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According to a research by Mayo clinic, people of normal weight but fat only at the belly could be at an increased risk of death when compared to obese people.

The research presented at the European Society of Cardiology Congress in Munich claims that says that people with central obesity-a high waist-to-hip ratio- were highly prone to cardiovascular death risk and health risk from all causes. 

"We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight," says senior author Francisco Lopez-Jimenez, M.D., a cardiologist at Mayo Clinic in Rochester, according to Medical Xpress. "This group has the highest death rate, even higher than those who are considered obese based on body mass index. From a public health perspective, this is a significant finding."

For the study, 12,785 people of 18 years and above were surveyed and taken as a sample of the U.S. population.

In the survey, body measurements of the participants such as height, weight, waist circumference and hip circumference, were recorded. Also considered for the study, were the socioeconomic status, co-morbidities, and physiological and laboratory measurements of the participants. 

The baseline data was compared to the National Death Index to determine deaths at follow-up.

The participants were divided on the basis of BMIs of three categories. 

Normal: 18.5 to 24.9 kg/m2;

Overweight: 25.0-29.9 kg/m2;

And Obese: >30 kg/m2

Also, there were two categories of waist-to-hip ratio

Normal: <0.85 in women and <0.90 in men;

And High: ≥0.85 in women and ≥0.90 in men.

The analysis took into consideration, the age, sex, race, smoking, hypertension, diabetes, dyslipidemia and baseline body mass index of the people, Medical Xpress reported.

The study excluded those with chronic obstructive pulmonary disease and cancer patients. 

After following up with the participants for more than 14 years, it was found that 1,138 deaths out of the total 2,562 deaths were due to cardiovascular related problems. Thus, the risk of cardiovascular death was 2.75 times and the risk of death from all causes was 2.08 times higher in people of normal weight and central obesity. 

"The high risk of death may be related to a higher visceral fat accumulation in this group, which is associated with insulin resistance and other risk factors, the limited amount of fat located on the hips and legs, which is fat with presumed protective effects, and to the relatively limited amount of muscle mass," says Karine Sahakyan, M.D., Ph.D., a cardiovascular research fellow at Mayo Clinic in Rochester. 

Dr. Lopez-Jimenez added that while many a people know their body mass index, a normal weight alone should not be taken for granted to make them risk free of heart diseases. 

Fat distribution pattern plays an important role and can be determined easily by getting a waist-to-hip measurement, he says.