1. Core measurements Hanna Tolonen EGHI subgroup on HES, 2 nd March 2011, Luxembourg

2. Causes of death in EU 1.Circulator diseases 2.Cancer 3.Ischemic heart disease 4.Respiratory diseases http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Causes_of_death_statistics

3. EHES core measurements Anthropometric measurements Weight Height Waist circumference Blood pressure Blood samples Total cholesterol HDL cholesterol Fasting glucose

4. WHY THESE MEASUREMENTS?

5. ANTHROPOMETRIC MEASUREMENTS

6. Main complications of obesity

7. Economic implications of obesity Cost of obesity Direct costs due to medical costs to treat the diseases associated with obesity Direct costs due to medical costs to treat the diseases associated with obesity Indirect costs due to lost productivity: absenteeism premature death Indirect costs due to lost productivity: absenteeism premature death Intangible costs due to missed opportunities psychological problems poorer quality of life Intangible costs due to missed opportunities psychological problems poorer quality of life

8. Obesity as a public health problem 2-8% of health costs in Europe are due to obesity or diseases stemming from obesity 10-13% of deaths are obesity related in different parts of Europe Source: WHO http://www.euro.who.int/obesity

9. Reporting bias - obesity

10. Reporting bias – weight and height Self-reported BMI underestimates measured BMI Varies by BMI level,age, sex, ethnicity Over the years, the difference between self-reported and measured BMI has increased Stommel M, Schoenburn CA. BMC Public Health 2009,9:421 Shiely F, Perry IJ, et al. BMC Public Health 2010, 10: 560

11. Reporting bias – waist circumference Self-reported waist circumference underestimated real waist circumference Women underestimate more than men Underestimation increases by increased BMI Source: Bigaard J, Spaggaard I et al. J Nutr. 2005; 135: 2263-2270

12. BLOOD PRESSURE

14. Reporting bias - hypertension 10-20% of people with elevated blood pressure are unaware of their condition

15. CHOLESTEROL

16. High cholesterol is a risk factor Coronary heart disease Stroke

17. Reporting bias – high cholesterol Up to 30% of people with elevated total cholesterol are unaware of their condition

18. Economic implications of CVD Total costs (2006) 192 billion 10% of health care costs Total costs (2006) 192 billion 10% of health care costs Direct costs of health care 110 billion Direct costs of health care 110 billion Indirect costs due to productivity loss 41 billion 2/3 due to premature deaths 1/3 due to illness Indirect costs due to productivity loss 41 billion 2/3 due to premature deaths 1/3 due to illness Informal care 42 billion Informal care 42 billion Source: http://www.heartstats.org/uploads/documents\PDF.pdf

19. DIABETES

20. Complications of diabetes foot infections chronic skin infections gum disease and tooth loss vision problems heart disease and blood circulation problems

21. Economic implications of diabetes Cost of diabetes Direct costs due to medical care, drugs, insulin and supplies cost to health care sector (hospital admissions) Direct costs due to medical care, drugs, insulin and supplies cost to health care sector (hospital admissions) Indirect costs due to lost productivity: sickness, absences, disability, premature retirement or death Indirect costs due to lost productivity: sickness, absences, disability, premature retirement or death Intangible costs due to decreased quality of life discrimination in the workplace difficulty or limitations in obtaining jobs Intangible costs due to decreased quality of life discrimination in the workplace difficulty or limitations in obtaining jobs

22. Economic implications of diabetes 3-15% of health costs in Europe are due to direct costs of diabetes related illnesses Indirect costs of diabetes through loss of productivity is estimated to be at least as high as direct costs Jönsson A. Diabetologia 2002; 45: S5-S12 WHO Fact Sheet no 236. Diabetes: cost of diabetes (2002)

23. Reporting bias - diabetes Up to 30% of those with diabetes do not know that they have diabetes

24. EHES core measurements Included to previous national HESs Can be standardized in population survey Clear interpretation of the results Can be modified in the population Can be administered in the survey setting Acceptable to the participants Ethically acceptable Reasonable cost

25. STANDARDIZATION OF MEASUREMENTS

26. Standardization of measurements To obtain reliable and comparable results from EU standardization of the measurements is needed Training Devices Measurement protocols External quality control