Anthropometric measurements to estimate overweight and obesity Background information

These slides can be used freely, translated and adapted to national use (e.g. concerning the equipment and fieldwork organization). However, it is important to keep in mind that no changes should be made to the measurement techniques, which need to be standardized.

Definition Overweight and obesity: abnormal or excessive fat accumulation that may impair health

Trends and estimates Worldwide obesity has more than doubled since 1980 In 2014, more than 1.9 billion adults were overweight and of these over 600 million were obese 39% of adults were overweight in 2014, and 13% were obese WHO. Obesity and Overweight. Fact Sheet. 2015. Available online: http://www.who.int/mediacentre/factsheets/fs311/en/

Imbalance between calories consumed and expended causes obesity Uusi slide, joka korvaa seur. Adapted from Centers for Disease Control and Prevention. Balancing calories. 2011. Available at http://www.cdc.gov/healthyweight/calories/index.html.

Factors that might promote or protect against weight gain and obesity Strength of evidence Decreased risk Increased risk Convincing Regular physical activity High dietary intake of fiber Sedentary lifestyle High intake of energy-dense foods Probable Home and school environments that support healthy food choices for children Breastfeeding Heavy marketing of energy-dense foods and fast-food outlets High intake of sugars-sweetened soft drinks and fruit juices Adverse socioeconomic conditions (in developed countries, especially for women) Possible Low glycemic index foods Large portion sizes High proportion of food prepared outside the home (developed countries) Rigid restraint/periodic disinhibition eating patterns Insufficient Increased eating frequency Alcohol Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series, No. 916. Geneva, WHO, 2003.

Causes of obesity Behavior Environment Genetics Pois?

Medical complications of obesity Healthcare costs are 36% higher for obese compared with normal weight individuals  (Kent et al. Obes Rev 2017) uusi Figure source: Adapted from Yale University Rudd Center for Food Policy and Obesity

Measurement Complex and expensive techniques such as magnetic resonance imaging (MRI) provide accurate estimates of body composition Anthropometric measures such as body mass index and waist circumference are easily-obtained and serve as inexpensive tools to identify general obesity

Devices Weight Height Waist and hip circumference balance beam scale electronic scale bioimpedance Height stadiometer Waist and hip circumference non-elastic measurement tape

Body-mass index The most common indicator of overweight and obesity BMI=weight (kg) / height (m)2 Classification BMI (kg/m2) Underweight <18.5 Normal range 18.50-24.99 Overweight ≥25 Pre-obese 25.00-29.99 Obese ≥30 Obese class I 30.00-34.99 Obese class II 35.00-39.99 Obese class III ≥40 Uusi WHO: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series, No 894. Geneva, WHO, 2000.

Waist circumference (WC) An indicator of abdominal obesity Risk of metabolic complications WC (cm) Increased >94 cm in men and >80 cm in women Substantially increased >102 cm in men and >88 cm in women  uusi WHO: Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva, WHO, 2011.

Waist-hip ratio (WHR) The waist circumference divided by the hip circumference An additional measure of body fat distribution Risk of metabolic complications WHR Substantially increased ≥90 cm in men and ≥85 cm in women  Uusi – entä waist – height ratio WHO: Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva, WHO, 2011.

Measured vs. self-reported values Self-reported (SR) BMI score and associated BMI category tend to be underestimated  If self-reported weight is 1 kg lower and height is 1 cm higher compared with actual measures BMI is underestimated by approximately 0.6 kg/m2 Lin DC. Nutr Today 2007; Gosse M. Nutr Bull 2014.

Measured vs. self-reported values The overall frequencies underestimation of weight 79 % overestimation of height 71% As measured BMI increases, the amount of inaccuracy in self reported BMI also increases obese individuals are most likely misclassified Other factors associated with reporting bias include age, sex, education, income, physical activity level and smoking status the evidence is inconsistent Lin DC. Nutr Today 2007; Gosse M. Nutr Bull 2014.

Acknowledgements Slides: Hanna Tolonen, Annamari Lundqvist Experiences and feedback from the EHES network have been utilized in the preparation of these slides Funding: Preparation of the slides is part of the activities of EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in 2009-2012 through SANCO/2008/C2/02-SI2.538318 EHES and Grand Agreement number 2009-23-01, and in 2015-2017 through Grand Agreement number 664691/BRIDGE Health

Disclaimer The views expressed here are those of the authors and they do not represent the Commission’s official position.