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HOW TO: Cresty Neck Scoring

Cresty neck scoring is used to determine regional fat accumulation on the neck. The proportion of fat in this area is disproportionate to total body fat, and can be used to assess adiposity (Carter et al, 2009; Busechian et al, 2022). This is useful due to some variation in how horses deposit fat, and how fat deposition reflects metabolic tissues.

For instance, a 2020 study measuring body fat in Thoroughbreds found that mares carry more fat at the neck and ribs than geldings of similar body condition (Fowler et al, 2020), which is why it is important to evaluate your horse as an individual!

Neck crest fat in horses has been suggested to be associated with insulin resistance and increased laminitis risk.

Studies have shown that CNS better predicts insulin dysregulation than body condition score alone (Fitzgerald et al, 2019), and as such, can be used to screen horses for insulin resistance and related metabolic issues (Frank et al, 2006).


Acceptable CNS range from 0-2, as scores 3+ are linked with increased risk of insulin dysregulation, while a CNS of 4+ can predict laminitis (Carter et al, 2009).


CNS 0 - Acceptable

CNS 1 - Acceptable

CNS 2 - Acceptable

CNS 3 - Risk of IR

CNS 4 - Risk of IR, Predictor of Laminitis

CNS 5 - Risk of IR, Predictor of Laminitis

Cresty neck scoring can be less overwhelming than body condition scoring while providing valuable information on your horse's metabolic health. If your horse's crest is thicker at the middle of their neck than at their poll or withers, this is a sign that they are becoming at risk for metabolic diseases. Moving away from any high sugar/starch feeds, controlling or restricting access to pasture, and monitoring their health for clinical signs of metabolic disease are all great first steps!

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Busechian, S., Turini, L., Sgorbini, M., Pieramti, C., Pisello, L., Orvieto, S., Rueca, F. 2022. Are Horse Owners Able to Estimate Their Animals’ Body Condition Score and Cresty Neck Score? Vet Sci 9(10): 544. 

Carter, RA., Geor, RJ., Burton Staniar, W., Cubitt, TA., Harris, PA. 2009.Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies. The Veterinary Journal 179(2): 204-210.

Carter, RA., Treiber, KH., Geor, RJ., Douglass, L., Harris, PA. 2009. Prediction of incipient pasture-associated laminitis from hyperinsulinemia, hyperleptinemia, and generalized and localized obesity in a cohort of ponies. Equine Vet J 41(2): 171-178.

Fitzgerald, DM., Anderson, ST., Sillence, MN., de Laat, MA. 2019. The cresty neck score is an independent predictor of insulin dysregulation in ponies. PLoS One 14(7): e0220203.

Fowler, AL., Pyles, MB., Bill, VT., Hayes, SH., Harris, PA.,Lawrence, LM. 2020. Relationship between measurements of body fat in Thoroughbred horses. Journal of Equine Veterinary Science 85(2020): 102873.

Frank, N., Elliott, SB., Brandt, LE., Keisler, DH. 2006. Physical characteristics, blood hormone concentrations, and plasma lipid concentrations in obese horses with insulin resistance. JAVMA 228 (9): 1383-1391.

Morrison, PK., Newbold, CJ., Jones, E., Worgan, HJ., Grove-White, DH., Dugdale, AH., Barefoot, C., Harris, PA., McG Argo, C. 2018. The Equine Gastrointestinal Microbiome: Impacts of Age and Obesity. Front Microbiol 2018(9):3017.


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