Background: Abdominal circumference (AC) is superior to body mass index (BMI) as a measure of risk for various health outcomes. Our objective was to compare AC and BMI as predictors of lower extremity overuse injury (LEOI) risk. Methods: Retrospective review of electronic medical records of 79,868 US Air Force personnel over a 7-year period (2005–2011) for incidence of new LEOI. Subjects were stratified by BMI and AC. Injury risk for BMI/AC subgroups was calculated using Kaplan–Meier curves and Cox proportional-hazards regression. Receiver operating characteristic curves with area under the curve were used to compare each model’s predictive value. Results: Cox proportional-hazards regression showed significant risk association between elevated BMI, AC, and all injury types, with hazard ratios ranging 1.230–3.415 for obese versus normal BMI and 1.665–3.893 for high-risk versus low-risk AC (P < .05 for all measures). Receiver operating characteristic curves with area under the curve showed equivalent performance between BMI and AC for predicting all injury types. However, the combined model (AC and BMI) showed improved predictive ability over either model alone for joint injury, overall LEOI, and most strongly for osteoarthritis. Conclusions: Although AC and BMI alone performed similarly well, a combined approach using BMI and AC together improved risk estimation for LEOI.