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J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-3463
10.4103/jfmpc.jfmpc_414_24
Letter to Editor
Measuring up: Harnessing neck circumference as a powerful tool in battling obesity epidemic
Nair Gayatri R.
Jadhav Sudhir L.
Community Medicine, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
Address for correspondence: Dr. Sudhir L. Jadhav, Community Medicine, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. E-mail: dr_slj173@yahoo.co.in
8 2024
26 7 2024
13 8 34633464
13 3 2024
15 3 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcSir,

In the article titled “Prevalence of obesity and bariatric surgery among medical students in Riyadh, Saudi Arabia” published in the December 2023 issue (p3064-3067, December 2023), the researchers uncovered the prevalence of obesity, its risk factors, and bariatric surgery among medical students. Recognizing the importance of early screening, I would like to emphasize the proactive approach of integrating routine screening into medical education and healthcare practices. This step is essential for ensuring better health outcomes in addressing obesity.

Obesity is the main cause of “New World Syndrome,” a grave menace brought about by the forces of industrialization and acculturation. The World Health Organization’s 2022 data show that one in eight people worldwide suffer from obesity, indicating the rise in the obesity epidemic. Of the adults who are 18 years of age or older, 2.5 billion are overweight, and 890 million are obese. Moreover, 37 million children under five were overweight, along with over 390 million children and adolescents aged 5–19 years, among whom 160 million were obese.[1]

Obesity is a significant risk factor for several conditions, such as metabolic syndromes, diabetes, secondary insulin resistance, cancer, hypertension, heart disease, arthritis, and Alzheimer’s disease. As a result, obesity screening is important.

An accumulation of fat in the upper body, particularly with increased visceral adipose tissue, is strongly associated with cardiovascular disease, glucose intolerance, hyperinsulinemia, diabetes, hypertriglyceridemia, gout, and uric calculus. Gold standard methods like computed tomography (CT), magnetic resonance imaging, and DEXA scans offer precise measurements of visceral fat, but their costliness limits widespread use.[2] While body mass index (BMI) is commonly used as an anthropometric tool, it does not fully reveal body composition and fails to assess central adiposity or visceral fat. Additionally, its calculation can be cumbersome and requires stadiometers and weighing machines.

Waist and hip ratio measurements are influenced by factors such as respiration, postprandial distension, and pregnancy, and may face resistance from certain communities due to cultural or privacy concerns, especially when individuals of a different gender are involved in the measurement process.

Neck circumference (NC), serving as a proxy for upper body subcutaneous fat, emerges as a promising solution. It reflects the distribution of subcutaneous fat in the upper body and exhibits strong correlations with visceral adiposity, as validated by CT scans. Notably, NC correlates significantly with established obesity measures such as BMI, waist circumference, and hip circumference.[3] In a large population-based study, NC was found to correlate with various components of metabolic syndrome, including elevated triglycerides and fasting glucose levels, low levels of high-density lipoprotein cholesterol, and insulin resistance index.

NC emerges as a superior screening tool due to its demonstrated good sensitivity and specificity, cost-effectiveness, minimal time requirement, and simplicity of use, requiring only a basic measuring tape, especially in resource-constrained settings. NC also showcases minimal intraobserver and interobserver variability. For the Indian population, the identified NC cut-offs are approximately 35.25 cm for males and 34.25 cm for females, based on available literature.[4] NC has also been proven to be a good screening tool for children.[5] While diverse studies have suggested different cut-off points for NC, there is a need for standardized guidelines to ensure effective mass screening and intervention strategies against obesity-related health complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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1 Alshamrani AM Al-Rayes OM Almaslmani AM Sabr MS Alfriedy RF Khalifa AF Prevalence of obesity and bariatric surgery among medical students in Riyadh, Saudi Arabia J Family Med Primary Care 2023 12 3064 38361841
2 Micklesfield LK Goedecke JH Punyanitya M Wilson KE Kelly TL Dual-energy X-ray performs as well as clinical computed tomography for the measurement of visceral fat Obesity (Silver Spring) 2012 20 1109 14 22240726
3 Yang GR Yuan SY Fu HJ Wan G Zhu LX Bu XL Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4 Diabetes Care 2010 33 2465 7 20724650
4 Sruthi KG John SM Marconi David S Assessment of obesity in the Indian setting: A clinical review Clinical Epidemiology and Global Health 2023 23 101348
5 Sreelatha PR Chinchilu RV Neck circumference - A simple and valid screening tool for obesity in school children J Surg Med 2021 5 1184 7
