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A new study from the American Cancer Society shows that having a large waist means a higher risk of death whether a person was normal weight, overweight or obese.

The researchers tracked the health of more than 100,000 people over nine years. They found that having a large waist size doubled the risk of dying from any cause compared to those with smaller waists.

The study reported a striking finding for women. It showed that the association between waist size and mortality risk was strongest among women who were at a normal weight.

“The take-home is that it’s important to watch your waist as well as your weight,” said Eric J. Jacobs, an epidemiologist with the American Cancer Society in Atlanta. “Even if your weight is normal for your height, if your waist size is increasing, if you’re moving to a bigger pant size, that’s a warning sign that it’s time to start eating better and exercising more.”

A thick waist has long been considered a risk factor for heart disease, but the new study found it also increases risk for dying from cancer, respiratory failure and other causes. Having a large waist is associated with large amounts of visceral fat around the abdominal organs, which can cause inflammation, high cholesterol, insulin resistance and other problems linked with poor health.