Classification and Severity Assessment of Obesity in Clinical Risk Prediction of Multimorbidity Trajectories

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Abstract
Obesity is a key risk factor for chronic disease and multimorbidity, yet variation in how obesity is defined may influence risk estimation in clinical practise. Waist‐to‐hip ratio (WHR) and waist‐to‐height ratio (WHtR) are better at capturing fat distribution than body mass index (BMI) and may have a role in obesity related multimorbidity prediction. To examine multimorbidity risk across obesity groups classified using BMI in combination with WHR/WHtR. A UK Biobank cohort free of comorbidity at baseline ( n = 179 876) was followed for incident first long‐term condition and multimorbidity (≥ 2 of 38 conditions) over a mean of 9.9 years. Six adiposity categories combining BMI with WHR/WHtR were analysed using Cox proportional hazards models. Subgroup analyses evaluated whether high central obesity (WHtR ≥ 0.6) provided additional risk stratification within BMI groups. Combined general with central obesity showed highest risk for the first condition (HR 1.11; 95% CI 1.087–1.138) and multimorbidity (HR 1.13; 95% CI 1.093–1.172). However, BMI‐stratified subgroup analyses, central obesity provided additional risk discrimination only among individuals in the overweight category (BMI 25–29.9 kg/m 2 ), but not among those with BMI ≥ 30 kg/m 2 . Waist‐based measures improved risk identification in adults with overweight BMI, supporting the potential role of combined BMI‐waist approaches for earlier multimorbidity prevention.

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