European Commission - Public Health: healthindicators.org

DOCUMENTATION SHEET FOR:

Indicator: 42. Body mass index

SHORTLIST sub-division: C) Health determinants

Status: implementation section

Date last modification documentation sheet: 03-06-2010

PDF version of documentation sheet

Operational indicators (Excel-file)

Definition

Proportion of adult persons (18+) who are obese, i.e. whose body mass index (BMI) is ≥ 30 kg/m².

Calculation

Body mass index (BMI), or Quetelet index, is defined as the individual’s body weight (in kilograms) divided by the square of their height (in metres). Weight and height derived from European Health Interview Survey (EHIS) questions BMI01: How tall are you? (cm), and BMI02: How much do you weight without clothes and shoes? (kg). EHIS data will not be age standardized.

Relevant dimensions and subgroups

• Country
• Calendar year
• Sex
• Age group (18-64, 65+)
• Socio-economic status (educational level. ISCED 3 aggregated groups: 0-2; 3+4; 5+6)
• Region (according to ISARE recommendations; see data availability)

Preferred data type and data source

Preferred data type

Now: HIS; in future: HES

Preferred data source

Eurostat (EHIS)

Data availability

BE, BG, CZ, DE, EE, EL, ES, FR, IT, CY, LV, HU, MT, AT, PL, RO, SI, SK, CH, NO and TR conducted a first wave of EHIS between 2006 and 2010. It is noted that not in all of these countries a full scale survey was carried out; in some only specific modules were applied, in others the full questionnaire was applied in a small pilot sample. It is expected that all EU Member States will conduct EHIS in the second wave, which is planned for 2014. The results of the first wave are expected to be published in two stages, 11 countries in October 2010, the remaining countries in April 2011. EHIS data are available by sex, 8 age groups (15-24/25-34/35-44/45-54/55-64/65-74/75-84/85+) and ISCED groups.

Data periodicity

EHIS will be conducted once every 5 years. The first wave took place in 2007/2010 (with some derogations in 2006) and the second wave is planned for 2014.

Rationale

Excessive body weight predisposes to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnoea and osteoarthritis. Obesity is a growing public health problem. Effective interventions exist to prevent and treat obesity. Many of the risks diminish with weight loss.

Remarks

• This indicator is also one of the Health and Long Term Care Indictors of the Social Protection Committee. ‘Overweight people’ is listed as an indicator to be developed for the set of Sustainable Development Indicators.
• According to current plans, Eurostat will probably not age-standardize EHIS data. For comparability reasons ECHIM would however prefer age-standardized data.
• Data on BMI derived from HIS are subject to some biases; generally (very) slim people tend to overestimate their weight, while (very) overweight people tend to underestimate their weight. Data derived from HES will be more accurate and therefore preferable. However, comparable HES data at European level are currently lacking. In 2010 a pilot EHES covering 14 countries has started. When EHES will be fully implemented in a majority of EU Member States, ECHIM will switch to using EHES as preferred data source for the BMI indicator.
• For children BMI is calculated the same way as for adults, but compared to typical values for other children of the same age. Different cut off points (e.g. 85th percentile, 95th percentile) are being used in national surveys. The International Obesity Task Force (IOTF) has recommended cut off points to be used in international comparisons of childhood obesity.
• A BMI between 18.5 and 25 is considered to be normal. Overweight is usually defined as having a BMI of ≥ 25 and below 30. People with a BMI of ≥ 30 are considered obese.
• The above definition and calculation are based on the first version of the EHIS questionnaire, as used in the first EHIS wave (2007/2010). The EHIS questionnaire will be revised, hence adaptations to the EHIS question underlying this indicator may occur in the second wave (planned for 2014).
• The legal basis for EHIS is regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work. This is an umbrella regulation. Specific implementing acts will define the details of the statistics Member States have to deliver to Eurostat. An implementing act on EHIS is expected to come into force in 2014.

References

• EHIS standard questionnaire (version of 11/2006, used in first wave)
• EHIS 2007-2008 Methodology: Information from CIRCA
• Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work
• European Health Examination Survey (EHES)
• Recommendations International Obesity Task Force on cut off points for childhood obesity
• Indicators of the Social Protection Committee, health and long term care strand
• Sustainable development indicators, public health
• Sustainable development in the European Union - 2009 monitoring report of the EU sustainable development strategy (including list of indicators and indicators to be developed)
• Health Indicators in the European Regions (ISARE) project

Work to do

• Monitor EHIS/Eurostat and EHES developments
• Consult experts of Child Health Indicators of Life and Development (CHILD) project and Health Behaviour in School-aged Children (HBSC) survey on separate operationalisation for children.