Waist circumference (WC) is the simple measure of length around a person’s abdomen. It can be particularly important in people with SCI for health and for function as many experience lack of core function and weight fluctuations.
Waist circumference is usually measured after a normal expiration at the narrowest part of the waist, often defined as the midpoint between the crest of the ilium and the last rib. It can be measured in the seated or the supine positions, but will have a larger value in the supine (Sumrell et al. 2018). There is evidence that self-reported and measured WC have sufficient correlation to be used in research (Battram et al., 2011; Rimm et al., 1990).

ICF Domain

Body Structures ▶ Structures Related to Movement

Number of Items



Tape measure or other measuring device



Training Required

Does not require advanced training.



# of studies reporting psychometric properties: 7


MCID: not established for SCI


  • Standard Error of Estimate:
    7.61 cm for walkers
    4.00 cm for non-walkers


  • Mean (SD) Scores:
    Seated Waist Circumference (cm) 88.8±9.3
    Supine Waist Circumference (cm) 85.9±11.8
  • Threshold Values:
    Not established in SCI. In the general population, WC > 102cm in men and WC > 88 cm in women are at high risk for developing medical conditions.


Intra-rater reliability for Waist Circumference is High (ICC=0.999)

(Edwards et al. 2008)


  • There is High correlation with the bioelectrical impedance analysis (r = 0.83), Body fat where
    Abdominal fat (r = 0.82) for mass and (r=0.76) for percentage, and Total fat (r = 0.73) for mass and (r=0.70) for percentage,
  • There is Moderate correlation with Framingham Risk Score (cardiovascular disease) (r = 0.66), and Body Mass Index (BMI) (Male: r = 0.46, Female: r = 0.45)

(Alschuler et al. 2012, Cragg et al. 2015, Eriks-Hoogland et al. 2011)


Not established in SCI.

Floor/ceiling effect

Not established in SCI.


Dr. Janice Eng, Kyle Diab, John Zhu, Risa Fox

Date Last Updated

3 August 2020

Alschuler KN, Gibbons LE, Rosenberg DE, et al. Body mass index and waist circumference in persons aging with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury. Disabil Health J. 2012;5(3):177-84.

Cragg JJ, Ravensbergen HJ, Borisoff JF, Claydon VE. Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury. Spinal Cord. 2015;53(1):64-8.

Edwards LA, Bugaresti JM, Buchholz AC. Visceral adipose tissue and the ratio of visceral to subcutaneous adipose tissue are greater in adults with than in those without spinal cord injury, despite matching waist circumferences. Am J Clin Nutr. 2008;87(3):600-7.

Eriks-hoogland I, Hilfiker R, Baumberger M, Balk S, Stucki G, Perret C. Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index. J Spinal Cord Med. 2011;34(4):416-22.

Han TS, Van leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401-5.

Ravensbergen HR, Lear SA, Claydon VE. Waist circumference is the best index for obesity-related cardiovascular disease risk in individuals with spinal cord injury. J Neurotrauma. 2014;31(3):292-300.

Willems A, Paulson TA, Keil M, Brooke-wavell K, Goosey-tolfrey VL. Dual-Energy X-Ray Absorptiometry, Skinfold Thickness, and Waist Circumference for Assessing Body Composition in Ambulant and Non-Ambulant Wheelchair Games Players. Front Physiol. 2015;6:356.

Zwierzchowska A, Głowacz M, Batko-szwaczka A, et al. The Body Mass Index and Waist Circumference as Predictors Of Body Composition in Post CSCI Wheelchair Rugby Players (Preliminary Investigations). J Hum Kinet. 2014;43:191-8.