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Epidemiology and Population Health

Use of self-reported height and weight biases the body mass index–mortality association

International Journal of Obesity volume 35, pages 401–408 (2011)Cite this article

Subjects

Abstract

Background:

Many large-scale epidemiological data sources used to evaluate the body mass index (BMI: kg/m2) mortality association have relied on BMI derived from self-reported height and weight. Although measured BMI (BMIM) and self-reported BMI (BMISR) correlate highly, self-reports are systematically biased.

Objective:

To rigorously examine how self-reporting bias influences the association between BMI and mortality rate.

Subjects:

Samples representing the US non-institutionalized civilian population.

Design and Methods:

National Health and Nutrition Examination Survey data (NHANES II: 1976–80; NHANES III: 1988–94) contain BMIM and BMISR. We applied Cox regression to estimate mortality hazard ratios (HRs) for BMIM and BMISR categories, respectively, and compared results. We similarly analyzed subgroups of ostensibly healthy never-smokers.

Results:

Misclassification by BMISR among the underweight and obesity ranged from 30–40% despite high correlations between BMIM and BMISR (r>0.9). The reporting bias was moderately correlated with BMIM (r>0.35), but not BMISR (r<0.15). Analyses using BMISR failed to detect six of eight significant mortality HRs detected by BMIM. Significantly biased HRs were detected in the NHANES II full data set (χ2=12.49; P=0.01) and healthy subgroup (χ2=9.93; P=0.04), but not in the NHANES III full data set (χ2=5.63; P=0.23) or healthy subgroup (χ2=1.52; P=0.82).

Conclusions:

BMISR should not be treated as interchangeable with BMIM in BMI mortality analyses. Bias and inconsistency introduced by using BMISR in place of BMIM in BMI mortality estimation and hypothesis tests may account for important discrepancies in published findings.

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Acknowledgements

This research was supported in part by NIH grants P30DK056336, T32HL079888, T32HL072757, K23MH066381, and AR49720.

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Author notes

  1. S W Keith

    Present address: 3Current address: Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA.,

Authors and Affiliations

  1. Department of Biostatistics, Section on Statistical Genetics and Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, AL, USA

    S W Keith, N M Pajewski, T Mehta & D B Allison

  2. Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    K R Fontaine

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Competing interests

DBA has received grants, honoraria, donations, and consulting fees from numerous food, beverage, pharmaceutical companies, and other commercial, government, and nonprofit entities with interests in obesity. Other authors declare no conflict of interest.

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Author Contributions

SWK: Conception of project, acquisition and statistical analysis of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. KRF: Interpretation of the data, critical revision of the manuscript important to the intellectual content, and supervision. NMP: Interpretation of the data, critical revision of the manuscript for important intellectual content, and technical support. TM: Interpretation of the data, critical revision of the manuscript for important intellectual content, and technical support. DBA: Conception of project, drafting sections and critical revision of the manuscript for important intellectual content, analysis and interpretation of data, obtaining funding, and supervision. SWK is the guarantor of the paper, having had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. He had final responsibility for the decision to submit for publication.

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Keith, S., Fontaine, K., Pajewski, N. et al. Use of self-reported height and weight biases the body mass index–mortality association. Int J Obes 35, 401–408 (2011). https://doi.org/10.1038/ijo.2010.148

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