Background: Central obesity is a critical predictor of cardiometabolic risk, yet universally applicable waist circumference cut-offs are confounded by ethnic discrepancies

Objectives: To determine the optimal WC cut-off points for identifying central obesity in the Iraqi population and evaluate associated sociodemographic risk factors.

Methods: A retrospective record review was conducted utilizing data from 3,924 participants (1,600 males, 2,324 females) who underwent anthropometric assessment in the National Iraqi STEPWISE Survey of non-communicable disease risk factors. Central obesity was referenced against the WHO Body Mass Index criteria, BMI (30kg/m2). Receiver Operating Characteristic (ROC) curves and the Youden index determined optimal Waist Circumference cut-offs. Multivariable logistic regression identified independent sociodemographic predictors.

Results: The optimal Waist Circumference cut-off points were established at> 91.75 cm for males (AUC: 0.900, 95% CI: 0.884–0.916; prevalence: 56.3%) and> 91.05 cm for females (AUC: 0.882, 95% CI: 0.865–0.899; prevalence: 60.8%). Multivariable analysis revealed that the 18–39 age group had significantly lower odds of having central obesity in both males (OR: 0.404, 95% CI: 0.222–0.735) and females (OR: 0.287, 95% CI: 0.177–0.464). Conversely, central obesity was independently elevated in males who were government employees (OR: 2.581, 95% CI: 1.447–4.604) or unemployed with an income (OR: 2.431, 95% CI: 1.341–4.407), and in females with no formal schooling (OR: 1.892, 95% CI: 1.062–3.373).

Conclusions: The Iraqi population exhibits distinct Waist Circumference thresholds that differ substantially from traditional international metrics, with the odds of central obesity significantly influenced by specific sociodemographic characteristics.