Introduction: The prevalence of obesity is reaching epidemic proportions in many countries. Recently, Egypt is enlisted as one of the top10 fattest countries in the world. However, little is known about which parameter of obesity can be associated with severity of coronary artery disease (CAD).Objectives: In this study, we examined the relationship between various parameters of obesity and extent of CAD in Egyptian patients.Methods: The study population consisted of 450 patients in whom elective coronary angiography was performed. All patients had measurement of BMI, WC, WHR and WHtR. Obesity was defined as BMI ≥30 kg/m2, WC ≥ 94cm for men and ≥ 80 cm for women, WHR≥ 0.85 in women and ≥0.90 in men or WHtR 0≥.5. Markers for significant CAD were >3 vessel disease (VD), >3 plaques causing ≥50% diameter stenosis (DS) or ≥ one proximal plaque (PP) causing ≥50% DS. CAD was considered severe if the patient had≥2 of these markers. Results: According to BMI, markers of significant CAD were less in obese patients. one or more PP causing ≥50% DS was met in only 41.4 of obese patients vs. 52.8% of non obese, p= 0.018. Classifying patients according to WC failed to show any significant difference between obese and non obese patients as regards prevalence and severity of CAD. High WHtR showed higher prevalence of CAD in obese patients. Increased WHR was the only measure of obesity that showed increased prevalence of >3 VD (15.3 vs. 2.7, p= 0.045), one or more PP causing 50% DS (49.9 vs. 18.9, p< 0.000) and severe CAD (19.6 vs. 5.4, p= 0.043).Conclusion: Compared with BMI, WC and WHtR, WHR showed the best association with severe CAD in Egyptian patients.