1. Measuring waist circumference

2. Based on EHES Manual, Part B. Fieldwork Procedures, 2nd edition (2016)
Available at:
These slides be used freely, translated and adapted to national use (e.g. concerning the equipment). However, it is important to keep in mind that no changes should be made to the measurement techniques, which need to be standardized.

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

4. Quality assurance: Checking
Daily:
Check the condition of the measurement tape visually; if there are cracks or the tape is torn, it should be replaced
Monthly:
Check the length of the measurement tape by using calibrated length rods; if the measuring tape is stretched, it should be replaced
Record the results of checking in the survey log book

5. Motivate participant Explain why waist circumference is measured
Previous measurements may be inaccurate and not comparable to the results from other participants
Waist circumference is likely to vary even daily
Waist circumference is an indicator of abdominal obesity

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

7. Clothing
The measurement is done on bare skin Ask the participant to reveal the waist, by loosing the belt, lowering the pants/skirt and lifting the shirt If the participant refuses or feels uncomfortable to undress, waist circumference can be measured over light tightly fitting clothing

8. Posture Ask the participant to stand straight
a small gap between the legs
weight evenly balanced on both legs
arms hanging loosely beside the body

9. Identify correct measurement place
Palpate the waist in order to find the midway between the lower rib margin and the iliac rest
If necessary and feasible, mark the place with cosmetic pencil

10. Check horizontal position of the measuring tape
Hold the tape firmly
Ask the participant to turn over
Move around the participant or
Check from the mirror (if available)

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

12. Our bodies are different
It isn’t always easy to find the right measurement place
Palpate and check the right place carefully
If needed, place the tape over lumpy, flabby areas

13. Record Measurement to the nearest millimetre
If the measurement was done over clothing
Pregnancy weeks, if necessary
Reasons, if not measured
Only measured values, self reported values are not acceptable

14. Acknowledgements
Slides prepared by: Johanna Mäki-Opas, Annamari Lundqvist, Hanna Tolonen, Päivikki Koponen
Photographs: Hanna Tolonen
Measurement demonstrations by Ulla Leskinen, Liisa Saarikoski and voluntary participants
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 the 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

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