1. Measuring the waist circumference 2nd EHES training seminar Johanna Mäki-Opas

2. Why waist circumference is measured? Waist circumference is used as an indicator of abdominal obesity and is associated with the cardiovascular diseases and type 2 diabetes

3. Equipment Non-elastic measurement tapes (200cm and 250cm) If feasible the full body mirror Carpenter’s level

4. Exclusion criteria If participant is immobile or in a wheelchair has difficulties in standing straight is pregnant (20 weeks or over) has a hernia in stomach/pelvis area

5. EHES protocol for measuring waist circumference The participant is asked to: reveal the waist, by loosing the belt, lowering the pants/skirt and lifting the shirt stand a small gap (10 cm) between the legs and weight equally distributed on both legs stand hands hanging loosely beside the body

6. The measurer palpates the waist in order to find the right measurement place: midway between the lower rip margin and the iliac crest

7. Horizontal position of measuring tape is verified by holding the measuring tape firmly by asking the participant to turn over/or by checking from the mirror The participant is asked to breath normally; the reading is taken at the end of light exhale

8. Challenges in measuring waist circumference Finding the right measurement place is not always easy

9. Recording The waist circumference is recorded to the closest 0,5 cm If the waist is not measured the reason should be specified and recorded Self-reported waist circumference is not acceptable

10. Calibration and checking the equipment The length of the measurement tape should be checked by using the calibrated length rods in regular intervals