Form 10 Att.13 Anthropometry

Attachment 13

Anthropometry Measurements	OMB#: ####-#### EXP.DATE: ##/##/####
NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN
Public reporting burden for this collection of information is estimated to average 10 minutes for this questionnaire, including the time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN:PRA (####-####).

Anthropometry Data Collection Form

WEIGHT

	Weight 1	Weight 2
Measured weight?	 (check if applicable)	 (check if applicable)
Weight in kg	___ ___ ___ . ___ kg	___ ___ ___ . ___ kg
Exceeds capacity?	 (check if applicable)
Could not obtain?	 (check if applicable)	 (check if applicable)

IF WEIGHT 1 AND WEIGHT 2 DIFFER BY GREATER THAN 0.3 KG, CONTINUE WITH WEIGHT 3 AND THEN GO TO INSTRUCTION FOR CALULATING THE MEAN VALUE FOR WEIGHT. OTHERWISE, GO DIRECTLY TO INSTRUCTION FOR CALCULATING THE MEAN VALUE FOR WEIGHT.

Weight 3

Measured weight?
 (check if applicable)Weight in kg	___ ___ ___ . ___ kg
Could not obtain?	 (check if applicable)

CALCULATE THE MEAN VALUE FOR THE WEIGHT:

IF WEIGHT 1 AND WEIGHT 2 DIFFER BY GREATER THAN 0.3 KG AND THE HIGHEST AND LOWEST MEASURES FOR WEIGHT 1, WEIGHT 2, AND WEIGHT 3 ARE EQUIDISTANT FROM THE MIDDLE MEASURE, USE THE MIDDLE VALUE FOR THE MEAN.

OTHERWISE, CALCULATE THE MEAN OF THE TWO CLOSEST MEASURMENTS.

MEAN WEIGHT: ___ ___ ___ . ___ kg

STANDING HEIGHT

	Standing Height 1	Standing Height 2
Measured standing height?	 (check if applicable)	 (check if applicable)
Standing height in cm	___ ___ ___ . ___ cm	___ ___ ___ . ___ cm
Exceeds capacity?	 (check if applicable)
Could not obtain?	 (check if applicable)	 (check if applicable)

IF STANDING HEIGHT 1 AND STANDING HEIGHT 2 DIFFER BY GREATER THAN 1.0 CM, CONTINUE WITH STANDING HEIGHT 3 AND THEN GO TO INSTRUCTION FOR CALCULATING THE MEAN VALUE FOR STANDING HEIGHT. OTHERWISE, GO DIRECTLY TO INSTRUCTION FOR CALCULATING THE MEAN VALUE FOR STANDING HEIGHT.

Standing Height 3
Measured standing height?	 (check if applicable)
Standing height in cm	___ ___ ___ . ___ cm
Could not obtain?	 (check if applicable)

CALCULATE THE MEAN VALUE FOR THE STANDING HEIGHT:

IF STANDING HEIGHT 1 AND STANDING HEIGHT 2 DIFFER BY GREATER THAN 1.0 CM AND THE HIGHEST AND LOWEST MEASURES FOR STANDING HEIGHT 1, STANDING HEIGHT 2, AND STANDING HEIGHT 3 ARE EQUIDISTANT FROM THE MIDDLE MEASURE, USE THE MIDDLE VALUE FOR THE MEAN.

OTHERWISE, CALCULATE THE MEAN OF THE TWO CLOSEST MEASURMENTS.

STANDING HEIGHT MEAN: ___ ___ ___ . ___ cm

ABOVE WAIST ADJUSTMENT: ___ ___ . ___ cm (enter 0 if no adjustment is needed)

BELOW WAIST ADJUSTMENT: ___ ___ . ___ cm (enter 0 if no adjustment is needed)

CALCULATE THE ADJUSTED STANDING HEIGHT:

SUBTRACT THE ABOVE WAIST AND BELOW WAIST ADJUSTMENT VALUES FROM THE STANDING HEIGHT MEAN TO GET THE ADJUSTED STANDING HEIGHT.

ADJUSTED STANDING HEIGHT: ___ ___ ___ . ___ cm

SITTING HEIGHT

	SITTING Height 1	SITTING Height 2
Measured sITTING height?	 (check if applicable)	 (check if applicable)
SITTING height in cm	___ ___ __ . ___ cm	___ ___ ___ . ___ cm
Exceeds capacity?	 (check if applicable)
Could not obtain?	 (check if applicable)	 (check if applicable)

IF SITTING HEIGHT 1 AND SITTING HEIGHT 2 DIFFER BY GREATER THAN 1.0 CM, CONTINUE WITH SITTING HEIGHT 3 AND THEN GO TO INSTRUCTION FOR CALCULATING THE MEAN VALUE FOR SITTING HEIGHT. OTHERWISE, GO DIRECTLY TO INSTRUCTION FOR CALCULATING THE MEAN VALUE FOR SITTING HEIGHT.

SITTING Height 3
Measured sITTING height?	 (check if applicable)
SITTING HEIGHT in cm	___ ___ ___ . ___ cm
Could not obtain?	 (check if applicable)

CALCULATE THE MEAN VALUE FOR THE SITTING HEIGHT:

IF SITTING HEIGHT 1 AND SITTING HEIGHT 2 DIFFER BY GREATER THAN 1.0 CM AND THE HIGHEST AND LOWEST MEASURES FOR SITTING HEIGHT 1, SITTING HEIGHT 2, AND SITTING HEIGHT 3 ARE EQUIDISTANT FROM THE MIDDLE MEASURE, USE THE MIDDLE VALUE FOR THE MEAN.

OTHERWISE, CALCULATE THE MEAN OF THE TWO CLOSEST MEASURMENTS.

SITTING HEIGHT MEAN: ___ ___ ___ . ___ cm

ABOVE WAIST ADJUSTMENT: ___ ___ . ___ cm (enter 0 if no adjustment is needed)

BELOW WAIST ADJUSTMENT: ___ ___ . ___ cm (enter 0 if no adjustment is needed)

CALCULATE THE ADJUSTED SITTING HEIGHT:

SUBTRACT THE ABOVE WAIST AND BELOW WAIST ADJUSTMENT VALUES FROM THE SITTING HEIGHT MEAN TO GET THE ADJUSTED SITTING HEIGHT.

ADJUSTED SITTING HEIGHT: ___ ___ ___ . ___ cm

MEASUREMENT COMMENTS FOR WEIGHT, STANDING HEIGHT, AND SITTING HEIGHT:

CHECK ALL THAT APPLY.

 None

 Weight greater than 180 kg; 2 scales used

 Position not straight for height/length

 Medical appliance/ cast not removed

 Amputation – leg

 Amputation - arm

HIP circumference

	Hip circumference 1	Hip circumference 2
Measured hip circumference?	 (check if applicable)	 (check if applicable)
Hip circumference in cm	___ ___ ___ . ___ cm	___ ___ ___ . ___ cm
Exceeds capacity?	 (check if applicable)
Could not obtain?	 (check if applicable)	 (check if applicable)

IF HIP CIRCUMFERENCE 1 AND HIP CIRCUMFERENCE 2 DIFFER BY GREATER THAN 1.0 CM, CONTINUE WITH HIP CIRCUMFERENCE 3 AND THEN GO TO WAIST CIRCUMFERENCE. OTHERWISE, GO DIRECTLY TO WAIST CIRCUMFERENCE.

Hip circumference 3
Measured hip circumference?	 (check if applicable)
Hip circumference in cm	___ ___ ___ . ___ cm
Could not obtain?	 (check if applicable)

waist circumference

	Waist circumference 1	Waist circumference 2
Measured waist circumference?	 (check if applicable)	 (check if applicable)
Waist circumference in cm	___ ___ ___ . ___ cm	___ ___ ___ . ___ cm
Exceeds capacity?	 (check if applicable)
Could not obtain?	 (check if applicable)	 (check if applicable)

IF WAIST CIRCUMFERENCE 1 AND WAIST CIRCUMFERENCE 2 DIFFER BY GREATER THAN 1.0 CM, CONTINUE WITH WAIST CIRCUMFERENCE 3 AND THEN GO TO MEASURMENT COMMENTS FOR CIRCUMFERENCES. OTHERWISE, GO DIRECTLY TO MEASUREMENT COMMENTS FOR CIRCUMFERENCES.

Waist circumference 3
Measured waist circumference?	 (check if applicable)
Waist circumference in cm	___ ___ ___ . ___ cm
Could not obtain?	 (check if applicable)

MEASUREMENT COMMENTS FOR CIRCUMFERENCES:

CHECK ALL THAT APPLY.

 None

 Measurement taken over thick clothing (hip)

 Measurement taken over thick clothing (waist)

 Other (Specify): ___________________________________________________

REPORT OF FINDINGS:

STANDING HEIGHT (in) = [ADJUSTED STANDING HEIGHT (cm) × 0.39] WHERE 12 in = 1 ft

STANDING HEIGHT: ___ ft ___ ___ in

WEIGHT (lbs) = MEAN WEIGHT (kg) × 2.2

WEIGHT: ___ ___ ___ lbs

BODY MASS INDEX: MEAN WEIGHT IN KG

(ADJUSTED STANDING HEIGHT IN CM × .01)²

BODY MASS INDEX: ___ ___ . ___

__ __ / __ __ / __ __ __ __ _________ ___________

Date Staff ID Participant ID

BMI TABLE*

Body Mass Index Weight Status

Below 18.5 Underweight

18.5 – 24.9 Normal

25.0 – 29.9 Overweight

30 & above Obese

*Categories are based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. NIH Publication, 2003.

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