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DAPA Measurement Toolkit

 

Waist and hip circumference

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Subjectively assessed waist and hip circumferences are often used in large-scale epidemiological studies to describe body fat distribution when the objective measurements are not feasible.

Individuals self-report their waist and hip circumferences or it is reported on their behalf by a proxy-reporter. Examples of frequently used questions:

  • "What is your waist size?"
  • "What is your hip size?"

Instructions

Accuracy of the subjective waits and hip circumferences may be higher if participants are provided with clear instructions and a standard tape measure; otherwise participants may report circumferences based on their clothing sizes, which is less accurate. Detailed instructions such as taking the measurement after breathing out normally, with the stomach relaxed and not pulled in may also contribute to greater accuracy.

Selection of data source

Data can be collected by interview, by self-administered questionnaire, or be collected by proxy reporter (e.g. friend or family member). Questions can be administered using pen and paper or an electronic device such as a mobile phone, tablet or computer, either face-to-face or remotely (e.g. by post or internet).

Validation study

When studies rely on subjective methods, a validation study in a sub-sample of the main study cohort may provide useful information to quantify the errors/bias; corrections can then be carried out at the analysis stage (see below).

If collecting repeated subjective data at different time points, their validity should ideally be monitored as this may vary over time.

Units of measurement

Unit of the measurement (e.g. metric units or imperial scale) should be clearly defined to avoid discrepancy in recorded height. Incorrect conversion may lead to substantial errors. Units should be appropriate for the population of interest, possibly providing a choice of alternatives.

Waist and hip circumferences, and calculated waist to hip ratio (waist divided by hip) are often used in epidemiological studies as estimates of central and peripheral fat and relative fat distribution.

It is possible to apply statistical methods that correct for or take into account errors if relevant validation data are available. Predictive equations for objectively measured circumferences using data from a random sample of the main cohort can be derived and applied to the whole cohor. For height and weight there are available prediction equations, but these are not widely available for waist and hip.

An overview of subjective waist and hip circumference methods is outlined in Table A.2.10.

Strengths

  • Low cost
  • Practical tool as it can be included in study questionnaires and be self-administered
  • Information can be obtained via mail, face to face or telephone interviews or the Internet
  • Can be obtained retrospectively
  • Low respondent burden
  • Large number of individuals can be approached
  • Non-intrusive
  • It could increase recruitment rates and participation retention, especially by individuals who are reluctant to be measured
  • No fieldwork required if self-administered or data collected online

Limitations

  • Prone to systematic errors in reporting by different body size and social-demographic characteristics
  • Prone to response bias e.g. social desirability
  • May not be feasible in certain population where recall bias is high (e.g. mis-reporting of this measure is higher in older individuals when compared to younger individuals).
  • Corrections may be necessary at analysis point

Table A.2.10 Characteristics of subjective waist and hip methods.

Characteristic Comment
Number of participants High
Cost of development Medium
Cost of use Low
Participant burden Low
Researcher burden of data collection Low
Researcher burden of coding and data analysis High if manual
Risk of reactivity bias No
Risk of recall bias Yes
Risk of social desirability bias Yes
Risk of observer bias Yes
Participant literacy required Yes, if self-administered
Cognitively demanding Yes
Suitable for use in the field Yes

The accuracy of circumference measures varies with body size, age, sex, education and socio-economic status. ‘Figure consciousness’ also appears to affect the reporting of these data, especially in men. Considerations relating to the use of waist and hip methods in specific populations are described in Table A.2.11.

Table A.2.11 Use of subjective waist and hip methods in different populations.

Population Comment
Pregnancy
Infancy and lactation
Toddlers and young children
Adolescents Younger people tend to more frequently underreport their waist and hip circumferences compared to older groups.
Adults Men tend underreport waist circumference more frequently than women.
Older Adults
Ethnic groups
Other Overweight individuals tend to underreport waist and hip circumferences more frequently compared to leaner people.
Underestimation of waist circumference is also more frequent among participants with lower educational level and social class.
  • Minimal resources are generally required with subjective methods as field work may not be necessary
  • Tape measure
  • Questionnaire via paper and pen or electronic device
  • Instructions for completion and return regardless of media
  • For mailed questionnaires a pre-paid stamped address envelope
  • Trained interviewers for interviewer-administered tools, plus standard operating procedures for interviewers
  • Data entry cleaning code
  • Standard operating procedures for data entry errors/extreme values/data cleaning
  • Statistical knowledge may be required if correction factors are applied to the data

A method specific instrument library is being developed for this section. In the meantime, please refer to the overall instrument library page by clicking here to open in a new page.

References

  1. Bigaard J, Spanggaard I, Thomsen BL, Overvad K, Tjonneland A. Self-reported and technician-measured waist circumferences differ in middle-aged men and women. J Nutr. 2005;135(9):2263-70.
  2. Cullum A, McCarthy A, Gunnell D, Davey Smith G, Sterne JA, Ben-Shlomo Y. Dietary restraint and the mis-reporting of anthropometric measures by middle-aged adults. Int J Obes Relat Metab Disord. 2004;28(3):426-33.
  3. Dekkers JC, van Wier MF, Hendriksen IJ, Twisk JW, van Mechelen W. Accuracy of self-reported body weight, height and waist circumference in a Dutch overweight working population. BMC Med Res Methodol. 2008;8:69.
  4. Park JY, Mitrou PN, Keogh RH, Luben RN, Wareham NJ, Khaw KT. Effects of body size and sociodemographic characteristics on differences between self-reported and measured anthropometric data in middle-aged men and women: the EPIC-Norfolk study. Eur J Clin Nutr. 2011;65(3):357-67.
  5. Park JY, Mitrou PN, Keogh RH, Luben RN, Wareham NJ, Khaw KT. Self-reported and measured anthropometric data and risk of colorectal cancer in the EPIC-Norfolk study. Int J Obes (Lond). 2012;36(1):107-18.