1. Measuring waist circumference EHES Training Material

2. Exclusion criteria Waist circumference is not measured, if participant is immobile or in a wheelchair has severe difficulties in standing straight has problems in the waist area, for example a hernia, stoma bag or recent abdominal surgery, preventing proper measurement is pregnant (over 20 weeks) refuses

3. Equipment Non-elastic measurement tapes (200cm and 250cm) Full body mirror, if feasible

4. Posture of the subject Ask the participant to: reveal the waist, by loosing the belt, lowering the pants/skirt and lifting the shirt stand weight evenly balanced on both legs keep hands hanging loosely beside the body

5. Measurement place Palpate the waist in order to find the right measurement place midway between the lower rib margin and the iliac rest

6. Position of the measurement tape Check the horizontal position of the tape by holding the tape firmly asking the participant to turn over moving around the participant checking from the mirror (if available )

7. Waist measurement Check that the tape is not too tight or too loose You should be able to place one finger between the tape and the subject’s body Ask the participant to breath normally Read the waist circumference at the end of a light exhale

8. Note It isn’t always easy to find the right measurement place Palpate and check the right place carefully

9. Recording Record waist circumference to the closest 0,1 cm Record if the measurement was done over bare skin or over clothing Record reason, if waist is not measured Do not record self-reported waist circumference, only measured values are acceptable

10. Acknowledgements Slides Johanna Mäki-Opas, Hanna Tolonen Photographs Hanna Tolonen Measurement demonstration Liisa Saarikoski, Sanna Ahonen, Kari Kuulasmaa, Shadia Rask, Ulla Leskinen, Marika Strang, Katri Kilpeläinen