Situation: The public health nurse of a Rural Health Unit (RHU) holds a Philippine Package of Essential NCD Interventions (PhilPEN) screening day for noncommunicable diseases (NCDs) at the barangay hall. Barangay health workers (BHWs) help register the residents. A 50-year-old man has a body mass index (BMI) of 24.1 kg/m² and a waist circumference of 92 cm. Using the Asia-Pacific cut-offs adopted locally, how should the nurse classify him?

Two cut-offs must be applied at once. Under the Asia-Pacific BMI cut-offs used locally, 23 to 24.9 kg/m² is overweight and 25 kg/m² or more is obese, so 24.1 kg/m² is overweight. A waist circumference of 90 cm or more in men (80 cm or more in women) is abdominal obesity, so 92 cm qualifies.

The classification requires simultaneous application of two anthropometric criteria. The first is the Asia-Pacific BMI cut-off, which defines overweight as a BMI of 23.0–24.9 kg/m² and obesity as ≥25.0 kg/m². The second is the waist circumference threshold for abdominal obesity, set at ≥90 cm in men and ≥80 cm in women under the local adaptation used in the Philippine setting.

For this 50-year-old man, the BMI of 24.1 kg/m² falls within the 23.0–24.9 range, placing him in the overweight category rather than normal weight or obese. His waist circumference of 92 cm exceeds the male cut-off of 90 cm, which independently qualifies him for abdominal obesity. Therefore, the correct classification is overweight, with abdominal obesity.

The rationale for using lower BMI thresholds in Asian populations stems from evidence that cardiometabolic risk rises at a lower body mass index than in Caucasian populations. The WHO Western Pacific Regional Office recommended these lower cut-offs in 2000 because Asian individuals tend to accumulate visceral adipose tissue at relatively lower BMI levels, and this visceral fat is strongly associated with insulin resistance, dyslipidemia, and cardiovascular disease ^[1][2]. A BMI of 23 kg/m² or higher is already associated with a meaningful increase in obesity-related morbidity in Asian populations, which is why the overweight category begins at 23 rather than 25 ^[2][4].

The waist circumference criterion captures central adiposity, which reflects visceral fat deposition around intra-abdominal organs. This visceral fat is more metabolically active than subcutaneous fat and is a stronger predictor of type 2 diabetes, hypertension, and coronary artery disease than BMI alone ^[3][4]. Key point! A person can have a normal BMI but still have abdominal obesity if waist circumference exceeds the sex-specific threshold, and this combination carries elevated cardiometabolic risk. In this case, however, both BMI and waist circumference are elevated, reinforcing the need for lifestyle intervention and cardiovascular risk screening.

The PhilPEN protocol uses these anthropometric measures as initial screening tools to identify individuals who require further assessment of blood pressure, fasting glucose, and lipid profile. The presence of both overweight and abdominal obesity doubles the indication for aggressive risk factor modification, because the two measures capture overlapping but not identical aspects of adiposity-related risk ^[3][4].

Category	BMI (kg/m²)	Waist circumference (men)	Waist circumference (women)
Normal weight	18.5–22.9	Less than 90 cm	Less than 80 cm
Overweight	23.0–24.9	90 cm or more	80 cm or more
Obese	25.0 or more	Same as above	Same as above

Watch out! Do not apply the standard WHO cut-offs of 25 kg/m² for overweight and 30 kg/m² for obesity when the question specifies Asia-Pacific or local Philippine criteria. The lower thresholds of 23 and 25 kg/m² must be used, and failing to recognize this distinction is a common source of error on licensure examinations. Watch out! Waist circumference is interpreted independently of BMI. Even if this man had a BMI below 23, a waist circumference of 92 cm would still classify him as having abdominal obesity, which is a separate and clinically significant finding.