Researchers examined associations between waist circumference and the risk of death in over 100,000 men and women aged 50 and older.
They found that people with very large waists, 47 inches or more for men and 42 inches or more for women, were about twice as likely to die, compared to thinner people from a variety of causes.
All participants had completed a mailed questionnaire about demographic, medical, and behavior factors and provided information about weight and waist circumference during the 1990s.
Researchers found that a larger waist was associated with a higher risk of death across all measures of BMI, including people of normal weight and people who were overweight or obese.
A somewhat surprising finding was that among women, the risk association between waist size and death was strongest for those with a normal BMI.
The most common cause of death in those with the strongest link between mortality and waist size was respiratory disease, followed by cardiovascular disease and then cancer.
Researchers warn that people who have a normal BMI and a big tummy are just as much at risk as someone who is classified as obese with a large tummy.
Previous studies have shown that abdominal obesity is a strong indicator for the development of coronary artery disease and is associated with insulin resistance and the development of Type 2 diabetes.
The study was published in the Archives of Internal Medicine.
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