If you carry excess weight, you’re more likely to have health problems. But even if your weight is in the normal range, your risk of death is still higher if your waist is wide, according to a new study.

Excess belly fat has been tied to medical troubles before. But it hadn’t been entirely clear if extra weight, rather than waist size, was the main culprit.

To take a closer look, NIH researchers studied a large group of people. They looked at weight, height and waist measurements from almost 155,000 men and over 90,000 women who were 51–72 years old at the beginning of the study.

During the 9-year study, the scientists found that people with the largest waist measurements had a significantly greater risk of dying than those with smaller waists. This was true whether or not the people were smokers or had a long-term illness, and regardless of their ethnic or racial groups.

The researchers were also able to tease apart the effects of weight vs. waist size. When they looked at people who had normal weights for their heights, those with large waist measurements—40 inches or more for men; 35 inches or more for women—had about a 20% greater risk of dying than those whose waists were in the normal-size range.

“People not only should look at their weight but also consider their waist,” said lead researcher Dr. Annemarie Koster of NIH’s National Institute on Aging. If you have a large waist, health experts recommend that you talk to your doctor about losing weight and increasing your physical activity.

Patients with high blood pressure, or hypertension, could better control their condition when they interacted twice a month with an online pharmacist. The new research suggests that Web-based tools may help people take a more active role in their own medical care.

Doctors and many patients know that better blood pressure control can reduce the risk of heart disease, stroke and kidney disease. But only about 1 in 3 patients with hypertension keep their blood pressure readings below target levels.

NIH-funded researchers tested whether Web-based tools might help patients control their hypertension. The team looked at over 700 patients, ages 27-75, whose blood pressure stayed high even though they received medications.

The patients were randomly assigned to 3 different groups. One received standard medical care. Another received a home blood pressure monitor and instructions for using a health Web site. The third group received the same as the other 2, plus private Web interactions with a clinical pharmacist every 2 weeks. The pharmacists could adjust the patients’ medications and doses.

After 1 year of treatment, more than half of the patients interacting with the online pharmacist achieved their target blood pressure readings. By comparison, about one-third of those in the other 2 groups reached that level of blood pressure control.

The scientists say that regular communications with a medical expert and fine-tuning of medications seemed to be key to the success of the online pharmacist. Web-based care might be especially helpful to patients who have difficulty traveling for clinic visits.

The researchers now plan to explore whether the strategy might prove helpful for treating other long-term diseases.