Risk of heart failure (HF) has been shown to increase as body mass index (BMI) increases; however, BMI has limitations as an obesity measure. Over median follow-up of 13 years, waist-to-height ratio (WtHR) was found to significantly predict incident HF in almost 2,000 individuals in the Malm Preventive Project. WtHR may be a better metric than BMI to identify patients with HF who could benefit from targeted obesity interventions.