WHtR-BFP dual-dimensional synergy: innovative construction of a nine-grid model for precision obesity management

Current obesity assessment tools often capture either fat distribution or overall adiposity, limiting precise risk stratification and individualized management. To address this gap, we developed a dual-dimensional framework for obesity assessment and tiered intervention.

Guided by Multidimensional Health Management Theory and the Stages of Change Theory, we constructed the waist-to-height ratio (WHtR)-body fat percentage (BFP) Dual-Dimensional Synergistic Nine-Grid Model. Using WHtR and BFP as orthogonal axes, the model establishes a 3 × 3 risk matrix linking phenotype classification with stage-matched behavioral intervention and tiered management.

The model defines nine obesity-related phenotypes and translates them into a five-tier management system (T1-T5). In a proof-of-concept application involving 50 university students, all participants were successfully classified into specific grid zones and intervention tiers, supporting the operational feasibility of the model. Compared with body mass index (BMI)-based categorization, the model provided greater phenotypic granularity and identified discordance between central adiposity and total body fat burden.

The WHtR-BFP nine-grid model provides a novel conceptual framework for obesity management by integrating central fat distribution and total adiposity into a unified risk stratification approach. It offers a structured pathway for more individualized obesity care, with potential applicability in primary care and digital health settings. Further validation, subgroup calibration, longitudinal outcome studies, and health economic evaluation are needed before broader implementation.