Accuracy of self-reported weight and height in women from Bogotá, Colombia

Silhouette showcards confirm altered obesity-associated body image perception in international cohort study of African-origin populations

OBJECTIVES

Given the increasing prevalence of obesity and need for effective interventions, there is a growing interest in understanding how an individual's body image can inform obesity prevention and management. This study's objective was to examine the use of silhouette showcards to measure body size perception compared with measured body mass index, and assess body size dissatisfaction, in three different African-origin populations spanning the epidemiological transition. An ancillary objective was to investigate associations between body size perception and dissatisfaction with diabetes and hypertension.

SETTING

Research visits were completed in local research clinics in respective countries.

PARTICIPANTS

Seven hundred and fifty-one African-origin participants from the USA and the Republic of Seychelles (both high-income countries), and Ghana (low/middle-income country).

PRIMARY AND SECONDARY OUTCOME MEASURES

Silhouette showcards were used to measure perceived body size and body size dissatisfaction. Objectively measured body size was measured using a scale and stadiometer. Diabetes was defined as fasting blood glucose ≥126 mg/dL and hypertension was defined as ≥130 mm Hg/80 mm Hg.

RESULTS

Most women and men from the USA and Seychelles had 'Perceived minus Actual weight status Discrepancy' scores less than 0, meaning they underestimated their actual body size. Similarly, most overweight or obese men and women also underestimated their body size, while normal weight men and women were accurately able to estimate their body size. Finally, participants with diabetes were able to accurately estimate their body size and similarly desired a smaller body size.

CONCLUSIONS

This study highlights that overweight and obese women and men from countries spanning the epidemiological transition were unable to accurately perceive their actual body size. Understanding people's perception of their body size is critical to implementing successful obesity prevention programmes across the epidemiological transition.

A quasi-cohort trend analysis of adult obesity in Colombia

In Colombia, the prevalence of obesity has been increasing in recent years due to changes in dietary and nutritional patterns. While previous studies have focussed on describing obesity and its associated factors, they have mainly used a cross-sectional methodology. Accordingly, this study aims to conduct a descriptive quasi-cohort analysis to capture age-specific cohort trends in body mass index (BMI) according to sex and ethnicity (indigenous, Afro-Colombian, and the remaining population). The study utilised data from the National Survey of the Nutritional Situation in Colombia (ENSIN) conducted in 2005, 2010, and 2015 that included 214,136 individuals aged 20-64 years after screening. Data on ethnicity were only available from the 2010 and 2015 surveys. Overall, the prevalence of obesity increased by 6.1 percentage points (from 15.2% to 21.3%) between 2005 and 2015 (men from 10.4% to 15.7%; women from 18.2% to 25.7%). Among Afro-Colombians, obesity rose 6.6 percentage points (from 19.4% to 26.0%), again more so in women than in men (2015: 35.2% versus 17.8%). Among indigenous people, the proportion increased by 5.3 percentage points (from 13.5% to 18.8%), with women reporting highest rates (2015: 23.7% against 12.6% in men). Age- and cohort-specific results also indicate that recent adult cohorts are experiencing sharp increases in BMI, for example, while 25-29-year-old males born in 1975-1979 had a BMI of 24.2 kg/m2, among 40-44-year-olds of the same cohort, this equalled 26.8 kg/m2. In the case of women, these age differences in BMI among the same cohort are even greater (24.4 and 28.0 kg/m2). In summary, the results of this study indicate that Colombia is still in the early stages of the obesity transition, urging the need to monitor obesity trends in Colombia from both an age and cohort perspective. To achieve this, longitudinal surveys or repeated cross-sectional surveys like the ENSIN could be utilised.

The accuracy of patient-reported weight prior to total joint arthroplasty and arthroscopy of the lower extremity

PURPOSE

The accuracy of preoperative patient-reported weight was never evaluated in patients undergoing lower extremity procedures. The purpose of this study was to: (1) compare the disparity between patient-reported and measured weights in patients undergoing lower extremity total joint arthroplasty (LE-TJA) and arthroscopy; and (2) investigate the association between patient-specific factors (patient age, BMI, zip code, and psychiatric comorbidities) and the accuracy of patient-reported weight.

METHODS

Preoperative self-reported weights were retrospectively compared to measured weights in 400 LE-TJA and 85 control arthroscopy patients. The difference between reported and measured weights was calculated. Additionally, the percent of accurate reporting within 0.5, 1, and 5 kg ranges of the measured weight was calculated. Outcomes were compared between surgical modalities as well as between patient-specific factors.

RESULTS

There was low disparity (p = 0.838) between patient-reported and measured weights among LE-TJA (mean difference 0.18 ± 3.63 kg; p = 0.446) and that of arthroscopy (0.27 ± 4.08 kg; p = 0.129) patients. Additionally, LE-TJA patients were equally likely to report weights accurately within 0.5 kg of the measured weight (74% vs. 71.76%; p = 0.908). LE-TJA and arthroscopy patients had similar reporting accuracy within 1 and 5 kg of the measured weights (p > 0.05).

CONCLUSION

Preoperative patient-reported weights demonstrated acceptable accuracy in both LE-TJA and lower extremity arthroscopic orthopaedic patient populations making it a potentially reliable parameter of preoperative assessment.

Utility of silhouette showcards to assess adiposity in three countries across the epidemiological transition

The Pulvers' silhouette showcards provide a non-invasive and easy-to-use way of assessing an individual's body size perception using nine silhouette shapes. However, their utility across different populations has not been examined. This study aimed to assess: 1) the relationship between silhouette perception and measured anthropometrics, i.e., body mass index (BMI), waist circumference (WC), waist-height-ratio (WHtR), and 2) the ability to predict with silhouette showcards anthropometric adiposity measures, i.e., overweight and obesity (BMI ≥ 25 kg/m2), obesity alone (BMI ≥ 30 kg/m2), elevated WC (men ≥ 94 cm; women ≥ 80 cm), and WHtR (> 0.5) across the epidemiological transition. 751 African-origin participants, aged 20-68 years old, from the United States (US), Seychelles, and Ghana, completed anthropometrics and selected silhouettes corresponding to their perceived body size. Silhouette performance to anthropometrics was examined using a least-squares linear regression model. A receiver operator curve (ROC) was used to investigate the showcards ability to predict anthropometric adiposity measures. The relationship between silhouette ranking and BMI were similar between sexes of the same country but differed between countries: 3.65 [95% CI: 3.34-3.97] BMI units/silhouette unit in the US, 3.23 [2.93-3.74] in Seychelles, and 1.99 [1.72-2.26] in Ghana. Different silhouette cutoffs predicted obesity differently in the three countries. For example, a silhouette ≥ five had a sensitivity/specificity of 77.3%/90.6% to predict BMI ≥ 25 kg/m2 in the US, but 77.8%/85.9% in Seychelles and 84.9%/71.4% in Ghana. Ultimately, silhouettes predicted BMI, WC, and WHtR similarly within each country and sex but not across countries. Our data suggest that Pulvers' silhouette showcards may be a helpful tool to predict anthropometric and adiposity measures in different populations when direct measurement cannot be performed. However, no universal silhouette cutoff can be used for detecting overweight or obesity status, and population-specific differences may stress the need to calibrate silhouette showcards when using them as a survey tool in different countries.

Gestational weight gain and childhood body mass index across three generations: Results from the 1993 Pelotas (Brazil) Birth Cohort

BACKGROUND

Gestational weight gain (GWG) has been associated with the accumulation of body fat in offspring, but little is known about the intergenerational relationship.

OBJECTIVE

To assess the effect of GWG in grandmothers and mothers on the child's body mass index (BMI).

METHODS

This is a sub-study nested in the 1993 Pelotas (Brazil) Birth Cohort at 22 years follow-up visit. We calculated the BMI-for-age z-score (BAZ) and evaluated overweight (>2 SD in ≤5 years of age and >1 SD for >5 years of age for BAZ). Grandmothers' and mothers' GWG were calculated as the difference between weight in the beginning of pregnancy and the last recorded weight before delivery. We standardized the GWG by adjusting for pre-gestational BMI. We also categorized GWG as adequate, excessive, or insufficient, in accordance with the Institute of Medicine (2009). Linear and logistic regressions stratified by child's age (≤2 years; 2.01-5 years; >5 years) were used. Structural equations were modelled to calculate the total, indirect, and direct effects of grandmothers' and mothers' GWG on children's BAZ.

RESULTS

Nine hundred and forty-six out of 1113 children evaluated were 5 years of age or under. There was an indirect effect (through maternal birthweight, maternal pre-gestational BMI, maternal GWG, and child birthweight) of grandmother GWG on grandchild BAZ, from 2.01 to 5 years of age [β = 0.12 _95% CI: 0.04-0.20 (P < 0.01)]. Maternal GWG directly increased the child's BAZ at >5 years of age [β = 0.34 _95% CI: 0.15-0.53 (P < 0.001)].

CONCLUSIONS

GWG's effect on BMI does seem to be transmitted across three generations. Managing this will require health education during the gestational period for women and their families.

Validation of Self-Reported Anthropometric Measures and Body Mass Index in a Subcohort of the DianaWeb Population Study

INTRODUCTION

DianaWeb is a community-based participatory project open to Italian breast cancer patients. The aim of the study was to assess the effectiveness of a lifestyle intervention in improving the prognosis after patients received diagnosis and surgery/chemotherapy. The DianaWeb study uses an interactive Web site (www.dianaweb.org) to monitor patients' lifestyles, and to obtain clinical and anthropometric data. Although detailed instructions for measuring height, body weight, waist circumference, and blood pressure (BP) are provided, individuals might tend to overestimate or underestimate those parameters. The aims of the present study were: (1) to compare self-recorded data with those from standardized ambulatory measurements; (2) to determine the trueness of a subject classification in the overweight/obesity or hypertensive subgroup on the basis of the patients' own measurements and estimates; and (3) to identify confounding variables.

PATIENTS AND METHODS

We compared self-reported with ambulatory measurements in a subgroup of 200 randomly selected women of approximately 1000 enrolled in the DianaWeb study (from September 2016 to March 2018).

RESULTS

Bland-Altman analysis showed a close agreement for self-reported and ambulatory-measured height, weight, and body mass index (BMI). On the contrary, women overestimated waist circumference and underestimated BP. Cohen κ statistics showed fair agreement only for hypertension. Binary logistic regression analysis showed that BMI and diastolic BP self-measurements were biased according to age.

CONCLUSION

The results suggest that self-reported height, weight, and BMI are satisfactorily accurate for patients in the DianaWeb study, such as accuracies of overweight/obese and central obesity classification, and that these data can be useful for our research.

A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: a literature review

Aims: Up-to-date information on the accuracy between different anthropometric data collection methods is vital for the reliability of anthropometric data. A previous review on this matter was conducted a decade ago. Our aim was to conduct a literature review on the accuracy of self-reported height, weight, and body mass index (BMI) against measured values for assessing obesity in adults. To obtain an overview of the present situation, we included studies published after the previous review. Differences according to sex, BMI groups, and continents were also assessed. Methods: Studies published between January 2006 and April 2017 were identified from a literature search on PubMed. Results: Our search retrieved 62 publications on adult populations that showed a tendency for self-reported height to be overestimated and weight to be underestimated when compared with measured values. The findings were similar for both sexes. BMI derived from self-reported height and weight was underestimated; there was a clear tendency for underestimation of overweight (from 1.8%-points to 9.8%-points) and obesity (from 0.7%-points to 13.4%-points) prevalence by self-report. The bias was greater in overweight and obese participants than those of normal weight. Studies conducted in North America showed a greater bias, whereas the bias in Asian studies seemed to be lower than those from other continents. Conclusions: With globally rising obesity rates, accurate estimation of obesity is essential for effective public health policies to support obesity prevention. As self-report bias tends to be higher among overweight and obese individuals, measured anthropometrics provide a more reliable tool for assessing the prevalence of obesity.

Validity of self-reported anthropometry in adult Mexican women

OBJECTIVE:

To compare direct and self-reported anthropometry in Mexican women.

MATERIALS AND METHODS:

Women aged 30-72 years, participating in the Mexican Teachers' Cohort, completed a questionnaire with their anthropometric data in 2006-2008. After eleven months (median time), technicians performed anthropometry in 3756 participants. We calculated correlations and multivariable-adjusted mean differences between direct and self-reported anthropometric measures.

RESULTS:

Correlations between direct and self-reported anthropometric measures ranged from 0.78 (waist circumference) to 0.93 (weight). On average, women over-reported their height by 2.2 cm and underreported their weight, body mass index (BMI) and waist and hip circumferences by 1.3 kg, 1.3 kg/m2, 1.8 cm and 1.9 cm, respectively. Errors in self-reported anthropometry increased with rising measured BMI and were also independently associated with age, education and socioeconomic status.

CONCLUSION:

Self-reported anthropometry is sufficiently valid for epidemiological purposes in adult Mexican women. Errors in self-reported anthropometry might result in underestimation of the prevalence of overweight and obesity.

Maternal Body Mass Index and Risk of Autism Spectrum Disorders in Offspring: A Meta-analysis

Controversial results of the association between maternal body mass index (BMI) and risk of autism spectrum disorder (ASD) in offspring were reported among several studies. This meta-analysis was conducted to estimate the overall association between maternal BMI and risk of ASD in offspring. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched until January 2016. Cohort and case-control studies addressing the association between maternal BMI and risk of ASD in offspring were included. We used random-effect models to estimate the summary relative risks (RRs), we also performed a dose-response meta-analysis to estimate the trend from the correlated log RR estimates across levels of BMI quantitatively. Totally, 6 cohort studies and 1 case-control study involving 8,403 cases and 509,167 participants were included for analysis. The summary RR (95% confidence interval) for ASD in offspring in relation to maternal underweight, overweight, and obesity vs. normal weight during pre-pregnancy or pregnancy, was 1.07 (0.93, 1.23), 1.28 (1.19, 1.36) and 1.36 (1.03, 1.78), respectively. A linear dose-response relationship was found, with a pooled RR of 1.16 (1.01, 1.33) for each 5 kg/m². increment in maternal BMI. The present study suggests that excessive maternal BMI is associated with increased ASD risk in offspring.

Validity of silhouette showcards as a measure of body size and obesity in a population in the African region: A practical research tool for general-purpose surveys

Background

The purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys.

Methods

A cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers’ silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements.

Results

Our study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P < 0.001). The silhouette showcards also showed high accuracy for detecting obesity as per a BMI ≥ 30 (Area under curve, AUC: 0.91/0.89, SE: 0.01), which was comparable to other measured adiposity indicators: fat percent (AUC: 0.94/0.94, SE: 0.01), waist circumference (AUC: 0.95/0.94, SE: 0.01), and waist to height ratio (AUC: 0.95/0.94, SE: 0.01) amongst men and women, respectively. The use of silhouettes in detecting obesity differences among different socioeconomic groups resulted in similar magnitude, direction, and significance of association between obesity and socioeconomic status as when using measured BMI.

Conclusions

This study highlights the validity and reliability of silhouettes as a survey tool for measuring obesity in a population in the African region. The ease of use and cost-effectiveness of this tool makes it an attractive alternative to measured BMI in the design of non-face-to-face online- or mobile device-based surveys as well as in-person general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements.