The validity of obesity based on self-reported weight and height: Implications for population studies

Objective: To validate self‐reported information on weight and height in an adult population and to find a useful algorithm to assess the prevalence of obesity based on self‐reported information. Research Methods and Procedures: This was a cross‐sectional survey consisting of 1703 participants (860 men and 843 women, 30 to 75 years old) conducted in the community of Vara, Sweden, from 2001 to 2003. Self‐reported weight, height, and corresponding BMI were compared with measured data. Obesity was defined as measured BMI ≥ 30 kg/m². Information on education, self‐rated health, smoking habits, and physical activity during leisure time was collected by a self‐administered questionnaire. Results: Mean differences between measured and self‐reported weight were 1.6 kg (95% confidence interval, 1.4; 1.8) in men and 1.8 kg (1.6; 2.0) in women (measured higher), whereas corresponding differences in height were ?0.3 cm (?0.5; ?0.2) in men and ?0.4 cm (?0.5; ?0.2) in women (measured lower). Age and body size were important factors for misreporting height, weight, and BMI in both men and women. Obesity (measured) was found in 156 men (19%) and 184 women (25%) and with self‐reported data in 114 men (14%) and 153 women (20%). For self‐reported data, the sensitivity of obesity was 70% in men and 82% in women, and when adjusted for corrected self‐reported data and age, it increased to 81% and 90%, whereas the specificity decreased from 99% in both sexes to 97% in men and 98% in women. Discussion: The prevalence of obesity based on self‐reported BMI can be estimated more accurately when using an algorithm adjusted for variables that are predictive for misreporting.     

Correlates of BMI misreporting among apparently healthy individuals: the ATTICA study

Objective: The aim of this study was to investigate correlates of misreporting in BMI, based on self‐reported weight and height, in a randomly selected population sample of Greek adults and to evaluate the effect of obesity status misclassification on the associations between obesity and disease. Research Methods and Procedures: During 2001 to 2002, we randomly enrolled 1514 men (18 to 87 years old) and 1528 women (18 to 89 years old) from the Attica area, Greece; the sampling was stratified by the age‐sex distribution of the region. Various sociodemographic, clinical, and psychological characteristics were self‐reported, and weight and height were measured and recorded in all participants. Results: The proportions of true positives and true negatives for correct obesity status identification were 62% and 97%, respectively. Women were 9 times more likely to be under‐reporters than men, whereas men were 7.5 times more likely to be over‐reporters. A 10‐year increase in age was associated with a 48% higher likelihood of being an under‐reporter and 26% lower likelihood of being an over‐reporter, irrespective of sex and other characteristics of the participants. Clinical status, such as the presence of hypertension and diabetes, was associated with under‐reporting of body weight. Furthermore, the use of self‐reported data may substantially exaggerate associations between obesity and obesity‐related diseases, such as diabetes, hypercholesterolemia, and hypertension. Discussion: The study indicates that, apart from age and sex, disease status may be another factor that influences misreporting of obesity status, with diabetic and hypertensive people to be more likely to under‐report their overweight. Use of self‐reported data may bias obesity—disease associations.     

Body height in relation to rural-urban migration in Poland

A survey was conducted among 2800 students studying in Wroc?aw, Poland. The questionnaire included questions on the body height of the students and their parents, and place of residence and migration patterns of the students themselves, their parents and their grandparents. Body height in both students and their parents was positively correlated with the size of their place of residence. This was particularly true for male students and their fathers. Body height in students and parents from mobile families was not significantly different from that of their peers from non-mobile families. Body height in mobile individuals was generally between that of non-mobile individuals from rural areas and that of non-mobile individuals from large urban centres. Students from families that had migrated from smaller urban centres to larger ones were taller than students from families that had migrated from rural areas to urban centres. Body height in students was also correlated with the kind of migration that took place. In the students' mothers, body height was higher if the maternal grandparents moved from smaller urban centres to larger urban centres than if the maternal grandparents moved from rural areas to urban centres. In female students, body height depended on whether their mothers had migrated from smaller places of residence to larger places of residence, but was not affected by the degree of migration. Intra-generational migration during the generation of the students' grandparents was associated with increased body height in the students' mothers. On the other hand, intergenerational migration during the generations of the students' grandparents and parents was associated with increased body height in the students' fathers and in female students. Body height was not a reliable indicator of whether an individual migrated from rural areas to Wroc?aw. Far more reliable indicators were the size of the place the student lived their whole life and whether the family had lived in an urban environment for at least two generations.     

What Is the Accurate Prevalence of Obesity in Sweden in the 21st Century? Methodological Experiences From the Skaraborg Project

Objective: To examine the impact of non‐response to self‐reported body weight and height in health questionnaires for the estimation of obesity prevalence. Methods and Procedures: A cross‐sectional population‐based health survey in the community of Vara with 16,009 residents (in year 2002) in South‐western Sweden. Participants randomly selected in strata by sex and age among residents being 30–74 years old were consecutively invited to the local health care center for a health examination, including two visits. Self‐reported information on body weight and height were obtained by health questionnaires at the first visit, and measured information on both variables at the second visit. For this study 1,809 subjects (904 men and 905 women) completed both visits (participation rate 81%), and a nurse measured body weight and height of all at visit two. Participants not self‐reporting body weight and/or height at the first visit were defined as non‐responders. Results: Both male and female non‐responders were significantly older than responders. Female non‐responders had significantly higher BMI (29.8 ± 5.8 kg/m²) than female responders (26.6 ± 5.3 kg/m²), (P < 0.001). No similar findings were seen in men. Non‐responders were more likely to be obese than responders both in men (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.03–4.11) and in women (OR 2.24, 95% CI 1.25–4.02). Discussion: Non‐responders to self‐reported body weight and height in health questionnaires contribute to the underestimation of obesity. Measured body weight and height are to prefer when describing the accurate prevalence of obesity in populations.     

Health perceptions and demographic characteristics associated with underassessment of body weight

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self‐reported general health, and perceived health risk in relation to one's body weight. Methods and Procedures: In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self‐reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest. Results: Among persons with a BMI ≥25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self‐rated health among obese women; and self‐rated health among obese men (P < 0.05). Discussion: While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.     

Sex,Race/Ethnicity,Socioeconomic Status,and BMI in Relation to Self‐Perception of Overweight

Objective: To compare the self‐perception of overweight in the study population according to sex, race/ethnicity, and socioeconomic status and to compare the self‐perception of overweight among individuals classified as normal weight, overweight, and obese. Research Methods and Procedures: Data from 5440 adults who participated in the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey conducted by the U.S. Department of Agriculture were analyzed. Data for analysis included self‐perceived weight status, self‐reported weight and height, and demographic and socioeconomic data. Underweight individuals, defined as those with a body mass index <18.5 kg/m², were excluded from the analysis. Results: Self‐perception of overweight was more common in women compared with men and in whites compared with blacks or Hispanics. Both the correct and incorrect perception of overweight was more common in normal weight and overweight white women compared with black women. More overweight and obese white men correctly perceived their overweight status compared with black men. Multiple logistic regression showed that the odds ratio of perceived overweight was significantly higher in women, whites, and individuals with higher body mass index, higher income, and higher education. Discussion: Self‐perceived overweight varied by sex, race/ethnicity, and socioeconomic status. Erroneous perception of body weight may have important health and behavioral implications. In particular, a considerable proportion of overweight men may be at risk of obesity if they continue to perceive themselves as having normal weight.     

Waist Circumference is an Independent Correlate of Errors in Self‐Reported BMI

Although there are issues of reporting bias surrounding the use of self‐reported BMI, it is frequently the method employed to establish the prevalence of obesity. The goal of this study was to assess whether, independently of measured BMI, waist circumference (WC) was associated with the magnitude of the difference between self‐reported and measured BMI within a large sample of European‐American (EA) and African‐American (AA) adults. Self‐reported height and weight, and measured height, weight, and WC were collected on 12,809 adults (61% women, 66% EA) aged 18–65 years. Mean negative BMI differences (self‐reported minus measured BMI) were identified in all race‐by‐sex groups (AA men: ?0.55; EA men: ?0.63; AA women: ?0.91; EA women: ?0.67). WC was negatively associated with the BMI difference such that a higher WC was associated with greater under‐reporting of BMI. However, after adjusting for age and measured BMI, WC was positively associated with the BMI difference in all race‐by‐sex groups. These results suggest that WC could be useful in gaining an insight into people's awareness of their own body size and fatness.     

The relationship of birth weight with longitudinal changes in body composition in adult women

Most research on birth weight and adult health status has reported adult measures at a single time point. This study examined the relationship of self‐reported birth weight to longitudinal changes in adult body composition in 587 women of the Michigan Bone Health and Metabolism Study, followed from 1992 to 2007 and aged 24–50 years at baseline. Linear mixed models were used to estimate the association between three birth weight categories and women's 15‐year changes in adult weight, height, BMI, waist and hip circumference, waist‐to‐hip ratio, and fat, lean, and skeletal muscle mass. Body composition measures increased in all women over the 15‐year study period. At their adult baseline, high birth weight women weighed 13% more and had waist circumference and lean mass measures that were 5.51 cm and 3.91 kg larger, respectively, than normal birth weight women. No differences were observed in adult body composition between low and normal birth weight women and rates of change in the adult measures did not vary across the birth weight groups. Women heavier at birth continued to be heavier through adulthood, corroborating previous reports based on single measures of adult body composition. Research to address whether higher adult body composition in high birth weight women increases the longitudinal risk for obesity‐related chronic diseases is needed.     

From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms

In this article, we describe differences in the self‐perception of weight status in the United States between the two most recent National Health and Nutrition Examination Survey (NHANES) periods (1988–1994 and 1999–2004), and test the hypothesis that secular increases in adult mean BMI, adult obesity, and childhood obesity contributed to changes over time in weight perceptions. We find that the probability of self‐classifying as overweight is significantly lower on average in the more recent survey, for both women and men, controlling for objective weight status and other factors. Among women, the decline in the tendency to self‐classify as overweight is concentrated in the 17–35 age range, and is more pronounced among women with normal BMI than those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups. Overweight men exhibit a sharper decline in feeling overweight than normal weight men. Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. We interpret the findings as evidence of a generational shift in social norms related to body weight. As a result, people may be less likely to desire weight loss than previously, limiting the effectiveness of public health campaigns aimed at weight reduction. On the other hand, there may be health benefits associated with improved body image.     

Census of single homeless people in Sheffield.

OBJECTIVE--To determine the number of single homeless people in Sheffield and to examine their demography and social and medical details. DESIGN--Census carried out between 8 am and 8 pm on one day. Participants completed a questionnaire designed to provide data relating to employment history, contact with welfare and health services, social state, prison history, medical history, and health state. SETTING--Sites in Sheffield identified by local workers as being places of residence of homeless people. SUBJECTS--340 single homeless people. MAIN OUTCOME MEASURES--Self reported history of alcohol or drug misuse, existence of a chronic medical condition, and use of general practitioner and hospital services. RESULTS--The mean age of the population was 42.5 years and a quarter of the population were aged less than 30; there were 48 women. Significant differences were noted between men and women with respect to self reported psychiatric illness (77/266 men v 27/42 women), self reported alcoholism (83/273 v 4/44), prison history (152/255 v 8/41), and registration with a general practitioner (73/275 v 38/46). Various chronic medical conditions were reported, and the perceived health state of the population was low; 129 claimed to have been admitted to a psychiatric hospital. 220 people were registered with a general practitioner, and 179 claimed to see their doctor. Sixty five had attended or been admitted to a general hospital in the month preceding the study, 45 for accident and emergency services. CONCLUSIONS--The homeless in this population were younger than those found in previous studies. The prevalence of psychiatric illness was high in the population, and the overall health state was poor. Most subjects obtained health services from general practitioners.     

Differences in Body Fat and Central Adiposity between Swedes and European Immigrants: The Malmö Diet and Cancer Study

Objective: Comparative data on ecological differences in body fatness and fat distribution within Europe are sparse. Migration studies may provide information on the impact of environmental factors on body size in different populations. The objective was to investigate differences in adiposity between European immigrants and native Swedes, specifically to examine gender differences and the effect of time since immigration, and to compare two selected immigrant groups with their native countrymen. Research Methods and Procedures: A cross‐sectional analysis of 27,808 adults aged 45 to 73 years participating in the Malmö Diet and Cancer prospective cohort study in Sweden was performed. Percentage body fat (impedance analysis) and waist‐hip ratio (WHR) were compared between Swedish‐born and foreign‐born participants. Results: Obesity was 40% more prevalent in non‐Swedish Europeans compared with Swedes. Controlling for age, height, smoking, physical activity, and occupation, it was found that women born in the former Yugoslavia, southern Europe, Hungary, and Finland had a significantly higher percentage of body fat, and those from Hungary, Poland, and Germany had more centralized adiposity compared with Swedish women. Men born in the former Yugoslavia, Hungary, and Denmark had a significantly higher mean percentage of body fat compared with Swedish‐born men, whereas Yugoslavian, Finnish, and German men differed significantly in mean WHR. Length of residence in Sweden was inversely associated with central adiposity in immigrants. A comparison between German and Danish immigrants, their respective native populations, and Swedes indicated an intermediate positioning of German immigrants with regard to body mass index and WHR. Discussion: Differences in general and central adiposity by country of origin appear to remain after migration. Central adiposity seems to be more influenced than fatness per se by time of residency in Sweden.     

Relationship of Body Composition to Body‐Fatness Estimation in Japanese University Students

Objective: To examine the relationship between self‐estimated whole body size and fatness and whole body and regional composition, and the relationship between self‐estimated whole body fatness and self‐estimated regional fatness in Japanese university students. Research Methods and Procedures: This was a cross‐sectional study using Japanese university students (110 men and 79 women). The percentage of body fat, fat mass (FM), and fat‐free mass (FFM) were measured by underwater weighing and used as body composition variables. Subcutaneous fat thicknesses were determined at seven sites by ultrasonography to estimate regional body composition, and six circumferences and four breadths to estimate regional size. Relative body size and fatness were self‐estimated using a questionnaire. Results: Only women tended to estimate themselves as being fatter than they actually were. Self‐estimated body fatness moderately correlated with the percentage of body fat (men, r = 0.41; women, r = 0.40) FM (men, r = 0.50; women, r = 0.51), and body mass index (r = 0.56 for men and 0.56 for women). After adjusting for the percentages of body fat and FM, self‐estimated fatness correlated with body mass index (r = 0.31 for men and r = 0.37 for women). Among self‐estimated regional fatness, self‐estimated abdominal fatness had the strongest correlation with self‐estimated whole body fatness in both genders. Discussion: The low correlation between estimated and actual body fatness in both genders indicates that Japanese university students, especially women, inaccurately estimate their percentage of body fat. In fact, both men and women primarily estimate their whole body fatness by body weight relative to height.     

Evolved gender differences in mate preferences: Evidence from personal advertisements

Evolutionary theorists have posited that contemporary men and women may differ in their specific psychological mechanisms having to do with mate selection because different strategies would have benefitted men versus women in our distant ancestral past. From these theorized gender differences in mating strategies, several hypotheses were generated and subsequently tested in the current study using a large sample of personal advertisements (N = 1111). The results were generally supportive of evolutionary predictions: men were more likely than women to offer financial resources and honesty/ sincerity, and to seek attractiveness, appealing body shape, and a photograph in selecting a potential mate; women were more likely than men to offer an appealing body shape and to seek financial resources, qualities likely to lead to resource acquisition, and honesty/sincerity in potential mates. Women were also more likely than men to seek male friendship and/or companionship and to offer greater involvement only after the establishment of such friendship, whereas men more frequently than women made explicit requests for a sexual relationship. In general, men sought potential mates who were younger than themselves, a trend which became more pronounced among older advertisers. Women generally sought mates who were older than themselves, a trend which decreased slightly with the age of the advertiser. Results are discussed with regard to implications for hypothesized gender differences in evolved psychological mechanisms.     

Cases of spermiogenesis in young European bison

Development of spermiogenesis and sizes of seminiferous tubules of the testes and epididymal duct were studied in 45 young European bisonBison bonasus (Linnaeus, 1758) males from an enclosed breeding centre and a free-ranging population in the Białowieża Forest. Of 13 males in age class II (up to two years), four showed the presence of elongated late spermatids: one male aged 15 months from the enclosed breeding centre and three from the free-ranging population (2 males aged 18 months and one about 24 months old). Of 7 males from age class III (up to 3 years), four showed spermiogenesis, of which the youngest, 26 and 32 months old, were from enclosed breeding. Spermiogenesis was observed in males with high body weight in a given age class. In males of age class I (up to one year old), the mean diameter of the seminiferous tubules was 49.8 μm, in class II — 110.7 μm, and in class III — 162 μm, the mean diameter of the epididymal duct being 110.8 μm, 187.2 μm and 273.4 μm, respectively. Measurements of seminiferous tubules and epididymal duct were significantly correlated with age and body weight of males and differed significantly between the three age classes.     

Does Childhood Sexual Abuse Predict Young Adult's BMI? A Birth Cohort Study

Objective: The objective was to identify the extent to which childhood sexual abuse (CSA) is associated with BMI and overweight status in young adulthood and to examine whether any associations differ by gender. Research Methods and Procedures: The Mater‐University of Queensland Study of Pregnancy is a prospective birth cohort from a population‐based sample involving 7223 singletons whose mothers were enrolled in the 1980s at the first antenatal visit. The present cohort consisted of a subgroup of 2461 young adults who had both self‐reported CSA data and measured BMI at 21 years. Results: Of 1273 men, 10.5% reported non‐penetrative and 7.5% reported penetrative CSA before age 16 years. Of 1305 women, 20.6% reported non‐penetrative and 7.9% reported penetrative CSA by age 16 years. We found young women's BMI and the prevalence of overweight at age 21 were greater in those who experienced penetrative CSA. This association was robust to adjustment for a variety of potential confounders. However, there was no association between non‐penetrative CSA and BMI in women and no association between either category of CSA and BMI in men. There was statistical evidence for a gender difference in the association of CSA with mean BMI at age 21 (p value for statistical interaction <0.01 in all models). Discussion: These findings suggest that among women, penetrative CSA is associated with greater BMI and increased odds of being overweight in later life, whereas in men, this association does not hold. This gender difference may reflect differences between women and men in the relationship between psychological trauma and body image or may be a chance subgroup finding.     

Body Weight and Health Status: Importance of Socioeconomic Position and Working Conditions

Objective: To examine the association between relative body weight and health status and the potential modifying effects of socioeconomic position and working conditions on this association. Research Methods and Procedures: The data were derived from three identical cross‐sectional surveys conducted in 2000, 2001, and 2002. Respondents to postal surveys were middle‐aged employees of the City of Helsinki (7148 women and 1799 men, response rate 67%). BMI was based on self‐reported weight and height. Health status was measured by the Short‐Form 36 subscales and component summaries. Results: Body weight was inversely associated with physical health, but in mental health, differences between BMI categories were small and inconsistent. In women, physical health deteriorated monotonically with increasing BMI, whereas in men, poor physical health was found among the obese only. Socioeconomic position did not modify the association between BMI and health. In women, the association between body weight and physical health became stronger with decreasing job control and increasing physical work load, whereas in men, a similar modifying effect was found for high job demands. Discussion: Body weight was associated with physical health only. Lower levels of relative weight in women than in men may be associated with poor physical health. High body weight combined with adverse working conditions may impose a double burden on physical health.     

Gender differences in chronotype diminish with age: a meta-analysis based on morningness/chronotype questionnaires

Chronotype is an individual difference trait that is closely linked to biological variables. Usually, men and women differ in their chronotype with men being more evening oriented than women. The aim of the study was to assess gender differences in chronotype based on a systematic review and meta-analysis. In addition, many recent studies do not report gender differences any more although researchers collected data on men and women. This motivated us to contact many researchers directly to obtain and use these additional data. We included 164 studies giving 201 effect size measures in a data set, which only included the most commonly used questionnaires (MEQ, rMEQ and CSM) totaling 186,289 participants in total, of which 75,622 were men and 110,667 were women. We calculated an effect size of the standardized mean difference of ?0.072 (95% CI from ?0.062 to ?0.082) in the fixed effects and of ?0.066 (95% CI from ?0.043 to- 0.089) in the random effects model. Men were on average more evening oriented than women. Type of questionnaire did not influence the standardized mean difference in chronotype between genders. Mean age, standard deviation of age and publication year (p ≤ 0.05) were found to have significant effects on the standardized mean difference in chronotype between genders. The standardized mean difference in chronotype between genders is predicted to change from negative to positive with increasing mean age (young women were more morning orientated than young men, but older women were less morning orientated than older men). This suggests that the differences between men and women diminish with time. The standardized mean difference in chronotype between genders is decreasing with increasing publication year, as well as with high variation in age of the samples.

Abbreviations: CSM: Composite Scale of Morningness (Smith et al. 1989); MEQ: Morningness-Eveningness Questionnaire (Horne and Ostberg, 1976); rMEQ: reduced Morningness-Eveningness Questionnaire (Adan & Almiral, 1991); SMD: standardized mean difference (measure of effect size).     

Inter-generational educational advancement and body height

This study investigates the association between body height and inter-generational social advancement through education. Questionnaire data were collected from 2800 students (1023 men and 1777 women) from the universities of Wroclaw, Poland. The questions referred to three generations: the students and their parents and grandparents. Information was collected on the age, body height and weight of the students and their parents, and on the parents' and grandparents' education. The lowest body heights were typically found for individuals from families with the lowest educational levels, whereas the greatest body heights were found for those brought up in families with a high educational status or in families who had upgraded their status. The size of the change in the educational level of parents is only associated with fathers' and female students' body height. Individuals who had advanced from a middle educational level or who came from families with this type of advancement were found to be significantly taller, on average, than those upgrading their educational level from the lowest position. The results show that, for men, educational advancement during the course of their lives or in the earlier generation is more favourable to achieving higher stature, whereas for women, the multi-generational tradition of a high educational status is of greater significance.     

Factors influencing plasma zinc levels in low-income pregnant women

Plasma zinc (Zn) concentrations were measured in 4376 indigent women (86% African-American), at a mean (±SD) gestational age of 15 (±7.8) wk to determine the relationship between various maternal characteristics and plasma Zn levels during pregnancy. Mean plasma Zn levels were lower in African-American women than in Caucasian women, in multiparous women than in primiparous women, and in women with body weight >69.9 kg than in those with body weight ≤69.9 kg (p≤0.001 for each comparison). There were no significant differences related to maternal age, marital status, education, or smoking habit. Multiple regression analysis, including maternal prepregnancy weight, race, age, parity, smoking habit, education, and marital status indicated that race, parity, and pregnancy weight were significantly associated with maternal plasma Zn levels, adjusted for gestational age. Maternal race was the best predictor of plasma Zn concentrations among the population of pregnant women studied A significant proportion of variance in maternal plasma Zn levels remained unexplained after taking into account various maternal characteristics. The reasons for lower plasma Zn levels in African-American women, compared to Caucasian women, during pregnancy are unknown.     

Antropologic factors in prediction of ovary cancer

The aim of the study was to determine a combination of anthropometric variables that would enable better differentiation between benign and malignant ovarian masses. Prospective study has been performed in a two year period in which 208 women with ovarian lesions were analyzed and correlated with histopathologic surgical findings. We examined the relation between self-reported anthropometric and other variables (height, weight, body mass index--BMI, parity, marital status, education, age, rural versus urban residence, menopausal status) and incidence of ovarian cancer. Age, parity, marital status and menopausal status individually showed statistical significance.