Overweight and obesity are defined as abnormal or excessive fat accumulation that poses a risk to health and are among the leading preventable causes of morbidity and mortality worldwide [1]. According to the World Health Organization (WHO), the global prevalence of obesity has nearly tripled since 1975, with more than 1.9 billion adults classified as overweight and over 650 million as obese in 2016 [2]. India, traditionally burdened with undernutrition, is currently undergoing a rapid epidemiological transition characterized by a rising prevalence of obesity and obesity-related non-communicable diseases such as diabetes mellitus, hypertension, and cardiovascular disease [3-8].

Body mass index (BMI) and waist circumference (WC) are the most commonly used anthropometric indices to assess obesity. BMI provides an estimate of generalized obesity but fails to differentiate between fat mass and lean mass and does not adequately reflect body fat distribution [9]. Waist circumference, a marker of central obesity, is influenced by factors such as posture, abdominal distension, respiration, cultural sensitivity, and observer variability, limiting its routine use in large-scale screening programs [10,11]. Furthermore, both BMI and WC require calculations or partial disrobing, which may reduce feasibility in busy clinical settings and community-based surveys [12].

Neck circumference (NC) has emerged as a novel anthropometric parameter representing upper-body subcutaneous fat distribution. Measurement of NC is simple, quick, inexpensive, culturally acceptable, and relatively stable throughout the day [13,14]. Upper-body fat accumulation, as reflected by increased NC, is metabolically active and has been shown to be associated with insulin resistance, dyslipidemia, hypertension, and cardiovascular risk [15–17]. The Framingham Heart Study highlighted that upper-body subcutaneous fat measured by NC may represent a unique pathogenic fat depot with independent metabolic significance [18].

Several studies conducted across different populations have demonstrated a significant correlation between NC and established indices of adiposity such as BMI, WC, hip circumference, and body fat percentage [13,14,19–22]. Despite this growing body of evidence, data from Indian adult populations remain limited, and optimal sex-specific NC cut-off values vary across ethnic groups [23–25]. Establishing population-specific NC thresholds is therefore essential for its effective application in clinical practice and public health settings. The present study was undertaken to evaluate the validity of neck circumference as a screening tool for overweight and obesity in adults and to determine appropriate sex-specific NC cut-off values in an Indian population.

OBJECTIVES

1. To evaluate neck circumference as a screening tool for overweight and obesity in adults.
2. To assess the correlation of neck circumference with BMI, waist circumference, hip circumference, and waist‑hip ratio.

MATERIALS AND METHODS

Study Design and Setting: This hospital‑based cross‑sectional study was conducted in the Department of Medicine, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, after obtaining approval from the Institutional Ethics Committee.

Study population and selection criteria: Adults aged 18–60 years of both genders attending the medicine outpatient department or admitted to medical wards were included after obtaining informed consent. A total of 210 participants (110 males and 100 females) were enrolled. Overweight or obese adults aged 18–60 years were included in the study. Known endocrine or metabolic disorders; thyroid disease or cervical pathology; pregnancy; professional bodybuilders; and Individuals on medications known to affect body weight were excluded from the study.

Methodology: Measurements were taken with participants wearing light clothing and no footwear. Weight was measured using a digital scale to the nearest 0.1 kg, and height using a stadiometer to the nearest 1 mm. BMI was calculated as weight (kg)/height² (m²). Waist circumference was measured at the midpoint between the costal margin and iliac crest, and hip circumference at the level of the greater trochanter. Neck circumference was measured at the midpoint between the mid‑cervical spine and the mid‑anterior neck, just below the laryngeal prominence in men. Data were analyzed using SPSS version 20.0. Continuous variables were expressed as mean ± standard deviation. Pearson’s correlation coefficient was used to evaluate associations between NC and other anthropometric indices. A p‑value < 0.05 was considered statistically significant.

RESULTS

The mean age of study participants was 40.82 ± 12.79 years, with the majority belonging to the 41–50‑year age group. The mean NC of the study population was 38.8 ± 3.3 cm. Mean BMI was 31.04 ± 3.7 kg/m². Neck circumference showed a strong positive correlation with BMI (r = 0.736), body weight (r = 0.722), waist circumference (r = 0.587), hip circumference (r = 0.594), and waist-hip ratio (r=0.178), all of which were statistically significant (p < 0.01). A negative correlation was observed between NC and height (p>0.05).

Table 1: Distribution of age among the study participants

Table 2: Mean anthropometric measurements among the study population

A B C

D E F

Figure: Scatter plots showing Linear regression equations and Pearson’s correlation of NC (Neck circumference) versus - (A)Weight; (B)BMI; (C)Height; (D)Waist Circumference; (E)Hip Circumference; and (F)Waist-Hip Ratio.

Table 3: Pearson’s correlation of Neck circumference and (A)Weight; (B)BMI; (C)Height; (D)Waist Circumference; (E)Hip Circumference; and (F) Waist-Hip Ratio

DISCUSSION

The present study demonstrates that neck circumference is a reliable and practical anthropometric measure for identifying overweight and obesity in adults. NC showed a strong positive correlation with BMI, waist circumference, hip circumference, and body weight, findings that are consistent with those reported in earlier studies conducted in Indian and international populations [13,14,22,26]. These correlations support the concept that NC reflects upper-body subcutaneous fat accumulation, which is metabolically active and strongly associated with cardiometabolic risk factors [15–18].

The practical advantages of NC measurement—including ease of assessment, minimal equipment requirements, cultural acceptability, and cost-effectiveness—make it particularly suitable for large-scale screening programs in resource-limited settings [13,19,27]. In peripheral health centers where accurate measurement of weight or waist circumference may not always be feasible, NC offers a simple alternative for early identification of individuals at risk of overweight and obesity.

Overall, the findings of the present study support the inclusion of neck circumference as an adjunct anthropometric measure for obesity screening. However, larger population-based studies incorporating metabolic parameters are warranted to further validate its predictive value for obesity-related comorbidities.

Limitations: Hospital‑based study design limits generalizability; relatively modest sample size; and lack of biochemical markers of metabolic risk.

CONCLUSION

Neck circumference is a simple, inexpensive, and effective screening tool for overweight and obesity in adults. NC values can facilitate early identification of individuals at risk and support obesity prevention strategies, particularly in low‑resource settings.

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