• Sidney C Smith and David Haslam.
• Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7075, USA. scs@med.unc.edu
• Curr Med Res Opin. 2007 Jan 1; 23 (1): 29-47.

ObjectiveAbdominal obesity, measured by waist circumference (WC), is a more accurate predictor of cardiometabolic risk than general obesity measured by body mass index (BMI). The 'Shape of the Nations' survey was performed to assess knowledge and understanding of the increased risk associated with abdominal obesity.Research Design And MethodsApproximately 100 primary care physicians (PCPs), 400 members of the general population and 100 patients at risk for cardiovascular disease (CVD) were interviewed in each of 27 countries using a structured questionnaire. Demographic characteristics were obtained and subjects were asked about their understanding of risk factors, assessment of body weight and shape, and use of WC to assess cardiometabolic risk.ResultsOn average, 39% of all people visiting a PCP worldwide were overweight or obese, according to PCP reports; in North America, this proportion was 49%. Abdominal obesity was recognised by 58% of PCPs worldwide as a significant risk factor for heart disease; an equal proportion considered high BMI to be a risk factor. Worldwide, 45% of all physicians reported never measuring WC and 52% overestimated the WC that puts their patients at risk. In the general population, 42% were aware of the association between abdominal obesity and risk, but a higher proportion (60%) considered high BMI an important risk factor. Very few of the general population measured their waist or knew the WC that is considered to confer significantly increased risk. More than half (59%) of at-risk patients had not been informed by their doctors about the link between abdominal obesity and heart disease.ConclusionsThe Shape of the Nations survey findings demonstrate the need for education and action to improve preventive health efforts worldwide by educating PCPs, the general population and patients at risk about the dangers of abdominal obesity and of WC as an easy, reliable way to assess cardiometabolic risk.

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