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1.  Validity and predictors of BMI derived from self-reported height and weight among 11- to 17-year-old German adolescents from the KiGGS study 
BMC Research Notes  2011;4:414.
Background
For practical and financial reasons, self-reported instead of measured height and weight are often used. The aim of this study is to evaluate the validity of self-reports and to identify potential predictors of the validity of body mass index (BMI) derived from self-reported height and weight.
Findings
Self-reported and measured data were collected from a sub-sample (3,468 adolescents aged 11-17) from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). BMI was calculated from both reported and measured values, and these were compared in descriptive analyses. Linear regression models with BMI difference (self-reported minus measured) and logistic regression models with weight status misclassifications as dependent variables were calculated.
Height was overestimated by 14- to 17-year-olds. Overall, boys and girls under-reported their weight. On average, BMI values calculated from self-reports were lower than those calculated from measured values. This underestimation of BMI led to a bias in the prevalence rates of under- and overweight which was stronger in girls than in boys. Based on self-reports, the prevalence was 9.7% for underweight and 15.1% for overweight. However, according to measured data the corresponding rates were 7.5% and 17.7%, respectively. Linear regression for BMI difference showed significant differences according to measured weight status: BMI was overestimated by underweight adolescents and underestimated by overweight adolescents. When weight status was excluded from the model, body perception was statistically significant: Adolescents who regarded themselves as 'too fat' underestimated their BMI to a greater extent. Symptoms of a potential eating disorder, sexual maturation, socio-economic status (SES), school type, migration background and parental overweight showed no association with the BMI difference, but parental overweight was a consistent predictor of the misclassification of weight status defined by self-reports.
Conclusions
The present findings demonstrate that the observed discrepancy between self-reported and measured height and weight leads to inaccurate estimates of the prevalence of under- and overweight when based on self-reports. The collection of body perception data and parents' height and weight is therefore recommended in addition to self-reports. Use of a correction formula seems reasonable in order to correct for differences between self-reported and measured data.
doi:10.1186/1756-0500-4-414
PMCID: PMC3216908  PMID: 22005143
2.  Validity of Self-Reported Weight and Height of Adolescents, Its Impact on Classification into BMI-Categories and the Association with Weighing Behaviour 
This paper investigated the validity of self-reported height and weight of adolescents for the diagnosis of underweight, overweight and obesity and the influence of weighing behaviour on the accuracy. A total of 982 adolescents reported their height, weight, weighing behaviour and eating patterns in a questionnaire. Afterwards, their height and weight were measured and their Body Mass Index (BMI)-categories were determined using age- and gender-specific BMI cut-off points. Both girls and boys underreported their weight, whilst height was overestimated by girls and underestimated by boys. Cohen’s d indicated that these misreportings were in fact trivial. The prevalence of underweight was overestimated when using the self-reported BMI for classification, whilst the prevalence of overweight and obesity was underestimated. Gender and educational level influenced the accuracy of the adolescents’ self-reported BMI. Weighing behaviour only positively influenced the accuracy of the self-reported weight and not height or BMI. In summary, adolescents’ self-reported weight and height cannot replace measured values to determine their BMI-category, and thus the latter are highly recommended when investigating underweight, overweight and obesity in adolescents.
doi:10.3390/ijerph6102696
PMCID: PMC2790101  PMID: 20054463
height; weight; body mass index; validity; adolescents; weighing behaviour
3.  Validity of Web-Based Self-Reported Weight and Height: Results of the Nutrinet-Santé Study 
Background
With the growing scientific appeal of e-epidemiology, concerns arise regarding validity and reliability of Web-based self-reported data.
Objective
The objectives of the present study were to assess the validity of Web-based self-reported weight, height, and resulting body mass index (BMI) compared with standardized clinical measurements and to evaluate the concordance between Web-based self-reported anthropometrics and face-to-face declarations.
Methods
A total of 2513 participants of the NutriNet-Santé study in France completed a Web-based anthropometric questionnaire 3 days before a clinical examination (validation sample) of whom 815 participants also responded to a face-to-face anthropometric interview (concordance sample). Several indicators were computed to compare data: paired t test of the difference, intraclass correlation coefficient (ICC), and Bland–Altman limits of agreement for weight, height, and BMI as continuous variables; and kappa statistics and percent agreement for validity, sensitivity, and specificity of BMI categories (normal, overweight, obese).
Results
Compared with clinical data, validity was high with ICC ranging from 0.94 for height to 0.99 for weight. BMI classification was correct in 93% of cases; kappa was 0.89. Of 2513 participants, 23.5% were classified overweight (BMI≥25) with Web-based self-report vs 25.7% with measured data, leading to a sensitivity of 88% and a specificity of 99%. For obesity, 9.1% vs 10.7% were classified obese (BMI≥30), respectively, leading to sensitivity and specificity of 83% and 100%. However, the Web-based self-report exhibited slight underreporting of weight and overreporting of height leading to significant underreporting of BMI (P<.05) for both men and women: –0.32 kg/m2 (SD 0.66) and –0.34 kg/m2 (SD 1.67), respectively. Mean BMI underreporting was –0.16, –0.36, and –0.63 kg/m2 in the normal, overweight, and obese categories, respectively. Almost perfect agreement (ie, concordance) was observed between Web-based and face-to-face report (ICC ranged from 0.96 to 1.00, classification agreement was 98.5%, and kappa 0.97).
Conclusions
Web-based self-reported weight and height data from the NutriNet-Santé study can be considered as valid enough to be used when studying associations of nutritional factors with anthropometrics and health outcomes. Although self-reported anthropometrics are inherently prone to biases, the magnitude of such biases can be considered comparable to face-to-face interview. Web-based self-reported data appear to be an accurate and useful tool to assess anthropometric data.
doi:10.2196/jmir.2575
PMCID: PMC3742400  PMID: 23928492
anthropometry; body weight; obesity; self-report; weights and measures; validation studies
4.  Validity of Self-Reported Height and Weight in a Korean Population 
Journal of Epidemiology  2011;21(1):30-36.
Background
Accessible public information on self-reported height and weight is not widely used in studies of obesity, mainly because of the questionable validity of body mass index (BMI) values calculated from these data. To assess the utility of self-reported measurement, we compared self-reported and standard measurements of height and weight in a Korean population that is leaner than Western populations.
Methods
A cross-sectional comparison of self-reported and measured height and weight was conducted among a population of participants in a cancer screening program. A total of 557 men and 1010 women aged 30 to 70 years were included in the current analysis.
Results
Self-reported height was higher than measured values in both men and women. Self-reported weight was higher than measured weight in women, but was not different in men. BMI calculated from measured values was higher than BMI derived from self-reported height and weight among men. Younger age was a predictor of accuracy in self-reported height, and higher weight and BMI were predictors of under-reporting of weight. The prevalence of obesity based on self-reported values was lower than the true prevalence of obesity. With respect to classifying individuals as obese, the specificity and sensitivity of BMI calculated from self-reported values were very high for both sexes.
Conclusions
Self-reported height and weight were reasonably valid in this study population.
doi:10.2188/jea.JE20100058
PMCID: PMC3899514  PMID: 20953091
validity; height; weight; body mass index; self-report
5.  Is There an Association between Socioeconomic Status and Body Mass Index among Adolescents in Mauritius? 
The Scientific World Journal  2012;2012:750659.
There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ2 = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.
doi:10.1100/2012/750659
PMCID: PMC3349152  PMID: 22606060
6.  Depression and Anxiety in Adolescent Females: The Impact of Sleep Preference and Body Mass Index 
Purpose
To examine the differences in depressive symptoms and anxiety between (a) normal weight and overweight, and (b) morning type and evening type (sleep chronotype) adolescent girls. The interaction of sleep chronotype and weight and depressive symptoms and anxiety were also examined.
Method
The design consisted of a cross-sectional study of 264 adolescent females (mean age= 14.9 ± 2.2, range 11–17 years). Sleep chronotype, depressive symptoms, and anxiety were obtained by self-report questionnaire. The mean of three measurements of height and weight was used to calculate the body mass index (BMI). BMI was plotted on the CDC BMI-for-age growth charts to obtain percentile ranking. Participants were categorized into two groups according to BMI percentile: normal weight (<85th percentile) and overweight (≥85th percentile).
Results
Compared with normal-weight females, overweight females were more likely to be non- Caucasian, lower socioeconomic status, have more advanced pubic hair and breast stages, and earlier age at menarche. No differences were observed with respect to sleep chronotype, depressive symptoms, and trait anxiety between normal weight and overweight females. Evening chronotype was associated with more depressive symptoms (β = −.65, p < .01) and higher trait anxiety (β =−.22, p < .05). Evening chronotype was associated with more depressive symptoms in both normal-weight and overweight females. However, the association was stronger in overweight females.
Conclusions
Individually, sleep and weight impact physical and mental health during adolescence. The combination of evening chronotype and overweight appears to have the strongest association on the emotional health of adolescent females. Further investigations are needed to provide potential biological mechanisms for this relationship.
doi:10.1016/j.jadohealth.2008.11.012
PMCID: PMC3676884  PMID: 19465319
Morningness; Eveningness; Depression; BMI
7.  Truth Be Told: Evidence of Wheelchair Users’ Accuracy in Reporting Their Height and Weight 
Objectives
To examine whether wheelchair users’ self-reports of height and weight differed significantly from direct measurements and whether weight category classifications differed substantially when based on self-reported or measured values.
Design
Single group, cross-sectional analysis. Analyses included paired t tests, chi-square test, analysis of variance, and Bland-Altman agreement analyses.
Setting
A university-based exercise lab.
Participants
Community-dwelling wheelchair users (N=125).
Interventions
Not applicable.
Main Outcome Measure
Participants’ self-reported and measured height, weight, and body mass index.
Results
Paired t tests revealed that there were significant differences between wheelchair users’ self-reported and measured values for height (difference of 3.1±7.6cm [1.2±3.0in]), weight (−1.7±6.5kg [−3.6±14.2lb]), and BMI (−1.6±3.3). These discrepancies also led to substantial misclassification into weight categories, with reliance on self-reported BMI underestimating the weight status of 20% of the sample.
Conclusions
Our findings suggest that similar to the general population, wheelchair users are prone to errors when reporting their height and weight and that these errors may exceed those noted in the general population.
doi:10.1016/j.apmr.2012.05.005
PMCID: PMC3562126  PMID: 22609118
Obesity; Overweight; Public health; Rehabilitation
8.  A Comparison between International Obesity Task Force and Center for Disease Control References in Assessment of Overweight and Obesity Among Adolescents in Babol, Northern Iran 
Objective:
This study compares the Center for Disease Control (CDC) and International Obesity Task Force (IOTF) references in assessment of overweight and obesity among Iranian adolescents.
Methods:
The data of this study was drawn from a cross sectional study of a representative sample of 1200 adolescents aged 12-17 years in Babol, northern Iran. A standard procedure was used to measure height and weight and the body mass index was calculated. Each subject was classified as overweight and obese based on IOTF cut off values of BMI and CDC references BMI percentile sets by age and sex. The kappa coefficients were estimated for the degree of agreement.
Results:
In assessment of obesity/overweight prevalence, the CDC and IOTF references produced a similar estimate by age group and sex. The maximum differences was about 1% and the kappa coefficients was 0.96 to 1 (P = 0.001). While for assessment of obesity, the CDC reference produced slightly a higher rate of obesity and the difference in prevalence between the two sets of references was ranged from 1.4% to 3.2% with kappa coefficients: 0.90 to 0.70 (P = 0.001) depending on the age group and sex and a greater difference was observed among younger age group.
Conclusion:
The findings suggest an excellent agreement between the TOTF and CDC references in assessment of overall overweight/obesity prevalence among adolescent boys and girls. While in assessment of obesity prevalence alone the degree of agreement between the two sets of references slightly diminished. Overall, the two references are comparable and the agreement varies a little with respect to age and sex.
PMCID: PMC3604857  PMID: 23543826
Adolescents; Babol; center for disease control; international obesity task force; obesity; overweight
9.  Eating Behaviour among Multi-Ethnic Adolescents in a Middle-Income Country as Measured by the Self-Reported Children’s Eating Behaviour Questionnaire 
PLoS ONE  2013;8(12):e82885.
Background
Escalating weight gain among the Malaysian paediatric population necessitates identifying modifiable behaviours in the obesity pathway.
Objectives
This study describes the adaptation and validation of the Children’s Eating Behaviour Questionnaire (CEBQ) as a self-report for adolescents, investigates gender and ethnic differences in eating behaviour and examines associations between eating behaviour and body mass index (BMI) z-scores among multi-ethnic Malaysian adolescents.
Methodology
This two-phase study involved validation of the Malay self-reported CEBQ in Phase 1 (n = 362). Principal Axis Factoring with Promax rotation, confirmatory factor analysis and reliability tests were performed. In Phase 2, adolescents completed the questionnaire (n = 646). Weight and height were measured. Gender and ethnic differences in eating behaviour were investigated. Associations between eating behaviour and BMI z-scores were examined with complex samples general linear model (GLM) analyses, adjusted for gender, ethnicity and maternal educational level.
Results
Exploratory factor analysis revealed a 35-item, 9-factor structure with ‘food fussiness’ scale split into two. In confirmatory factor analysis, a 30-item, 8-factor structure yielded an improved model fit. Reliability estimates of the eight factors were acceptable. Eating behaviours did not differ between genders. Malay adolescents reported higher Food Responsiveness, Enjoyment of Food, Emotional Overeating, Slowness in Eating, Emotional Undereating and Food Fussiness 1 scores (p<0.05) compared to Chinese and Indians. A significant negative association was observed between BMI z-scores and Food Fussiness 1 (‘dislike towards food’) when adjusted for confounders.
Conclusion
Although CEBQ is a valuable psychometric instrument, adjustments were required due to age and cultural differences in our sample. With the self-report, our findings present that gender, ethnic and weight status influenced eating behaviours. Obese adolescents were found to display a lack of dislike towards food. Future longitudinal and qualitative studies are warranted to further understand behavioural phenotypes of obesity to guide prevention and intervention strategies.
doi:10.1371/journal.pone.0082885
PMCID: PMC3857802  PMID: 24349385
10.  Sexual orientation and bias in self-reported Body Mass Index 
Obesity (Silver Spring, Md.)  2012;20(8):10.1038/oby.2012.9.
Our objective was to determine if sexual orientation groups differ in accuracy of body mass index (BMI kg/m2) calculated from self-reported height and weight and if weight status modifies possible differences. Using gender-stratified multiple linear regression to analyze Wave III of the National Longitudinal Study of Adolescent Health (n=12,197) we examined the association of sexual orientation with BMI calculated from self-reported height and weight (self-reported BMI) , controlling for BMI calculated from objectively measured height and weight (objectively measured BMI) as well as demographic, health, and behavioral variables. We tested for effect modification of the relationship between sexual orientation and self-reported BMI by objectively-measured BMI. The population underestimated their BMI (females: beta=0.87, p<0.001; males=0.86, p<0.001). Sexual orientation groups differed little in their accuracy of reporting; only gay males had significant underreporting (beta=−0.37, p=0.038) relative to their heterosexual peers. We found no evidence of effect modification of the relationship of sexual orientation and self-reported BMI by objectively measured BMI. With the exception of gay males, sexual orientation groups are consistent in their underreporting of BMI thus providing confidence in most comparisons of weight status based on self-report. Self-reporting of weight and height by gay males may exaggerate the differences in BMI between gay and heterosexual males.
doi:10.1038/oby.2012.9
PMCID: PMC3837393  PMID: 22282109
sexual orientation; bias; self-reported BMI
11.  Measurement matters in the association between early adolescent depressive symptoms and body mass index 
General hospital psychiatry  2008;30(5):458-466.
Objective
To examine associations between depressive symptoms and body mass over one year during early adolescence and to assess how the associations might differ depending upon whether self-reported or directly measured height and weight were used.
Method
Participants were 446 sixth-grade Seattle students. Depressive symptoms were assessed using the Mood and Feelings Questionnaire. Regression models were used to examine whether baseline depression status was associated with 12-month BMI (using self-reported height and weight), and whether baseline overweight status was associated with 12-month depressive symptom score. Analyses were re-run among a sub-sample (n = 165) who had height and weight directly measured.
Results
Using BMI derived from self-reported values, depressed males had a significantly lower BMI than non-depressed males, while depressed females had a significantly higher BMI than non-depressed females, after adjusting for covariates. Among a sub-sample using measured height and weight values, however, depression was no longer associated with BMI in either gender. Baseline overweight status did not predict 12-month depression score.
Conclusions
Observed associations between depression and subsequent BMI were explained by differential misclassification of self-reported height and weight by depression status and gender. Direct measurement of height and weight may be necessary to ensure validity in studies of adolescent depression and weight-related outcomes.
doi:10.1016/j.genhosppsych.2008.06.008
PMCID: PMC2566776  PMID: 18774430
Depression; body mass; overweight/obesity; adolescence; differential misclassification
12.  Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006 
BMC Public Health  2009;9:421.
Background
The Body Mass Index (BMI) based on self-reported height and weight ("self-reported BMI") in epidemiologic studies is subject to measurement error. However, because of the ease and efficiency in gathering height and weight information through interviews, it remains important to assess the extent of error present in self-reported BMI measures and to explore possible adjustment factors as well as valid uses of such self-reported measures.
Methods
Using the combined 2001-2006 data from the continuous National Health and Nutrition Examination Survey, discrepancies between BMI measures based on self-reported and physical height and weight measures are estimated and socio-demographic predictors of such discrepancies are identified. Employing adjustments derived from the socio-demographic predictors, the self-reported measures of height and weight in the 2001-2006 National Health Interview Survey are used for population estimates of overweight & obesity as well as the prediction of health risks associated with large BMI values. The analysis relies on two-way frequency tables as well as linear and logistic regression models. All point and variance estimates take into account the complex survey design of the studies involved.
Results
Self-reported BMI values tend to overestimate measured BMI values at the low end of the BMI scale (< 22) and underestimate BMI values at the high end, particularly at values > 28. The discrepancies also vary systematically with age (younger and older respondents underestimate their BMI more than respondents aged 42-55), gender and the ethnic/racial background of the respondents. BMI scores, adjusted for socio-demographic characteristics of the respondents, tend to narrow, but do not eliminate misclassification of obese people as merely overweight, but health risk estimates associated with variations in BMI values are virtually the same, whether based on self-report or measured BMI values.
Conclusion
BMI values based on self-reported height and weight, if corrected for biases associated with socio-demographic characteristics of the survey respondents, can be used to estimate health risks associated with variations in BMI, particularly when using parametric prediction models.
doi:10.1186/1471-2458-9-421
PMCID: PMC2784464  PMID: 19922675
13.  Validation of self-reported height and weight in fifth-grade Korean children 
Nutrition Research and Practice  2013;7(4):326-329.
Height and weight are important indicators to calculate Body Mass Index (BMI); measuring height and weight directly is the most exact method to get this information. However, it is ineffective in terms of cost and time on large population samples. The aim of our study was to investigate the validity of self-reported height and weight data compared to our measured data in Korean children to predict obese status. Four hundred twenty-two fifth-grade (mean age 10.5 ± 0.5 years) children who had self-reported and measured height and weight data were final subjects for this study. Overweight/obese was defined as a BMI of or above the 85th percentile of the gender-specific BMI for age in the 2007 Korean National Growth Charts or a BMI of 25 or higher (underweight : < 5th, normal : ≥ 5th to < 85th, overweight : ≥ 85th to < 95th). The differences between self-reported and measured data were tested using paired t-test. Differences based on overweight/obese status were tested using analysis of variance (ANOVA) and linear trends. Pearson's correlation and Cohen's kappa were tested to examine agreements between the self-reported and measured data. Although measured and self-reported height, weight and BMI were significantly different and children tended to overreport their height and underreport their weight, the correlation between the two methods of height, weight and BMI were high (r = 0.956, 0.969, 0.932, respectively; all P < 0.001), and both genders reported their overweight/non-overweight status accurately (Cohen's kappa = 0.792, P < 0.001). Although there were differences between the self-reported and our measured methods, the self-reported weight and height was valid enough to classify overweight/obesity status correctly, especially in non-overweight/obese children. Due to bigger underestimation of weight and overestimation of height in obese children, however, we need to be aware that the self-reported anthropometric data were less accurate in overweight/obese children than in non-overweight/obese children.
doi:10.4162/nrp.2013.7.4.326
PMCID: PMC3746168  PMID: 23964321
Self-report; measure; height; weight; children
14.  Ethnic variation in validity of the estimated obesity prevalence using self-reported weight and height measurements 
BMC Public Health  2011;11:408.
Background
We examined ethnic differences between levels of body mass index (BMI) based on self-reported and measured body height and weight and the validity of self-reports used to estimate the prevalence of obesity (BMI≥30 kg/m2) in Turkish, Moroccan, and Dutch people in the Netherlands. Furthermore, we investigated whether BMI levels and the prevalence of obesity in Turkish and Moroccan people with incomplete self-reports (missing height or weight) differ from those with complete self-reports.
Methods
Data on self-reported and measured height and weight were collected in a population-based survey among 441 Dutch, 414 Turks and 344 Moroccans aged 18 to 69 years in Amsterdam, the Netherlands in 2004. BMI and obesity were calculated from self-reported and measured height and weight.
Results
The difference between measured and estimated BMI was larger in Turkish and Moroccan women than in Dutch women, which was explained by the higher BMI of the Turkish and Moroccan women. In men we found no ethnic differences between measured and estimated BMI. Sensitivity to detect obesity was low and specificity was high. In participants with available self-reported and measured height and weight, self-reports produced a similar underestimation of the obesity prevalence in all ethnic groups. However, many obese Turkish and Moroccan women had incomplete self-reports, missing height or weight, resulting in an additional underestimation of the prevalence of obesity. Among men (all ethnicities) and Dutch women, the availability of height or weight by self-report did not differ between obese and non obese participants.
Conclusions
BMI based on self-reports is underestimated more by Turkish and Moroccan women than Dutch women, which is explained by the higher BMI of Turkish and Moroccan women. Further, in women, ethnic differences in the estimation of obesity prevalence based on self-reports do exist and are due to incomplete self-reports in obese Turkish and Moroccan women. In men, ethnicity is not associated with discrepancies between levels of BMI and obesity prevalence based on measurements and self-reports. Hence, our results indicate that using measurements to accurately determine levels of BMI and obesity prevalence in public health research seems even more important in Turkish and Moroccan migrant women than in other populations.
doi:10.1186/1471-2458-11-408
PMCID: PMC3125373  PMID: 21624122
15.  The Use of Stunkard’s Figure Rating Scale to Identify Underweight and Overweight in Chinese Adolescents 
PLoS ONE  2012;7(11):e50017.
Background
To compare the performance of Stunkard’s current body size (CBS) with self-reported body mass index (BMI), waist circumference (WC) and waist to stature ratio (WSR) in predicting weight status in Chinese adolescents, and to determine the CBS cutoffs for overweight/obesity and underweight.
Methodology
This cross-sectional study was conducted in a sample of 5,418 secondary school students (45.2% boys; mean age 14.7 years). Height and weight were measured by trained teachers or researchers. Subjects were classified as underweight, normal weight, or overweight/obese according to the International Obesity Task Force cutoffs. Subjects were asked to select the figure that best resembled their CBS on the Stunkard’s figure rating scale. Self-reported height, weight, WC and WSR were also obtained. The performance of CBS, self-reported BMI, WC and WSR as a weight status indicator was analysed by sex-specific receiver operating characteristic curves. The optimal CBS cutoffs for underweight and overweight/obesity were determined based on the Youden Index.
Principal Findings
Apart from self-reported BMI, CBS had the greatest area under curve (AUC) for underweight in boys (0.82) and girls (0.81). For overweight/obesity, CBS also had a greater AUC (0.85) than self-reported WC and WSR in boys, and an AUC (0.81) comparable to self-reported WC and WSR in girls. In general, CBS values of 3 and 5 appeared to be the optimal cutoffs for underweight and overweight/obesity, respectively, in different sex-age subgroups.
Conclusions/Significance
CBS is a potentially useful indicator to assess weight status of adolescents when measured and self-reported BMI are not available.
doi:10.1371/journal.pone.0050017
PMCID: PMC3506537  PMID: 23189177
16.  Validity of self-reported height and weight among adolescents: the importance of reporting capability 
Background
This study proposes a new approach for investigating bias in self-reported data on height and weight among adolescents by studying the relevance of participants’ self-reported response capability. The objectives were 1) to estimate the prevalence of students with high and low self-reported response capability for weight and height in a self-administrated questionnaire survey among 11–15 year old Danish adolescents, 2) to estimate the proportion of missing values on self-reported height and weight in relation to capability for reporting height and weight, and 3) to investigate the extent to which adolescents’ response capability is of importance for the accuracy and precision of self-reported height and weight. Also, the study investigated the impact of students’ response capability on estimating prevalence rates of overweight.
Methods
Data was collected by a school-based cross-sectional questionnaire survey among students aged 11–15 years in 13 schools in Aarhus, Denmark, response rate =89%, n = 2100. Response capability was based on students’ reports of perceived ability to report weight/height and weighing/height measuring history. Direct measures of height and weight were collected by school health nurses.
Results
One third of the students had low response capability for weight and height, respectively, and every second student had low response capability for BMI. The proportion of missing values on self-reported weight and height was significantly higher among students who were not weighed and height measured recently and among students who reported low recall ability. Among both boys and girls the precision of self-reported height and weight tended to be lower than among students with low response capability. Low response capability was related to BMI (z-score) and overweight prevalence among girls. These findings were due to a larger systematic underestimation of weight among girls who were not weighed recently (−1.02 kg, p < 0.0001) and among girls with low recall ability for weight (−0.99 kg, p = 0.0024).
Conclusion
This study indicates that response capability may be relevant for the accuracy of girls’ self-reported measurements of weight and height. Consequently, by integrating items on response capability in survey instruments, participants with low capability can be identified. Similar analyses based on other and less selected populations are recommended.
doi:10.1186/1471-2288-13-85
PMCID: PMC3711890  PMID: 23805955
Height/weight; Self-reports; Validity; Response capability; Adolescents
17.  Measured body mass index, body weight perception, dissatisfaction and control practices in urban, low-income African American adolescents 
BMC Public Health  2009;9:183.
Background
Current understanding of the associations between actual body weight status, weight perception, body dissatisfaction, and weight control practices among low-income urban African American adolescents is limited. The knowledge can help direct future intervention efforts.
Methods
Cross-sectional data including measured weight and height and self-reported weight status collected from 448 adolescents in four Chicago Public Schools were used.
Results
The prevalence of overweight and obesity (BMI ≥ 85th percentile) was 39.8%, but only 27.2% considered themselves as obese, although 43.4% reported trying to lose weight. Girls were more likely to express weight dissatisfaction than boys, especially those with BMI ≥ 95th percentile (62.9% vs. 25.9%). BMI ≥ 85th percentile girls were more likely to try to lose weight than boys (84.6% vs. 66.7%). Among all adolescents, 27.2% underestimated and 67.2% correctly judged their own weight status. Multinomial logistic models show that those with BMI ≥ 85th percentile, self-perceived as obese, or expressed body dissatisfaction were more likely to try to lose weight; adjusted odds ratios and 95% confidence intervals were 4.52 (2.53–8.08), 18.04 (7.19–45.30), 4.12 (1.64–10.37), respectively. No significant differences were found in diet and physical activity between those trying to lose weight and those not trying, but boys who reported trying to lose weight still spent more television time (P < 0.05).
Conclusion
Gender differences in weight perception, body dissatisfaction, and weight control practices exist among African American adolescents. One-third did not appropriately classify their weight status. Weight perception and body dissatisfaction are correlates of weight control practices. Adolescents attempting to lose weight need be empowered to make adequate desirable behavioral changes.
doi:10.1186/1471-2458-9-183
PMCID: PMC2704208  PMID: 19523206
18.  The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents 
BMC Public Health  2007;7:80.
Background
The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.
Methods
A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15–18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-spesific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.
Results
Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.
Conclusion
The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.
doi:10.1186/1471-2458-7-80
PMCID: PMC1888702  PMID: 17506879
19.  Accuracy of Self-reported Weight and Height in Binge Eating Disorder: Misreport is Not Related to Psychological Factors 
Obesity (Silver Spring, Md.)  2009;18(6):1266-1269.
This study examined the degree of misreport in weight, height, and BMI among overweight adults (n=392) with binge eating disorder (BED) and tested whether the degree of misreport was associated with eating disorder psychopathology and psychological variables. Male (n=97) and female (n=295) participants self-reported height and weight and were subsequently measured by clinic staff. Participants also completed a series of diagnostic interviews and self-report assessments. Discrepancies between self-reported and measured values were modest. The degree of misreport for weight, height, and BMI was not related to eating disorder features, depression, and self-esteem. Overall, the errors in self-reported weight and height by overweight patients with BED were very slight. The degree of discrepancy between self-reported and measured values was not related to eating disorder or psychological features, suggesting that such data are not biased or systematically related to individual differences in overweight patients with BED.
doi:10.1038/oby.2009.347
PMCID: PMC2877172  PMID: 19834465
20.  Correlates of weight status among Norwegian 11-year-olds: The HEIA study 
BMC Public Health  2012;12:1053.
Background
The underlying mechanisms of overweight and obesity in adolescents are still not fully understood. The aim of this study was to investigate modifiable and non-modifiable correlates of weight status among 1103 Norwegian 11-year-old adolescents in the HEalth in Adolescents (HEIA) study, including demographic factors such as gender and parental education, and behavioral factors such as intake of sugar-sweetened beverages, snacks and breakfast consumption, watching TV and playing computer games, physical activity and sedentary time.
Methods
Weight and height were measured objectively, body mass index (BMI) was calculated and International Obesity Task Force cut-offs were used to define weight status. Physical activity and sedentary time were measured by accelerometers. Other behavioral correlates and pubertal status were self-reported by questionnaires. Parental education was reported by the parents on the consent form for their child. Associations were investigated using logistic regressions.
Results
There were gender differences in behavioral correlates of weight status but not for weight status itself. Adolescents with parents in the highest education category had a 46% reduced odds of being overweight compared to adolescents with parents in the lowest education category. Adolescents with parents with medium education had 42% lower odds of being overweight than adolescents with parents with the lowest education category. Level of parental education, breakfast consumption and moderate to vigorous physical activity were positively associated with being normal weight, and time watching TV was positively associated with being overweight for the total sample. Gender differences were detected; boys had a doubled risk of being overweight for every additional hour of watching TV per week, while for girls there was no association.
Conclusions
The present study showed a social gradient in weight status in 11-year-olds. Both breakfast consumption and moderate to vigorous physical activity were inversely associated with weight status. No associations were found between intake of sugar-sweetened beverages and snacks, playing computer games and weight status. Watching TV was positively associated with weight status for boys but not for girls. Interventions are needed to gain more insight into the correlates of change in weight status.
doi:10.1186/1471-2458-12-1053
PMCID: PMC3538064  PMID: 23216675
Overweight; Physical activity; Sedentary time; Parental education; Diet; Children; Adolescents
21.  Validation of self-reported anthropometrics in the Adventist Health Study 2 
BMC Public Health  2011;11:213.
Background
Relying on self-reported anthropometric data is often the only feasible way of studying large populations. In this context, there are no studies assessing the validity of anthropometrics in a mostly vegetarian population. The objective of this study was to evaluate the validity of self-reported anthropometrics in the Adventist Health Study 2 (AHS-2).
Methods
We selected a representative sample of 911 participants of AHS-2, a cohort of over 96,000 adult Adventists in the USA and Canada. Then we compared their measured weight and height with those self-reported at baseline. We calculated the validity of the anthropometrics as continuous variables, and as categorical variables for the definition of obesity.
Results
On average, participants underestimated their weight by 0.20 kg, and overestimated their height by 1.57 cm resulting in underestimation of body mass index (BMI) by 0.61 kg/m2. The agreement between self-reported and measured BMI (as a continuous variable), as estimated by intraclass correlation coefficient, was 0.97. The sensitivity of self-reported BMI to detect obesity was 0.81, the specificity 0.97, the predictive positive value 0.93, the predictive negative value 0.92, and the Kappa index 0.81. The percentage of absolute agreement for each category of BMI (normoweight, overweight, and obese) was 83.4%. After multivariate analyses, predictors of differences between self-reported and measured BMI were obesity, soy consumption and the type of dietary pattern.
Conclusions
Self-reported anthropometric data showed high validity in a representative subsample of the AHS-2 being valid enough to be used in epidemiological studies, although it can lead to some underestimation of obesity.
doi:10.1186/1471-2458-11-213
PMCID: PMC3079646  PMID: 21466678
22.  Validation of obesity based on self-reported data in Spanish women participants in breast cancer screening programmes 
BMC Public Health  2011;11:960.
Background
Measurement of obesity using self-reported anthropometric data usually involves underestimation of weight and/or overestimation of height. The dual aim of this study was, first, to ascertain and assess the validity of new cut-off points, for both overweight and obesity, using self-reported Body Mass Index furnished by women participants in breast cancer screening programmes, and second, to estimate and validate a predictive model that allows recalculate individual BMI based on self-reported data.
Methods
The study covered 2927 women enrolled at 7 breast cancer screening centres. At each centre, women were randomly selected in 2 samples, in a ratio of 2:1. The larger sample (n = 1951) was used to compare the values of measured and self-reported weight and height, to ascertain new overweight and obesity cut-off points with self-reported data, using ROC curves, and to estimate a predictive model of real BMI using a regression model. The second sample (n = 976) was used to validate the proposed cut-off points and the predictive model.
Results
Whereas reported prevalence of obesity was 19.8%, measured prevalence was 28.2%. The sensitivity and specificity of this classification would be maximised if the new cut-off points were 24.30 kg/m2 for overweight and 28.39 kg/m2 for obesity. The probability of classifying women correctly in their real weight categories on the basis of these points was 82.5% in the validation sample. Sensitivity and specificity for determining obesity using the new cut-off point in the validation sample were 90.0% and 92.3% respectively. The predictive model for real BMI included the self-reported BMI, age and educational level (university studies vs lower levels of education). This model succeeded in correctly classifying 90.5% of women according to BMI categories, but its performance was similar to that obtained with the new cut-off points.
Conclusions
Quantification of self-reported obesity entails a considerable underestimation of this problem, thereby questioning its validity. The new cut-off points established in this study and the predictive equation both allow for more accurate estimation of these prevalences.
doi:10.1186/1471-2458-11-960
PMCID: PMC3268784  PMID: 22208614
23.  Effects of Parenting Style and Parent-Related Weight and Diet on Adolescent Weight Status 
Journal of Pediatric Psychology  2012;38(3):321-329.
Objective This study examined the interaction between parental limit setting of sedentary behaviors and health factors (weight status, physical activity [PA], fruit and vegetable [FV] intake) on standardized body mass index (zBMI) in African American adolescents. Methods Data were from 67 parent–adolescent dyads. Parental limit setting, PA and FV intake were assessed via self-report, and objective height and weight measurements were collected. Results Regressions examined the interaction between parental limit setting and BMI, PA, FV intake on adolescent zBMI. The model for parent BMI and FV intake accounted for 31% of the variance in adolescent zBMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher (vs. lower) limit setting was associated with lower adolescent zBMI. Higher parent FV consumption was associated with lower adolescent zBMI. Conclusion Future interventions should integrate parent limit setting and target parent fruit and vegetable intake for obesity prevention in underserved adolescents.
doi:10.1093/jpepsy/jss127
PMCID: PMC3604826  PMID: 23248345
adolescent; health behavior; obesity; parenting style; parents
24.  Excess Body Mass Index–Years, a Measure of Degree and Duration of Excess Weight, and Risk for Incident Diabetes 
Objective
To evaluate the relation between excess body mass index (BMI)–years, a measure of the degree to which an individual’s BMI (calculated as weight in kilograms divided by height in meters squared) exceeds the reference BMI and the duration for which he or she carries excess BMI, and incident diabetes.
Design
Longitudinal analysis.
Setting
United States of America.
Participants
A total of 8157 adolescents and young adults aged 14 to 21 years at the start of the National Longitudinal Survey of Youth 1979 with self-reported measures of height, weight, and diabetes status (type unspecified) from 1981 through 2006.
Main Exposure
Excess BMI-years, which were calculated by subtracting the reference BMI (25.0 for adults or 85th percentile for adolescents) from the actual BMI for each study year and cumulating excess BMI for the study duration.
Main Outcome Measure
We conducted logistic regression models to predict presumed type 2 diabetes (after excluding presumed type 1 diabetes) as a function of age, sex, race, excess BMI-years, and specific interactions.
Results
A higher level of excess BMI-years was associated with an increased risk of diabetes. For example, on average, white men aged 40 years with 200 excess BMI-years had 2.94 times (95% confidence interval, 2.36-3.67) higher odds of developing diabetes compared with men of the same age and race with 100 excess BMI-years. For a given level of excess BMI-years, younger compared with older and Hispanic and black compared with white individuals had higher risk of developing diabetes. Our study is limited by use of self-reported data without specification of diabetes type.
Conclusions
Because younger compared with older individuals have a higher risk of self-reported diabetes for a given level of excess BMI-years and cumulative exposure to excess BMI is increasing among younger US birth cohorts, public health interventions should target younger adults.
doi:10.1001/archpedi.166.1.42
PMCID: PMC3524333  PMID: 22213749
25.  Parent and family associations with weight-related behaviors and cognitions among overweight adolescents 
Purpose
To examine parent and family variables in relation to adolescent weight control and eating behaviors, body satisfaction, and importance of thinness among overweight adolescents.
Methods
This study examined parent-reported use of weight control behaviors (i.e., healthy and unhealthy behaviors, behavioral changes, other diet strategies), parent psychosocial functioning (i.e., depression, self-esteem, body satisfaction, importance of thinness), and family functioning (i.e., cohesion and adaptability) in relation to adolescent weight control and eating behaviors, body satisfaction, and importance of thinness. Surveys were completed by 103 overweight (BMI ≥ 85th percentile) adolescents, ages 12 to 20, and their parents. Height and weight were also measured. Linear regression equations were used for continuous outcomes and logistic regression equations for dichotomous outcomes.
Results
Adolescent report of lower body satisfaction and engagement in more “severe” or less healthy forms of weight control behavior were associated with parent weight control behaviors. Adolescent report of overeating was associated with lower scores of family cohesion and adaptability. Adolescent report of lower body satisfaction was positively associated with parent report of body satisfaction and self-esteem. Adolescent report of greater importance placed on thinness was associated with parent report of lower self-esteem.
Conclusions
Findings indicate that several parent and family variables are associated with weight control behaviors, episodes of overeating, and body satisfaction and importance of thinness among overweight adolescents. Parent weight control behaviors and adolescent cognitions about body image may be important variables to target within intervention research and treatment programs for overweight youth.
doi:10.1016/j.jadohealth.2010.02.009
PMCID: PMC3581019  PMID: 20708565
Weight control behavior; overweight; body satisfaction; family functioning; adolescents

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