Many say they are very large so I ordered two sizes just in case. (I'm returning one.) I have a 46 inch waist. I fit a medium/large size with the elastic fully stretched, but that's about it. The large/extra large fits me very comfortably and might fit 4 inches too small and 4 inches too big. It is precisely aligned with Velcro. The velcro strip is very long so you can accommodate a significantly larger waist if you don't mind the velcro showing (but then you don't get a full wrap either so you can show part of the leg).
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