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Correlation Vs Causation Alert! -Anxiety Linked to Waist Size

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In a study in the Journal Menopause, scientists performing a secondary analysis of data from a multi-center study of women between 40 and 59 years old from 11 Latin America countries, claim to have found a link between waist size and anxiety levels in postmenopausal women. 

Despite the large percentage of postmenopausal women that report to suffer from anxiety in this study, it is important to remember that correlation does not necessarily mean causation in this case. Meaning, the cause of the anxiety may not be a larger waist size, despite the correlation found by the authors.

Below is the news story from the North American Menopause Society...

Anxiety is one of the most common mental health disorders, and it’s more likely to affect women, especially middle-aged women. Although anxiety can be caused by many factors, a new study suggests that the amount of abdominal fat a woman has could increase her chances of developing anxiety. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Everyone is familiar with the term “stress eating” that, among other things, can lead to a thicker waistline. In this study that analyzed data from more than 5,580 middle-aged Latin American women (mean age, 49.7 years), the cause-and-effect relationship was flipped to determine whether greater abdominal fat (defined as waist-to-height ratio in this instance) could increase a woman’s chances of developing anxiety. Although this is not the first time this relationship has been examined, this study is the first of its kind known to use waist-to-height ratio as the specific link to anxiety. Waist-to-height ratio has been shown to be the indicator that best assesses cardiometabolic risk. A general guideline is that a woman is considered obese if her waist measures more than half of her height.

The article “Association between waist-to-height ratio and anxiety in middle-aged women: a secondary analysis of a cross-sectional multicenter Latin American study” reports that 58% of the study population were postmenopausal, and 61.3% reported experiencing anxiety. The study found that those women in the middle and upper thirds of waist-to-height ratios were significantly more likely to have anxiety, and those in the upper third were more likely to actually display signs of anxiety compared with women in the lower two-thirds.

Anxiety is a concern because it is linked to heart disease, diabetes, thyroid problems, respiratory disorders, and drug abuse, among other documented medical problems. Research has shown an increase in the frequency of anxiety in women during midlife, likely as a result of decreased levels of estrogen, which has a neuroprotective role. 

“Hormone changes may be involved in the development of both anxiety and abdominal obesity because of their roles in the brain as well as in fat distribution. This study provides valuable insights for healthcare providers treating middle-aged women, because it implies that waist-to-height ratio could be a good marker for evaluating patients for anxiety,” says Dr. JoAnn Pinkerton, NAMS executive director. 

This article has been republished from materials provided by The North American Menopause Society. Note: material may have been edited for length and content. For further information, please contact the cited source.


Arroyo, K. J., Ramos-Torres, G., Mezones-Holguin, E., Blümel, J. E., Barón, G., Bencosme, A., . . . Chedraui, P. (2018). Association between waist-to-height ratio and anxiety in middle-aged women. Menopause, 1. doi:10.1097/gme.0000000000001089