📝 Anthropometrist’s Reflections: Alice Bullas – from Hallam to Hawai’i – More than a flight

This summer (August 2026) I  (Alice Bullas) am undertaking an international research secondment at the John A. Shepherd Research Laboratory within the University of Hawaiʻi Cancer Center. Supported by my UK Research and Innovation (UKRI) Future Leaders Fellowship. This is blog 2 of 8.For more background content please see my introductory blog (blog 1 of this series)

The Practical Reality of Getting Set Up in Hawaiʻi

When people hear that I’m completing a research secondment in Hawaiʻi, the assumption I think is that the biggest challenge is the research work itself. In reality, before any meetings, collaborations or data collection could begin, there was an equally important task: figuring out how to temporarily relocate a family to the middle of the Pacific Ocean.

Secondments are often described in terms of research outputs, professional development and collaborations. Those aspects are undoubtedly important, but they sit on top of a much less visible foundation of logistics, planning, administration and family life. Without that foundation, none of the research would happen.

Before We Even Left: The Logistics Nobody Talks About

Before we boarded a plane, there was an enormous amount of work involved in simply getting here.

I want to be clear from the outset that I know how fortunate I am to have this opportunity. I am incredibly grateful to Sheffield Hallam University, the fellowship funding that made this placement possible, my hosts in Hawaiʻi and everyone who helped make the secondment happen. I am also very aware that many of the challenges I describe fall firmly into the category of first-world problems. That said, gratitude and stress are not mutually exclusive.

Organising visas, flights, accommodation and travel arrangements was one of the most administratively demanding experiences I can remember. As a university employee, travel bookings had to go through the usual Sheffield Hallam University processes and KeyTravel. For anyone familiar with this system you will know that it can pose challenges – for anyone not familiar with this system think of it like trying to assemble flat-pack furniture while speaking to someone over a crackly phone line who only had half the instructions and was absolutely convinced the remaining pages weren’t necessary.

I am sure everyone had the best of intention to help – but it often look like that. The point at which a KeyTravel member of staff asked in if I had a Travel Company I could book through, at which point I reminded them they were the travel company and the representative laughed. Whilst looking back this seems ridiculous, at the time it was most certainly a low point.

However, I suspect much of the stress came from knowing I wasn’t only responsible for myself. If I had been travelling alone, many of the obstacles would have felt relatively minor. Instead, every decision carried additional weight because my partner and two children were coming too. Visas, passports, flights, insurance, accommodation, finances and contingency plans all felt far more significant when other people were depending on them.

At times it felt as though every task completed revealed three more tasks that I hadn’t considered.

Looking back now, everything worked out. At the time, however, it often felt like trying to solve a giant jigsaw puzzle while someone else had hold of the puzzle pieces.

The Journey Itself

After all that preparation, the flights themselves were actually much better than expected. With a time difference this large (11 hours back in time), there isn’t really a perfect flight schedule. Someone is always going to be tired at the wrong time.

Fortunately, the children embraced the adventure. An early departure worked surprisingly well. They were excited about travelling, happy to play games, watch films and explore the novelty of a long-haul flight.

The most challenging part was our connection in Los Angeles.

On paper, the transfer looked entirely reasonable. In reality, moving from an international arrival to a domestic departure felt more like an airport-based endurance event. We found ourselves power-walking, jogging and occasionally outright running through terminals while attempting to keep children, luggage and travel documents all moving in the same direction – all whilst verbally barraged with complaints form my eldest about how they were “the hottest I’ve ever been in my life, so why are you now asking me to run” etc etc.

At the time, it felt slightly stressful. Looking back, it is already one of those family stories that has become considerably funnier than it felt in the moment.

Despite the airport sprint, we made every connection and eventually arrived in Hawaiʻi in one piece.

The biggest advantage of the itinerary was that by the time we arrived, the children were utterly exhausted. After a very long day they essentially collapsed into bed.

Problem solved? Not quite.

The Reality of Jet Lag With Children

The children adapted remarkably well, but a ten-hour time change is still a ten-hour time change. For about a week, mornings started very early. Very, very early.

Fortunately, before the secondment started, we spent a week in Kauaʻi as a family. Partly, this was a chance to spend some time together before work commitments began, but it also provided an opportunity to start adapting to the ten-hour time difference between the UK and Hawaiʻi. Rather than trying to fight jet lag, we decided to embrace it. There are certainly worse places in the world to be awake at 3 a.m.

We filled them with sunrise beach walks, early adventures, coffee stops just after dawn and, to my daughter’s delight, regular açaí bowls. We also found ourselves catching snippets of the Tour de France on television while much of the island was still asleep. Watching professional cyclists tackle Alpine climbs while sitting in Hawaiʻi with a cup of tea was not something I had anticipated when planning a research secondment, but it quickly became part of our temporary routine.

By the time we came to Oʻahu, everyone had largely adapted. And a further 5 days of getting to know there area locally has given us the chance to establish some stability before the secondment really began.

Finding Somewhere to Live

One of the biggest challenges before departure was finding suitable accommodation. Like many visiting researchers, we had a long list of requirements that immediately reduced our options.  However, it was further complicated by Hawaiʻi’s tightening of short-term rental regulations. Though this is most certainly a positive move towards improving local housing availability for residents, it did mean we were a little short of options; caught between expensive hotels and longer-term rentals that require commitments beyond the length of a typical secondment.

We would initially be without a car. We needed reasonable access to shops and transport. We were travelling with young children. Above all, we needed somewhere safe and practical for family life.  This led to some surprisingly specific criteria.

For example, I spent far more time than expected scrutinising photographs of balconies. As parents of young children, you quickly begin assessing railings, locks and access points very differently. A balcony only becomes useful once you know it can be safely secured from a curious toddler.

The other unexpectedly important requirement was a bath. Parents of young children will understand immediately. While showers are perfectly acceptable in theory, trying to wash a slippery, wriggling toddler covered in soap is not a task to be undertaken regularly or lightly stood upright. The presence of an actual bath quickly moved from “nice bonus” to “essential requirement”.

Finding accommodation that met all these needs while remaining within budget was considerably harder than I had anticipated.

Learning How to Feed a Family Again

Once accommodation was sorted, the next challenge was food. Food in Hawaiʻi is expensive. Very expensive.

At least it certainly feels that way when you’re mentally converting prices back into pounds every time you visit a supermarket.

Before leaving the UK, we purchased a Costco membership after several people recommended it as a way of managing costs. That turned out to be one of the most useful decisions we made before departure.

Though this challenge was expected, another unexpected challenge has been balancing several competing priorities. We want to experience local food and culture. We want to try new things. We also need to feed a family for several weeks without completely destroying the budget. That has meant finding a balance between cooking at home and eating out.

There is an understandable temptation to treat every meal as part of a holiday, but the reality is that when you’re living somewhere for several weeks, practical considerations quickly become important. Sometimes the exciting local restaurant wins. Sometimes the homemade pasta wins. Most weeks involve both.

The Japanese Influence I Didn’t Expect

One aspect of Hawaiʻi that genuinely surprised me was the extent of Japanese influence throughout everyday life.

Before arriving, I expected strong American influences. What I had not appreciated was how visible Japanese culture is across food, shops and household products.

Rice features prominently in everyday meals. Rice cookers are everywhere. Japanese supermarkets, snacks and convenience foods are commonplace. Japanese appliances appear throughout homes and shops.

My son has been very happy with the abundance of rice-based food options. Meanwhile, my daughter and I have discovered a shared enthusiasm for mochi. There are also Japanese-style toilets, kitchen gadgets and household appliances that have rapidly been added to our growing list of things we would quite like at home one day, finances permitting.

Learning to Say Hawaiʻi Properly

One thing I have been trying to do throughout this experience is use the correct Hawaiian place names and terminology wherever possible. You’ll notice I write Hawaiʻi rather than Hawaii.

The symbol between the final two vowels is called an ʻokina. It represents a glottal stop and forms part of the correct spelling. The same applies to place names such as Oʻahu and Kauaʻi.

I certainly don’t get everything right. My Dyslexia can make learning unfamiliar spellings and pronunciations challenging, particularly when there are many new names being encountered simultaneously. However, I think making the effort matters. Being a visitor involves respecting local language, culture and identity, even while you’re still learning.

Working Differently

Another adjustment has been time. At home, I typically work four days per week. Here, I am working five.

The reason is simple. Opportunities like this do not come around often, and I want to make the most of every day available. Each additional day creates opportunities to learn, observe, meet people and develop collaborations.

At the same time, it has made me more conscious of family time. Even though it is only one extra working day each week, it changes the rhythm of family life. I find myself feeling a lot of pressure at the weekends. I hope to take some of this time back in lieu when I return home, but the experience has certainly reinforced how much I value time with my children.

Getting Around Without a Car

We deliberately chose not to hire a car immediately. Partly this was financial. Partly it was because I wanted to understand what daily life would genuinely be like.

For commuting, I have settled into a combination of public transport and cycling. The bus system is extensive in Honolulu and relatively easy to use through a HOLO card, while the Biki bike-share scheme has become my preferred option for travelling to and from work. The arrangement has worked surprisingly well. It gives me a practical way to build movement into the day, helps me explore the local area and provides a small amount of exercise that might otherwise disappear from the schedule.

The Things You Don’t Put in the Grant Application

Research proposals tend to focus on objectives, outputs and timelines. They usually don’t mention finding a bath. They don’t mention running through Los Angeles airport with children. They don’t mention comparing supermarkets, figuring out transport systems, working out whether a rental car is worth the expense, discovering a family passion for mochi, or trying to transport groceries home by bike.

Yet these are the experiences that shape the reality of an international secondment.

The first few weeks in Hawaiʻi have reminded me that successful research travel isn’t simply about arriving at a host institution. It is about creating enough stability in everyday life that you have the capacity to focus on the work once you get there. It has made me reflect on the support I give my own internationally visitors and maybe what else I could do to help them in this process.

I remain extremely grateful for the opportunity to be here. I know how lucky I am. I also know that relocating a family halfway around the world is hard work, even when everything goes well.

Fortunately, we are now reaching the point where routines are established, the children are settled, commuting makes sense, and Hawaiʻi is starting to feel a little less like somewhere we’re visiting and a little more like somewhere we’re temporarily calling home.

Only now does it feel as though the secondment itself can truly begin.

 

NHANES

What is NHANES?

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative U.S. health surveillance programme conducted by the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC). Unlike many health surveys that rely primarily on self-reported information, NHANES combines health interviews, physical examinations, anthropometric assessments, laboratory testing, medical imaging, and body composition measurements within the same participants, providing a uniquely comprehensive picture of population health. Since becoming a continuous survey in 1999, NHANES has generated some of the most influential datasets in epidemiology, nutrition, anthropometry, obesity research, and body composition science.

Key Facts

NHANES has evolved from a series of periodic health examination surveys into a continuous national surveillance programme. Data are generally released in approximately two-year cycles and are collected using a complex multistage probability sampling design that enables findings to be generalized to the wider U.S. civilian, non-institutionalised population. To improve precision for certain analyses, selected demographic groups are routinely oversampled. Importantly, NHANES relies on direct measurement rather than self-report, making it one of the most robust population health resources available. Data collection takes place in specially designed Mobile Examination Centers (MECs), which provide standardised environments for measurements and testing. Anthropometry has been included since NHANES I (1971-1975), making the programme one of the longest-running sources of population anthropometric data worldwide.

Anthropometry and Body Composition in NHANES

Anthropometry sits at the core of NHANES and provides valuable information on growth, nutritional status, body size, adiposity, and disease risk. Core measurements include stature (height), body mass (weight), and recumbent length in infants and young children. Depending on the survey cycle, additional measurements have included waist, arm, hip, and thigh circumferences; sitting height; knee height; upper leg length; skeletal breadths; and skinfold thicknesses. Skinfold measurements, collected in selected survey cycles, were used to estimate subcutaneous adiposity and contributed to early body composition research.

A major advancement within NHANES was the introduction of Dual-Energy X-ray Absorptiometry (DXA), allowing large-scale assessment of fat mass, lean soft tissue mass, bone mineral content, and bone mineral density. Few population studies have incorporated body composition imaging at this scale, making NHANES a highly valuable resource for obesity, ageing, bone health, and sarcopenia research.

Derived Variables

Beyond direct measurements, NHANES provides a range of widely used derived variables, including:

    • Body Mass Index (BMI)
    • BMI-for-age percentiles
    • Waist-to-height ratio
    • Fat Mass Index (FMI)
    • Lean Mass Index (LMI)

These variables have informed national obesity estimates, growth references, clinical guidelines, and epidemiological research investigating relationships between body size, body composition, and health outcomes.

Accessing the Data

One of NHANES’ greatest strengths is its commitment to scientific transparency and accessibility. Most datasets are available free of charge and can be accessed without application through the NHANES data portal. Researchers can download anthropometry, DXA, nutrition, laboratory, questionnaire, and health datasets alongside detailed codebooks, procedures manuals, and analytic guidance documents. Restricted-use variables, which are not publicly released due to confidentiality concerns, can be accessed through application to the NCHS Research Data Center (RDC) with an approved research proposal.

Analysis Essentials

Researchers using NHANES should recognise that it employs a complex survey design. Appropriate analysis requires the use of sampling weights, strata variables, and primary sampling units (PSUs). When combining multiple survey cycles, adjusted combined weights must be calculated according to NCHS guidance. Researchers should also review cycle-specific documentation carefully because measurement protocols and variable availability can change over time.

Historical Milestones

The NHANES programme has developed over more than six decades:

    • NHES: 1959-1962
    • NHANES I: 1971-1975 (anthropometry formally incorporated)
    • NHANES II: 1976-1980
    • NHANES III: 1988-1994
    • Continuous NHANES: 1999-present

These repeated surveys allow researchers to monitor secular trends in growth, obesity, body composition, and health at the population level.

NHANES has contributed substantially to:

    • Obesity and growth surveillance
    • Body composition and sarcopenia research
    • Nutritional epidemiology
    • Cardiometabolic health research
    • Bone health and osteoporosis research
    • Development of CDC growth references and dietary guidance

Its integration of anthropometry, body composition, health outcomes, biomarkers, and lifestyle data within the same participants has made NHANES one of the most heavily used resources in public health and epidemiological research.

Strengths and Limitations

NHANES offers several important strengths. It provides nationally representative, objectively measured data, includes large sample sizes, offers open access to most datasets, maintains extensive documentation and methodological transparency, and contains one of the richest publicly available DXA body composition datasets available.

However, limitations should be acknowledged. Most NHANES analyses are based on repeated cross-sectional surveys, which limits causal inference. Reference values are derived from U.S. populations and may not generalise fully to other countries. Measurement protocols have evolved across cycles, requiring careful harmonisation for trend analyses. In addition, DXA participation differs across survey cycles and some body composition datasets contain cycle-dependent missing data that must be considered during analysis.

Despite these limitations, NHANES remains one of the most valuable resources available for anthropometry and body composition research. Its combination of rigorous methodology, nationally representative sampling, detailed body composition data, and unparalleled transparency continues to support advances in research, policy, and practice across nutrition, health, epidemiology, and human measurement science.

Yes. For the NHANES fact sheet, I would add a short**”Key Links and Resources”** section immediately after the Accessing the Data section and before Analysis Essentials.

Key Links and Resources

NHANES Home Page

The main NHANES website provides access to survey information, data releases, documentation, publications, questionnaires, procedures manuals, and methodological guidance (CDC, 2025).

Website: National Health and Nutrition Examination Survey (NHANES)

NHANES Data Portal

Access publicly available datasets, codebooks, questionnaires, data documentation, and analytic guidance.

Website: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx

Latest Anthropometry Procedures Manual

The Anthropometry Procedures Manual provides detailed guidance on:

    • Participant preparation
    • Equipment requirements
    • Anatomical landmarking
    • Measurement protocols
    • Equipment calibration
    • Quality assurance procedures
    • Examiner responsibilities
    • Data recording procedures

The current publicly available manual is: CDC NHANES Anthropometry Procedures Manual (2021): Download Anthropometry Procedures Manual

NHANES Procedures Manuals Library

NHANES publishes manuals for many survey components, including:

    • Anthropometry
    • Body Composition
    • Laboratory Procedures
    • Blood Pressure
    • Dietary Assessment
    • Physical Activity
    • Examination Components

Website: NHANES Procedures Manuals

NHANES Analytic Guidelines

Researchers using NHANES should review the analytic guidance covering:

    • Survey weights
    • Stratification
    • Primary Sampling Units (PSUs)
    • Combining survey cycles
    • Missing data considerations

Website: https://wwwn.cdc.gov/nchs/nhanes/tutorials/default.aspx

NHANES Research Data Center (Restricted Data)

Researchers wishing to access restricted-use data may apply through the NCHS Research Data Center.

Website: https://www.cdc.gov/rdc/

NHANES Publications and Reference Data

A useful resource for locating key NHANES outputs, including anthropometric reference values and methodological reports.

Website: https://www.cdc.gov/nchs/products/index.htm

Standardisation Systems

Anthropometry and body composition science are supported by a number of complementary systems, organisations, and resources, each designed to answer different questions. Some focus on how measurements are collected, others on how growth is assessed, while others provide population surveillance data or large-scale research datasets. Understanding the purpose, strengths, and limitations of each is essential for selecting the most appropriate framework for practice, education, research, or public health applications.

The five systems highlighted below represent some of the most widely used and influential resources in anthropometry and body composition science. Together, they provide a strong foundation for understanding measurement standardisation, growth assessment, population health monitoring, and research-based discovery.

System Primary Purpose Population Main Output Key Strength
ISAK Anthropometry accreditation and standardisation Practitioners Standardised measurements and competency accreditation Measurement quality and reliability
NHANES National health and nutrition surveillance U.S. population Anthropometry, DXA, health and nutrition data Nationally representative surveillance
WHO Growth Standards Global growth assessment Children from birth to 19 years Growth standards and z-score classifications International growth monitoring
CDC Growth Monitoring U.S. child growth assessment Children and adolescents 2-20 years Growth references and percentile classifications Clinical growth assessment in the U.S.
UK Biobank Biomedical and population health research UK adults aged 40-69 years at recruitment Anthropometry, imaging, genetics, biomarkers and health outcomes Large-scale prospective research

ISAK

ISAK is fundamentally different from the other systems because it is not a dataset, surveillance programme, or growth reference. Instead, it is an international accreditation framework designed to improve the quality, reliability, and comparability of anthropometric measurements through standardised training and competency assessment. Its focus is the anthropometrist rather than the population being measured.

NHANES: Monitoring Population Health

NHANES is a national surveillance programme conducted in the United States. It combines anthropometry, body composition, laboratory testing, health examinations, nutrition assessment, and health outcomes within a nationally representative sample. NHANES provides reference data and population health statistics that underpin much of modern obesity, body composition, and epidemiological research.

WHO Growth Standards

The WHO Growth Standards were developed from healthy children living under favourable environmental conditions and describe how children should grow under optimal circumstances. They are widely used internationally for assessing growth, nutritional status, stunting, wasting, and overweight in children and adolescents.

CDC Growth Monitoring

CDC Growth Charts are growth references based on measurements collected from U.S. children. Unlike WHO standards, they are descriptive rather than prescriptive and are primarily used within U.S. healthcare. They provide percentile-based assessment tools for monitoring height, weight, and BMI from ages 2 to 20 years.

UK Biobank

UK Biobank is a large-scale prospective research cohort rather than a surveillance system or growth monitoring framework. It combines anthropometry, body composition, imaging, genetics, biomarkers, lifestyle data, and linked health records in approximately 500,000 participants. Its purpose is to improve understanding of disease mechanisms, risk factors, and health outcomes across the lifespan.

Bringing the Systems Together

Together, these five systems provide a comprehensive foundation for understanding modern anthropometry and body composition science. ISAK focuses on how measurements are collected and standardised, WHO and CDC focus on how growth is assessed and interpreted, NHANES focuses on population-level surveillance and health monitoring, and UK Biobank focuses on long-term research and disease discovery.

Understanding where each system fits within the broader landscape of human measurement science helps practitioners, educators, and researchers select the most appropriate methods, datasets, standards, and frameworks for their specific objectives, while also appreciating how these systems complement one another.