1. Anthropometric measurements to estimate overweight and obesity Background information

2. 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.

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

4. 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 Available online: 

5. Imbalance between calories consumed and expended causes obesity
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Adapted from Centers for Disease Control and Prevention. Balancing calories Available at

6. 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 Geneva, WHO, 2003.

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

9. 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

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

11. 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
Overweight
≥25
Pre-obese
Obese
≥30
Obese class I
Obese class II
Obese class III
≥40
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WHO: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series, No 894. Geneva, WHO, 2000.

12. 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 
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WHO: Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva, WHO, 2011.

13. 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.

14. 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.

15. 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.

16. 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 through SANCO/2008/C2/02-SI EHES and Grand Agreement number , and in through Grand Agreement number /BRIDGE Health

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