Obesity Indices and Abnormal Lipid Levels: What the Research Reveals

Obesity has emerged as one of the most significant public health challenges of our time, affecting over one-third of the global population. What makes this condition particularly concerning is its well-established link to various metabolic disorders, including dyslipidemia—abnormal levels of lipids in the blood. Recent research has begun to unravel the complex relationship between different obesity measurements and various types of blood lipid abnormalities, offering new insights for early screening and intervention strategies.

In this comprehensive analysis, we'll explore cutting-edge research on how different obesity indices correlate with and predict abnormal lipid levels, particularly in young and middle-aged adults. We'll examine traditional measurements like BMI and waist circumference alongside newer indices such as the Body Roundness Index (BRI) and Abdominal Volume Index (AVI), to determine which offers the most reliable indicator for identifying individuals at risk of dyslipidemia.

Understanding Obesity Measurements: Beyond BMI

For decades, Body Mass Index (BMI) has been the go-to metric for assessing obesity. However, mounting evidence suggests that BMI alone provides an incomplete picture, as it fails to account for body composition and fat distribution—factors that significantly influence metabolic health.

Traditional Anthropometric Indices

Several conventional measurements have been widely used to assess obesity:

• Body Mass Index (BMI): Calculated as weight in kilograms divided by height in meters squared, BMI provides a simple, general assessment of weight status. However, it does not differentiate between muscle and fat, nor does it account for fat distribution.

• Waist Circumference (WC): Measures the circumference around the abdomen at the level of the navel. WC directly assesses abdominal fat accumulation, which is more strongly linked to metabolic disorders than overall adiposity.

• Waist-to-Hip Ratio (WHR): Calculated by dividing waist circumference by hip circumference, WHR provides information about fat distribution patterns.

• Waist-to-Height Ratio (WHtR): Divides waist circumference by height, accounting for the influence of height on waist circumference.

Novel Anthropometric Indices

Recent years have seen the emergence of several innovative obesity indices:

• Body Roundness Index (BRI): Proposed by Thomas and colleagues, BRI is based on height and waist circumference and aims to predict body fat percentage and visceral adiposity tissue. Values typically range from 1 to 16.

• Abdominal Volume Index (AVI): Estimates the volume of the abdomen using waist circumference and hip measurements.

• Conicity Index (CI): Based on geometric theory that as abdominal fat accumulates, body shape changes from a "cylinder" to a double "cone," providing insight into central obesity.

• Neck Circumference (NC): A simple measurement that correlates with upper-body subcutaneous fat.

• Waist-to-Weight Index (WWI): A relatively new index that accounts for both waist circumference and weight.

The Complex Relationship Between Obesity and Blood Lipids

Blood lipids, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), serve as critical markers for cardiovascular health. Research has consistently demonstrated that obesity disrupts normal lipid metabolism, but the exact patterns of these disruptions can vary.

Mechanisms Linking Obesity to Dyslipidemia

The physiological pathways connecting excess adiposity to abnormal lipid profiles involve:

• Adipose Tissue Dysfunction: Excessive adipose tissue, particularly visceral fat, produces inflammatory cytokines and alters adipokine secretion.

• Insulin Resistance: Obesity-induced insulin resistance increases free fatty acid flux to the liver, promoting hepatic triglyceride synthesis.

• Altered Lipoprotein Metabolism: Changes in the production, clearance, and composition of lipoproteins, leading to elevated triglycerides, reduced HDL-C, and increased small, dense LDL particles.

• Genetic and Environmental Factors: Individual genetic predispositions interact with dietary habits and physical activity levels to influence how obesity affects lipid profiles.

Interestingly, recent studies have challenged the idea that obesity-induced dyslipidemia follows a single pattern. Some obese individuals, described as "metabolically healthy obese" (MHO), maintain relatively normal lipid profiles despite excess weight.

Recent Research Findings: Obesity Indices and Lipid Abnormalities

Study 1: Comprehensive Analysis of Nine Obesity Indices

A recent study conducted from July to November 2022 evaluated the association between nine obesity indices and various types of abnormal lipid levels in young and middle-aged adults. The research collected complete data from 1,174 participants, analyzing their anthropometric measurements and blood lipid profiles.

Key Findings:

• Triglycerides (TG) showed the strongest correlation with various body measurements.

• Waist Circumference (WC) demonstrated the highest risk association with abnormal TG levels (Odds Ratio: 2.61, P < 0.001) and HDL-C levels (OR: 1.96, P < 0.001).

• Waist-to-Hip Ratio (WHR) showed the greatest association with abnormal LDL-C levels (OR: 1.35, P < 0.05) and non-HDL-C levels (OR: 1.59, P < 0.001).

• In ROC curve analyses, all tested variables gave the highest area under the curve (AUC) values for predicting high TG compared to other plasma lipid abnormalities.

• WC, AVI, and BMI showed AUC values of 0.81, 0.80, and 0.79, respectively, for predicting high TG.

This study concluded that specific obesity-related anthropometric measurements—particularly WC, AVI, and WHR—demonstrate improved predictive accuracy in identifying abnormal lipid levels across diverse types.

Study 2: Normoglycemic vs. Prediabetic Obesity

Another recent study published in the Journal of Personalized Medicine revealed that the relationship between obesity and blood lipids is further complicated by blood sugar status. The research found distinct patterns of lipid abnormalities in obese individuals depending on whether they had normal blood sugar or prediabetes.

Key Findings:

• Normoglycemic Obesity (Normal Blood Sugar):

  • Higher total cholesterol

  • Higher LDL cholesterol

  • Moderately elevated triglycerides

  • Normal HDL cholesterol

• Prediabetic Obesity:

  • Significantly higher triglycerides

  • Lower HDL cholesterol

  • Less dramatic changes in LDL cholesterol

  • More severe overall lipid abnormalities

This study emphasized the importance of considering blood sugar status when assessing obesity-related dyslipidemia and developing personalized treatment approaches.

Lipid Ratios: Enhanced Risk Assessment

Both studies highlighted the value of examining lipid ratios, which often provide more insight than individual lipid measurements:

• Total Cholesterol to HDL Ratio (TC/HDL): Higher values indicate greater cardiovascular risk.

• Triglycerides to HDL Ratio (TG/HDL): Elevated ratios signal insulin resistance and increased heart disease risk.

• LDL to HDL Ratio (LDL/HDL): Higher values suggest greater risk of atherosclerotic plaque development.

These ratios were consistently elevated in both studies, with TC/HDL proving especially valuable in predicting who might develop prediabetes.

Practical Applications: Which Obesity Indices Are Most Valuable?

Based on the combined evidence from these studies, several obesity indices emerge as particularly useful in clinical and public health settings:

• Waist Circumference (WC)

  WC consistently demonstrated the strongest association with various lipid abnormalities, particularly TG and HDL-C. With an AUC of 0.81 for predicting high TG, WC qualifies as an "excellent" indicator according to established criteria. The simplicity of WC measurement makes it particularly valuable for widespread screening efforts.

• Abdominal Volume Index (AVI)

  The AVI showed comparable predictive ability to WC, with an AUC of 0.80 for TG. As a relatively new measure, AVI represents a promising tool for assessing obesity-related health risks in young and middle-aged adults.

• Waist-to-Hip Ratio (WHR)

  WHR demonstrated the strongest association with LDL-C and non-HDL-C abnormalities, suggesting it provides unique information about lipid metabolism that other indices might miss.

• Body Mass Index (BMI)

  Despite its limitations, BMI still showed reasonable predictive ability for lipid abnormalities, with an AUC of 0.79 for TG. Its widespread familiarity and ease of calculation ensure BMI remains a valuable screening tool when more sophisticated measurements aren't available.

Implications for Clinical Practice

• Comprehensive Assessment

  Rather than relying on a single obesity measure, clinicians should consider using multiple complementary indices, particularly WC, AVI, and WHR, to comprehensively assess cardiometabolic risk.

• Blood Sugar Status Consideration

  Assessment of obesity-related dyslipidemia should include evaluation of blood sugar status, as patterns of lipid abnormalities differ between normoglycemic and prediabetic obese individuals.

• Personalized Intervention Strategies

  Treatment approaches should be tailored based on specific patterns of anthropometric measurements and lipid abnormalities. For example:

  • Individuals with elevated WC and abnormal TG might benefit from interventions targeting visceral fat reduction.

  • Those with high WHR and abnormal LDL-C may require more focused attention on LDL-lowering strategies.

• Early Screening

  Given the predictive ability of these indices, incorporating them into routine health assessments could help identify individuals at risk of dyslipidemia before overt cardiovascular disease develops.

Limitations and Future Research Directions

While the studies provide valuable insights, several limitations should be acknowledged:

• Cross-sectional Design: Both studies employed cross-sectional designs, limiting causal inferences about the relationships between obesity indices and lipid abnormalities.

• Potential Confounders: Although the studies controlled for common confounding factors like age, sex, and lifestyle habits, other unmeasured variables might influence the observed associations.

• Binary Cut-offs for Lipids: Using binary thresholds for lipid abnormalities, rather than treating them as continuous variables, may oversimplify complex relationships.

• Regional Specificity: The findings may not generalize to populations with different genetic backgrounds, dietary patterns, or environmental exposures.

Lifestyle Strategies for Improving Obesity-Related Dyslipidemia

Managing dyslipidemia in obesity requires a comprehensive lifestyle approach that targets both weight reduction and lipid profile improvement. Here are key strategies:

✅ Dietary Modifications – Adopting a Mediterranean or DASH diet rich in vegetables, fruits, whole grains, healthy fats (olive oil, nuts), and lean proteins helps regulate lipid metabolism. Reducing refined carbohydrates, added sugars, and trans fats lowers triglycerides and LDL-C while improving HDL-C levels.

✅ Regular Physical Activity – Aerobic exercises (e.g., brisk walking, jogging, cycling) enhance lipid clearance and insulin sensitivity, reducing triglycerides and increasing HDL-C. Resistance training (e.g., weightlifting) improves muscle mass and metabolic rate, promoting long-term lipid control.

✅ Weight Management – A 5-10% weight loss significantly improves lipid profiles, particularly triglycerides and LDL-C. Central obesity reduction (waist circumference) is especially crucial for lowering cardiovascular risk.

✅ Stress Management & Sleep Hygiene – Chronic stress and poor sleep contribute to metabolic dysfunction. Practices like meditation, yoga, and proper sleep hygiene support hormonal balance and lipid regulation.

✅ Limiting Alcohol & Avoiding Smoking – Reducing alcohol intake (especially in those with high triglycerides) and quitting smoking enhances cardiovascular health by improving HDL-C and lowering oxidative stress.

Bottom Line: A multi-faceted lifestyle approach integrating nutrition, exercise, weight control, stress reduction, and behavioral modifications is essential for managing obesity-related lipid abnormalities and reducing cardiovascular risk.

Key Takeaways

• Different obesity indices provide complementary information about cardiometabolic risk, with WC, AVI, and WHR showing particularly strong associations with lipid abnormalities.

• Among blood lipids, triglycerides and HDL-C demonstrate the strongest relationships with obesity measures.

• Patterns of lipid abnormalities differ between obese individuals with normal blood sugar and those with prediabetes, highlighting the need for personalized assessment.

• Lipid ratios (TC/HDL, TG/HDL, LDL/HDL) offer enhanced risk assessment compared to individual lipid measurements.

• Early screening using appropriate obesity indices could facilitate timely intervention to prevent progression to more serious cardiometabolic disorders.

Call to Action

If you're concerned about your weight and its potential impact on your heart health, consider these steps:

• Schedule a comprehensive health assessment that includes not just BMI but also waist circumference and other relevant anthropometric measurements.

• Request a complete lipid profile that includes TC, TG, HDL-C, LDL-C, and calculated ratios.

• Discuss your blood sugar status with your healthcare provider, as this influences how obesity affects your lipid profile.

• Work with healthcare professionals to develop a personalized intervention plan that addresses your specific pattern of risk factors.

• Implement lifestyle modifications including a balanced diet, regular physical activity, stress management, and adequate sleep—all of which can improve both weight status and lipid profiles.

Remember, early detection and intervention are key to preventing the progression from obesity and dyslipidemia to more serious cardiovascular complications.

Frequently Asked Questions (FAQs)

• What is the most accurate way to measure obesity?

  There is no single "best" measure of obesity. Different indices provide complementary information. For comprehensive assessment, consider combining multiple measures including BMI, waist circumference, and waist-to-hip ratio. Research suggests that waist circumference (WC) and abdominal volume index (AVI) are particularly valuable for predicting lipid abnormalities.

• How does obesity cause abnormal blood lipid levels?

  Obesity disrupts lipid metabolism through several mechanisms: adipose tissue dysfunction, insulin resistance, altered hepatic lipid processing, and changes in lipoprotein metabolism. These processes typically lead to elevated triglycerides, reduced HDL-C, and sometimes increased LDL-C levels. The exact pattern varies between individuals based on factors including fat distribution and blood sugar status.

• Can you have normal blood lipids while being obese?

  Yes, some individuals classified as "metabolically healthy obese" maintain relatively normal lipid profiles despite excess weight. However, research suggests this state may be transitional, with many eventually developing metabolic abnormalities over time. Regular monitoring is still advisable.

• Should I be concerned if only my triglycerides are high?

  Elevated triglycerides alone warrant attention, as they're strongly associated with insulin resistance and increased cardiovascular risk. Recent research shows triglycerides have the strongest correlation with various obesity indices, particularly waist circumference. Lifestyle modifications including reducing refined carbohydrates and increasing physical activity can effectively lower triglycerides.

• How often should I have my blood lipids checked?

  Most health organizations recommend adults have their lipid levels checked every 4-6 years if they have no other risk factors. However, if you have obesity, especially with elevated waist circumference or waist-to-hip ratio, annual testing might be appropriate. Discuss your specific needs with your healthcare provider.

• Which obesity index is best for predicting heart disease risk?

  Research suggests that measures of central obesity, particularly waist circumference (WC) and waist-to-hip ratio (WHR), often outperform BMI in predicting cardiovascular risk. The recent studies reviewed show that WC had the highest association with abnormal triglyceride and HDL levels, both significant predictors of heart disease.

• Can improving my obesity indices normalize my blood lipids?

  Yes, reducing central obesity can significantly improve lipid profiles. Even modest weight loss (5-10% of body weight) that reduces waist circumference can lower triglycerides, increase HDL-C, and improve other metabolic parameters. The effect is often more pronounced when weight loss is achieved through a combination of dietary changes and increased physical activity.

• What's the relationship between obesity, blood sugar, and lipids?

  Recent research reveals that blood sugar status significantly influences how obesity affects lipid profiles. Obese individuals with normal blood sugar typically show different patterns of lipid abnormalities compared to those with prediabetes. This highlights the importance of comprehensive metabolic assessment rather than focusing solely on weight or BMI.

• Are there genetic factors that influence the obesity-lipid relationship?

  Yes, genetic factors play a significant role in determining how obesity affects lipid metabolism. Some individuals are genetically predisposed to develop specific lipid abnormalities when gaining weight. Family history of dyslipidemia or premature cardiovascular disease suggests increased genetic risk and may warrant earlier or more frequent screening.

• What lifestyle changes are most effective for improving obesity-related dyslipidemia?

  Evidence supports several lifestyle modifications:

  • Mediterranean or DASH dietary patterns rich in vegetables, fruits, whole grains, and healthy fats

  • Regular physical activity combining aerobic exercise and resistance training

  • Limiting added sugars and refined carbohydrates, which particularly affect triglyceride levels

  • Maintaining adequate sleep and managing stress, which influence both weight regulation and metabolic health

  • Moderate alcohol consumption and avoiding tobacco products

Related Article

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Journal References

Zhou, X., Zou, Z., Liu, Y., Yan, Y., Wu, J., Zhou, G., & Li, M. (2025). Association of anthropometric and obesity indices with abnormal blood lipid levels in young and middle-aged adults. Heliyon, 11(1), e41310. https://doi.org/10.1016/j.heliyon.2024.e41310

Alshuweishi, Y.; Almufarrih, A.A.; Abudawood, A.; Alfayez, D.; Alkhowaiter, A.Y.; AlSudais, H.; Almuqrin, A.M. Patterns of Lipid Abnormalities in Obesity: A Comparative Analysis in Normoglycemic and Prediabetic Obese Individuals. J. Pers. Med. 2024, 14, 980. https://doi.org/10.3390/jpm1409098

Feingold KR. Obesity and Dyslipidemia. [Updated 2023 Jun 19]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305895/

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The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.