Bland–Altman methods for assessing the agreement between two measures are highly cited. However, these methods may often not be used to assess agreement, and when used, they are not always presented or interpreted correctly. Our objective was to evaluate the use and the quality of reporting of Bland–Altman analyses in studies that compare self-reported with measured weight and height.
We evaluated the use of Bland–Altman methods in 394 published articles that compared self-reported and measured weight and height data for adolescents or adults. Six reporting criteria were developed: assessment of the normality of the distribution of differences, a complete and correctly labeled Bland–Altman plot displaying the mean difference and limits of agreement (LOA), numerical values and confidence intervals, standard errors, or standard deviations for mean difference, numerical values of LOA, confidence intervals for LOA, and prespecified criteria for acceptable LOA.
Only 72/394 (18%) studies comparing self-reported with measured weight and height or BMI used some form of Bland–Altman analyses. No study using Bland–Altman analyses satisfied more than four of the six criteria. Of the 72 studies, 64 gave mean differences along with confidence intervals or standard deviations, 55 provided complete Bland–Altman plots that were appropriately labeled and described, 37 provided numerical values for LOA, 4 reported that they examined the normality of the distribution of differences, 3 provided confidence intervals for LOA, and 3 had prespecified criteria for agreement.
Bland–Altman methods appear to be infrequently used in studies comparing measured with self-reported weight, height, or BMI, and key information is missing in many of those that do use Bland–Altman methods. Future directions would be defining acceptable LOA values and improving the reporting and application of Bland–Altman methods in studies of self-reported anthropometry.
Subscribe to Journal
Get full journal access for 1 year
only $64.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Altman DG, Bland JM. Assessing agreement between methods of measurement. Clin Chem. 2017;63:1653–4.
Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003;22:85–93.
Giavarina D. Understanding Bland Altman analysis. Biochem Med. 2015;25:141–51.
Hamilton C, Stamey J. Using Bland-Altman to assess agreement between two medical devices-don’t forget the confidence intervals! J Clin Monit Comput. 2007;21:331–3.
Ludbrook J. Confidence in Altman-Bland plots: a critical review of the method of differences. Clin Exp Pharmacol Physiol. 2010;37:143–9.
Phatak AG, Nimbalkar SM. Method comparison (agreement) studies: myths and rationale. J Clin Diagn Res. 2017;11:Ji01–3.
Twomey PJ. How to use difference plots in quantitative method comparison studies. Ann Clin Biochem. 2006;43:124–9.
Watson PF, Petrie A. Method agreement analysis: a review of correct methodology. Theriogenology. 2010;73:1167–79.
Dewitte K, Fierens C, Stockl D, Thienpont LM. Application of the Bland-Altman plot for interpretation of method-comparison studies: a critical investigation of its practice. Clin Chem. 2002;48:799–801. Author reply 801–792.
Abu-Arafeh A, Jordan H, Drummond G. Reporting of method comparison studies: a review of advice, an assessment of current practice, and specific suggestions for future reports. Br J Anaesth. 2016;117:569–75.
Berthelsen PG, Nilsson LB. Researcher bias and generalization of results in bias and limits of agreement analyses: a commentary based on the review of 50 Acta Anaesthesiologica Scandinavica papers using the Altman-Bland approach. Acta Anaesthesiol Scand. 2006;50:1111–3.
Mantha S, Roizen MF, Fleisher LA, Thisted R, Foss J. Comparing methods of clinical measurement: reporting standards for bland and altman analysis. Anesth Analg. 2000;90:593–602.
Chhapola V, Kanwal SK, Brar R. Reporting standards for Bland-Altman agreement analysis in laboratory research: a cross-sectional survey of current practice. Ann Clin Biochem. 2015;52:382–6.
Zaki R, Bulgiba A, Ismail R, Ismail NA. Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review. PLoS ONE. 2012;7:e37908.
Bowman RL, DeLucia JL. Accuracy of self-reported weight: a meta-analysis. Behav Ther. 1992;23:637–55.
Connor Gorber S, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8:307–26.
Engstrom JL, Paterson SA, Doherty A, Trabulsi M, Speer KL. Accuracy of self-reported height and weight in women: an integrative review of the literature. J Midwifery Womens Health. 2003;48:338–45.
He J, Cai Z, Fan X. Accuracy of using self-reported data to screen children and adolescents for overweight and obesity status: a diagnostic meta-analysis. Obes Res Clin Pract. 2017;11:257–67.
Headen I, Cohen AK, Mujahid M, Abrams B. The accuracy of self-reported pregnancy-related weight: a systematic review. Obes Rev. 2017;18:350–69.
Maukonen M, Mannisto S, Tolonen H. A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: a literature review. Scand J Public Health. 2018;46. https://doi.org/10.1177/1403494818761971.
Seijo M, Minckas N, Cormick G, Comande D, Ciapponi A, Belizan JM. Comparison of self-reported and directly measured weight and height among women of reproductive age: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018;97:429–39.
Sherry B, Jefferds ME, Grummer-Strawn LM. Accuracy of adolescent self-report of height and weight in assessing overweight status: a literature review. Arch Pediatr Adolesc Med. 2007;161:1154–61.
De Rubeis V, Bayat S, Griffith LE, Smith BT, Anderson LN. Validity of self-reported recall of anthropometric measures in early life: a systematic review and meta-analysis. Obes Rev. 2019;20:1426–40.
Cuspidi C, Negri F, Giudici V, Muiesan ML, Grandi AM, Ganau A, et al. Self-reported weight and height: implications for left ventricular hypertrophy detection. An Italian multi-center study. Clin Exp Hypertens. 2011;33:192–201.
Wang Z, Patterson CM, Hills AP. A comparison of self-reported and measured height, weight and BMI in Australian adolescents. Aust N Z J Public Health. 2002;26:473–8.
Bes-Rastrollo M, Sabate J, Jaceldo-Siegl K, Fraser GE. Validation of self-reported anthropometrics in the Adventist Health Study 2. BMC Public Health. 2011;11:213.
Celis-Morales C, Livingstone KM, Woolhead C, Forster H, O’Donovan CB, Macready AL, et al. How reliable is internet-based self-reported identity, socio-demographic and obesity measures in European adults? Genes Nutrition. 2015;10:28.
Villarini M, Acito M, Gianfredi V, Berrino F, Gargano G, Somaini M, et al. Validation of self-reported anthropometric measures and body mass index in a subcohort of the dianaweb population study. Clin Breast Cancer. 2019;19:e511–8.
Xie YJ, Ho SC, Liu ZM, Hui SS. Comparisons of measured and self-reported anthropometric variables and blood pressure in a sample of Hong Kong female nurses. PLoS ONE. 2014;9:e107233.
Burton NW, Brown W, Dobson A. Accuracy of body mass index estimated from self-reported height and weight in mid-aged Australian women. Aust N Z J Public Health. 2010;34:620–3.
Elgar FJ, Stewart JM. Validity of self-report screening for overweight and obesity. Evidence from the Canadian Community Health Survey. Can J Public Health. 2008;99:423–7.
Haverkort EB, de Haan RJ, Binnekade JM, van Bokhorst-de van der Schueren MA. Self-reporting of height and weight: valid and reliable identification of malnutrition in preoperative patients. Am J Surg. 2012;203:700–7.
Yoshitake N, Okuda M, Sasaki S, Kunitsugu I, Hobara T. Validity of self-reported body mass index of Japanese children and adolescents. Pediatr Int. 2012;54:397–401.
Zhou X, Dibley MJ, Cheng Y, Ouyang X, Yan H. Validity of self-reported weight, height and resultant body mass index in Chinese adolescents and factors associated with errors in self-reports. BMC Public Health. 2010;10:190.
Barrios P, Martin-Biggers J, Quick V, Byrd-Bredbenner C. Reliability and criterion validity of self-measured waist, hip, and neck circumferences. BMC Med Res Methodol. 2016;16:49.
Krakowiak P, Walker CK, Tancredi DJ, Hertz-Picciotto I. Maternal recall versus medical records of metabolic conditions from the prenatal period: a validation study. Matern Child Health J. 2015;19:1925–35.
Pursey K, Burrows TL, Stanwell P, Collins CE. How accurate is web-based self-reported height, weight, and body mass index in young adults? J Med Internet Res. 2014;16:e4.
Powell-Young YM. The validity of self-report weight and height as a surrogate method for direct measurement. Appl Nurs Res. 2012;25:25–30.
Fonseca H, Silva AM, Matos MG, Esteves I, Costa P, Guerra A, et al. Validity of BMI based on self-reported weight and height in adolescents. Acta Paediatr. 2010;99:83–88.
Kee CC, Lim KH, Sumarni MG, Teh CH, Chan YY, Nuur Hafizah MI, et al. Validity of self-reported weight and height: a cross-sectional study among Malaysian adolescents. BMC Med Res Methodol. 2017;17:85.
Olivarius NF, Andreasen AH, Loken J. Accuracy of 1-, 5- and 10-year body weight recall given in a standard questionnaire. Int J Obes Relat Metab Disord. 1997;21:67–71.
De Vriendt T, Huybrechts I, Ottevaere C, Van Trimpont I, De Henauw S. Validity of self-reported weight and height of adolescents, its impact on classification into BMI-categories and the association with weighing behaviour. Int J Environ Res Public Health. 2009;6:2696–711.
Yoong SL, Carey ML, D’Este C, Sanson-Fisher RW. Agreement between self-reported and measured weight and height collected in general practice patients: a prospective study. BMC Med Res Methodol. 2013;13:38.
Pasalich M, Lee AH, Burke L, Jancey J, Howat P. Accuracy of self-reported anthropometric measures in older Australian adults. Australas J Ageing. 2014;33:E27–32.
McAdams MA, van Dam RM, Hu FB. Comparison of self-reported and measured BMI as correlates of disease markers in US adults. Obesity. 2007;15:188–96.
Steventon A, Chaudhry SI, Lin Z, Mattera JA, Krumholz HM. Assessing the reliability of self-reported weight for the management of heart failure: application of fraud detection methods to a randomised trial of telemonitoring. BMC Med Inform Decis Mak. 2017;17:43.
Bowring AL, Peeters A, Freak-Poli R, Lim MS, Gouillou M, Hellard M. Measuring the accuracy of self-reported height and weight in a community-based sample of young people. BMC Med Res Methodol. 2012;12:175.
Brestoff JR, Perry IJ, Van den Broeck J. Challenging the role of social norms regarding body weight as an explanation for weight, height, and BMI misreporting biases: development and application of a new approach to examining misreporting and misclassification bias in surveys. BMC Public Health. 2011;11:331.
Lawlor DA, Bedford C, Taylor M, Ebrahim S. Agreement between measured and self-reported weight in older women. Results from the British Women’s Heart and Health Study. Age Ageing. 2002;31:169–74.
Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002;5:561–5.
Wright FL, Green J, Reeves G, Beral V, Cairns BJ. Validity over time of self-reported anthropometric variables during follow-up of a large cohort of UK women. BMC Med Res Methodol. 2015;15:81.
Pirie P, Jacobs D, Jeffery R, Hannan P. Distortion in self-reported height and weight data. J Am Diet Assoc. 1981;78:601–6.
Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990;1:466–73.
Luo J, Thomson CA, Hendryx M, Tinker LF, Manson JE, Li Y, et al. Accuracy of self-reported weight in the Women’s Health Initiative. Public Health Nutr. 2019;22:1–10.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Flegal, K.M., Graubard, B. & Ioannidis, J.P.A. Use and reporting of Bland–Altman analyses in studies of self-reported versus measured weight and height. Int J Obes (2019) doi:10.1038/s41366-019-0499-5