that central obesity is bad for health, this study presents the new idea that fat distribution is important even for people of normal weight. This group has the highest risk of death, even more than those identified as obese by BMI measurements. From a public health perspective, the implications of this finding are significant.” The researchers analyzed data from a representative sample of the U.S. population from the Third National Health and Nutrition Examination Survey (NHANES III), which included 12,785 people aged 18 and older. The census provided experts with physical measurements including height, weight, hip circumference and waist circumference, as well as comorbidities, socioeconomic status, and physiological and laboratory test results. To determine the number of follow-up deaths, baseline data were matched to the National Death Index (NDI). Respondents were classified into the following 3 categories based on BMI: Normal: 18.5 to 24.9 kg/m2 Overweight: 25.0 to 29.9 kg/m2 Obese: >30 kg/m2 Respondents were classified into the following 2 categories based on waist-to-hip ratio: Normal: <0.85 for women; <0.90 for men Hypertrophy: ≥0.85 for women; ≥0.90 for men The researchers examined age, sex, race , diabetes mellitus, hypertension, smoking, dyslipidemia, and baseline BMI, and excluded patients with chronic obstructive pulmonary disease and cancer. The mean age of those included was 44 years, of whom 47.4% were men, with a median follow-up period of 14.3 years. 2562 deaths, of which 1138 were related to cardiovascular disease. The analysis showed that those with normal weight but central obesity had a 2.08-fold higher risk of death from all causes and a 2.75-fold higher risk of death from cardiovascular disease compared to those with normal BMI and waist-to-hip ratio. Dr. Karine Sahakyan, a cardiovascular disease researcher at Mayo Medical Center in Rochester, said, "The possible reasons for the high risk of death are the greater accumulation of visceral fat, which is associated with insulin resistance and other risk factors, and the lower amount of fat in the hips and thighs, which is thought to be protective of the more limited muscle mass ". Dr. Lopez-Jimenez wants readers to understand that even though they may have a normal BMI, it does not mean they are at low risk for heart disease. People can assess their risk by measuring their waist-to-hip ratio, as the distribution of fat can reveal a lot about them, even if they are of normal weight.