What is the NowPatient Adiposity Ratio Service?
Your waist tells a story your weight can’t. The NowPatient Adiposity Ratio Service uses your Waist-to-Height Ratio (WHtR) — the NICE-endorsed measure of central fat — to flag your real risk of Type 2 Diabetes, cardiovascular disease, and metabolic syndrome. Free, automatic, and always up to date, it alerts you when your risk changes and tracks your progress over time.
What is WHtR and why is it used?
WHtR stands for Waist-to-Height Ratio. It is calculated by dividing your waist circumference by your height, both measured in centimetres. A boundary value of 0.5 was first suggested by Ashwell and Cole in 1996 as a threshold for increased health risk, and has since been validated across numerous global populations.
NICE adopted it in their October 2022 guidelines as a recommended screening tool for central adiposity, endorsing the message: ‘keep your waist circumference to less than half your height.’ A key advantage of WHtR is that the same threshold applies across all adult ages, both sexes, and all ethnic groups — avoiding the need for age, sex, and ethnic-specific adjustments.
Is the Adiposity Ratio Service free?
Yes. The Adiposity Ratio Service is a free service available to all registered NowPatient users.
Is the Adiposity Ratio Service a medical device?
Yes. The Adiposity Ratio Service is classified as a Class I medical device under UK MDR 2002 regulations for its intended use.
Where do I find the Adiposity Ratio Service in my account?
Navigate to the ‘Personalised Insights’ section of your account homepage. The Adiposity Ratio Service Card will be displayed there. If you completed your Health Profile when you first created your NowPatient account, your score will already be calculated and visible. If not, the card will appear locked — select the ‘Unlock’ button and complete the series of questions to activate it.
How is the Adiposity Ratio calculated?
The Waist-to-Height Ratio (WHtR) is calculated using the formula: WHtR = Waist Circumference (cm) ÷ Height (cm). For example, a person with a waist circumference of 85 cm and a height of 170 cm would have a WHtR of 0.50 (85 ÷ 170 = 0.50).
What information does NowPatient need to calculate my score?
The Adiposity Ratio Service uses the following data from your Health Profile:
Waist circumference (cm or inches)
Height (cm, metres, or feet/inches)
Why is central adiposity more harmful than fat elsewhere on the body?
Central adiposity refers to fat stored around your middle, particularly visceral fat around your internal organs. This type of fat is more harmful to your health than fat stored elsewhere, such as on your hips or thighs. Research shows that central adiposity is a stronger predictor of serious health conditions than overall body weight or BMI alone — even if your weight or BMI appears normal, you may still have harmful levels of visceral fat.
How should I measure my waist circumference?
According to WHO guidance, waist circumference should be measured:
At the midpoint between the lower margin of the last palpable rib and the top of the iliac crest
With you standing, arms relaxed at sides
At the end of a normal expiration (breathing out)
Using a non-elastic measuring tape held snugly without compressing the skin
NowPatient recommends measuring your waist at the same time of day each month — for example, first thing in the morning — for the most consistent results.
Step 1 At the midpoint between the lower margin of the last palpable rib and the top of the iliac crest
Step 2 With you standing, arms relaxed at sides
Step 3 At the end of a normal expiration (breathing out)
Step 4 Using a non-elastic measuring tape held snugly without compressing the skin
What is the NICE message about waist size?
NICE recommends the following simple public health message: “Keep your waist circumference to less than half your height.” This translates directly to the WHtR threshold of 0.5, below which no increased cardiometabolic risk from central adiposity is indicated.
What do the Adiposity Ratio scores mean?
Your WHtR places you into one of four risk categories. The table below explains each category and the recommended actions:
Does a high Adiposity Ratio score mean I will definitely develop health problems?
No. The scores only indicate the likelihood of obesity-related health risks. They do not mean you will definitely develop these conditions. Early risk-based interventions and lifestyle changes — such as improving diet, increasing physical activity, and achieving weight loss — can significantly reduce your risks.
What health conditions are associated with an elevated Adiposity Ratio?
Elevated WHtR (≥0.5) is associated with increased risk of the following conditions:
Type 2 Diabetes Mellitus
Cardiovascular Disease (coronary heart disease, stroke)
Hypertension (high blood pressure)
Dyslipidaemia (abnormal cholesterol levels)
Metabolic Syndrome
Non-Alcoholic Fatty Liver Disease
Obstructive Sleep Apnoéa
What should I do if my score puts me at increased or very high risk?
It is very important that you speak to your doctor about screening for cardiometabolic risk factors. Your doctor can arrange tests such as blood pressure measurement, HbA1c (blood sugar), and lipid profile (cholesterol). Ask your doctor about programmes and services that could help reduce your central adiposity — these will be different depending on where you live.
How will NowPatient support me if I am at risk?
NowPatient may automatically qualify you for risk-reducing strategies such as the Weight Loss Programs Service. You will be notified if you are eligible. NowPatient’s AI algorithms continuously monitor your risk factors and send push and in-app notifications if your risk level changes.
What lifestyle changes can help reduce central adiposity?
Making changes to your diet and increasing physical activity are the most effective ways to reduce central adiposity. Achieving a sustained reduction in waist circumference can significantly lower your risk of cardiometabolic conditions. Your doctor can advise on specific programmes and weight management services available in your area, including NHS weight management options for NHS patients.
How do I track my Adiposity Ratio over time?
NowPatient provides a long-term trend graph accessible from the Adiposity Ratio Service Card. Tap on the card and select ‘View Trend’ or ‘View History’ to see all your measurements plotted over time. You can zoom in on specific time periods or view your complete measurement history.
How does the trend graph work?
The tracking system works as follows:
Monthly reminders: You will receive a push notification and in-app reminder once a month, prompting you to update your waist measurement.
Long-term trend graph: All your measurements are displayed on an interactive graph showing your WHtR history. The graph uses colour-coded zones (green, amber, red) so you can easily see which risk category you fall into.
Progress tracking: The graph shows your trend direction — whether your WHtR is improving, stable, or worsening — so you can see the results of your efforts.
Quick updates: Since your height doesn’t change, you only need to enter your new waist measurement each month. It takes just seconds to update.
Why is regular tracking of my Adiposity Ratio important?
Regular tracking allows you to:
Monitor the effectiveness of diet and exercise changes
See the impact of any weight loss medications
Stay motivated by viewing your progress
Share accurate, up-to-date information with your healthcare providers
Catch any concerning trends early before they become serious
What symptoms might indicate obesity-related health problems?
Signs and symptoms that may indicate obesity-related health problems include:
Increased thirst and frequent urination
Fatigue and feeling more tired than usual
Shortness of breath during normal activities
Snoring or interrupted breathing during sleep
Joint pain, particularly in weight-bearing joints
Skin changes, including dark patches (acanthosis nigricans)
Difficulty with wound healing
High blood pressure readings
If you experience any of these symptoms, speak to your doctor as soon as possible.
What are the limitations of the Adiposity Ratio Service?
The service uses the Waist-to-Height Ratio (WHtR), a widely used and validated tool. As with any risk assessment screening, there are limitations to be aware of:
Not standalone: Should be used alongside other clinical assessments, not in isolation.
Abdominal conditions: Results may be affected by ascites, pregnancy, or other causes of abdominal distension.
Height extremes: Very short or tall individuals may require additional clinical judgement.
Fat type: Does not distinguish between subcutaneous and visceral fat.
BMI range: NICE recommends using WHtR for patients with BMI under 35 kg/m².
Self-report errors: Users may misreport waist or height measurements, which could affect the accuracy of the score.
Should I rely solely on my Adiposity Ratio score to manage my health?
No. The Adiposity Ratio Service is a screening and monitoring tool, not a diagnostic service. It should be used alongside other risk assessments like BMI & Type II Diabetes Risk. NowPatient clinicians can also order appropriate tests, interpret your full clinical picture, and recommend the most suitable interventions for you, like Weight Loss Programs, if applicable.