Most epidemiologic studies which evaluate the association between obesity and disease consider only total adipose tissue and ignore its distribution. The present study used data from a national survey of women in TOPS (a weight reduction organization) in 1969. The purpose of this study was to evaluate the distribution of adipose tissue as a risk factor for disease using girth, height, and weight measurements in 21,065 women 40-59 years of age and 11,791 women 20-39 years of age. It was found that an index of body fat distribution, the ratio of waist girth to hip girth, was significantly associated with diabetes, hypertension, and gallbladder disease in women aged 40-59 and with menstrual abnormalities in women aged 20-39. Relatively more fat around the waist (as compared to hips) was associated with higher disease prevalence even among women with comparable total body fat. These findings suggest that indices based only on weight and height may not adequately characterize the risks associated with obesity.