Value of measuring waist circumference in primary care: a mixed-methods study

Background It remains a challenge for GPs to identify all patients at increased risk of cardiovascular disease (CVD) in their practice, as performing cardiovascular risk assessment in every single patient is not feasible in routine practice. There is need for a simple tool to screen who is eligible for cardiovascular risk assessment and identify those at increased CVD risk. Aim To investigate the value of measuring waist circumference in primary care by investigating: current recording practices of GPs; barriers and facilitators; and its contribution as a screening tool in the identification of patients at increased risk of CVD. Design and setting A mixed-methods study was conducted in Dutch primary care. Method We investigated the following three datasets: routine data from general practices ( n = 676 708 health records of adults); qualitative data from six focus groups ( n = 21 GPs); data from the Netherlands Epidemiology of Obesity (NEO) study ( n = 6671 middle-aged individuals). Results Between 2012 and 2023, incidence rates of recorded waist circumference by GPs decreased from 47 to 3 per 1000 person-years. Barriers to GPs measuring waist circumference included discomfort, inability to measure it accurately, lack of measuring tape, and perceived uselessness. Facilitators included knowledge that increased waist circumference is a cardiovascular risk factor. In the NEO study population, after excluding patients already treated for the prevention of CVD ( n = 2407), 1731 patients were at increased risk of CVD ( n = 1113 intermediate risk, n = 618 high risk). Measuring waist circumference would identify 89% (993/1113) of those at intermediate and 93% (575/618) of those at high predicted cardiovascular risk. Conclusion Waist circumference measurement may serve as a valuable screening tool to select patients eligible for cardiovascular risk assessment to identify those at increased risk of CVD in primary care. Since GPs currently rarely measure waist circumference, inclusion in guidelines and addressing identified barriers and facilitators is warranted.