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BMI is treated as the number that tells you whether your weight is a health risk. If it is normal, the thinking goes, you are fine. A large European study says that picture is incomplete. Where the weight sits matters too, and it matters even at a normal BMI. The EPIC study followed 359,387 adults across 9 European countries for an average of almost 10 years. During that time, 14,723 of them died. The researchers looked at BMI, waist size and waist-to-hip ratio together, and they accounted for smoking, education, alcohol, physical activity and height. What it found: 1. Comparing the largest fifth of waists with the smallest fifth at the same BMI, men had about twice the risk of death over about 10 years and women had about 1.8 times the risk. 2. Each extra 2 inches (5 cm) of waist at a given BMI went along with about 17% higher risk in men and about 13% higher risk in women. 3. The pattern held in people with a normal BMI. Among them, the largest waists were still linked to about twice the risk in men and about 1.8 times the risk in women. 4. BMI did not stop mattering. Both measures carried their own information, so waist size adds to BMI rather than replacing it. Waist size may matter at the same weight because it is a rough guide to the fat stored around the organs, which is more closely tied to inflammation and insulin resistance than the fat under the skin. Two people with the same BMI can carry very different amounts of it. This study observed people rather than changing their waist size, so it shows a link and not proof that shrinking a waist lowers risk by a set amount. The comparison is between the top fifth and the bottom fifth of waists, not a typical difference between two people. The paper also dates from 2008 and covers only Europeans, so it is not new data, although it remains one of the largest studies of its kind. A tape measure adds something a bathroom scale cannot show.