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Background: To analyze differences in the distributions of waist circumference (WC) and waist-to-height ratio (WHtR) between Polish (PL) and German (GE) children and adolescents. Methods: Two samples of children and adolescents aged 7-18 y: From PL ( n = 11,326) GE ( n = 8,218) participated. The two WC cut-off points (WC1 as central fat distribution and WC2 as central obesity) corresponding at age 18 to the adult criteria were determined. Furthermore, the mean WC cut-off points (WC1m, WC2m) for boys and girls aged 14-18 from both countries were evaluated. For the WHtR, values over 0.5 were used as a definition of central fat distribution. The effect of different WC and WHtR criteria on the prevalence of abdominal obesity in both study groups was evaluated. Results: The mean and percentile values of WC and WHtR were generally higher in all German children as compared to their peers from Poland. When WC1m is used, the mean (95% CI) prevalence of central fat distribution in the 14-18 y Polish groups was lower ( P < 0.05) than those from Germany (boys: 4.4% (3.6-5.2) vs. 8.9% (7.3-10.5); girls: 10.7% (9.0-12.3) vs. 26.4% (23.2-29.6)), whereas, using the WHtR > 0.5, the results were similar for boys - 6.7% (5.9-7.5) vs. 8.5% (8.1-8.9); they were significantly ( P < 0.05) lower for Polish and German girls: 5.3% (5.0-5.6) vs. 12.7% (9.7-16.4). The prevalence of central obesity using WC2m as a criterion in the Polish vs. German groups was as follows: (boys - 1.1% (0.8-1.4) vs. 3.1% (2.2-4.0), P < 0.05; girls - 3.1% (2.5-3.7) vs. 10.2% (8.4-12.0), P < 0.05). Conclusions: The results highlight the greater central obesity associated with the German children, both in terms of WC and WHtR, in comparison to their peers from Poland. The prevalence of AO is significantly associated with the criteria used. The results demonstrate the need for the development of international WC references for pediatric subjects.