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<span class="paragraphSection">Editor—We thank Dr Molokhia for his interest in our editorial<a href="#aew454-B1" class="reflinks">¹</a>. We too had acknowledged the limitation of waist circumference (WC) in not being able to differentiate between visceral and subcutaneous fat. Indeed, all anthropometric indices of abdominal adiposity are subject to inaccuracies. This applies to both WC and sagittal abdominal diameter (SAD) owing to the different anatomical locations adopted for measurements<a href="#aew454-B1" class="reflinks">¹</a> and lack of evidence on optimal cut-offs. The intention of our editorial was to highlight some of the drawbacks of BMI and to suggest a suitable alternative that can be of similar practical utility to BMI in the perioperative setting. Waist circumference can be measured with a simple measuring tape rather than needing specialized abdominal callipers or any expensive methods, such as computed tomography or magnetic resonance imaging. In fact, both WC and SAD have been found to be correlated strongly with visceral adipose tissue at the abdominal level<a href="#aew454-B3" class="reflinks">³</a> and cardiometabolic risk factors.<a href="#aew454-B2" class="reflinks">²</a> Moreover, another study found no advantage of SAD over other simpler measures, such as WC.<a href="#aew454-B4" class="reflinks">⁴</a> Hence, until further large-scale robust research provides conclusive evidence of the superiority of SAD, WC is just as good and simpler than SAD to incorporate in routine perioperative evaluation.</span>

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