Background: Symptoms and secondary disorders associated with excess central fat distribution are being increasingly recognised. We aimed to define the symptoms and assess risks of chronic disorders in people with large waist circumferences.

Methods: We did a cross-sectional study of 5887 men and 7018 women aged 20-59 years from the general population of Maastricht, Amsterdam, and Doetinchem, Netherlands. We assessed in health centres respiratory insufficiency, low back pain, degree of physical function, presence of non-insulin-dependent diabetes, and cardiovascular risk factors. We measured bodyweight, body-mass index, and waist circumference by action levels (men: less than action level 1 <94.0 cm, action levels 1-2 94.0-101.9 cm, more than action level 2 > or =102.0 cm; women: less than action level 1 <80.0 cm, action levels 1-2 80.0-87.9 cm) more than action level 2 > or =88.0 cm). The reference group were people with waist circumferences lower than action level 1.

Findings: All symptoms and risks increased among participants higher than action level 2, after adjustment for age and lifestyle, by 3.1 (95% CI 2.5-3.7) in men and 2.7 (2.3-3.1) in women for shortness of breath when walking upstairs; 4.5 (2.5-7.8) and 3.8 (1.9-7.3) for non-insulin-dependent diabetes; and 4.2 (3.6-5.0) and 2.8 (2.4-3.2) for at least one major cardiovascular risk factor. Above action level 2, compared with the reference group, men and women were at twice the risk of difficulties in everyday activities, women were 1.5 times more likely to have low back pain or symptoms of intervertebral disc herniation, with secondary problems including hindrance to daily activities.

Interpretation: People with large waist circumferences have excess burden of ill health. Waist action levels could be useful for health promotion to raise awareness of the need for weight management.