No abstract

Objective-The purpose of this study was to assess the accuracy of BMI categories based on selfreported height and weight in adult women. Methods-BMIcategories from self-reported responses were compared to categories measured during physical examination from women, age 18 or older, who participated in the National Health and Examination Survey, 1999Survey, -2004. We first examined strength of agreement using Cohen's kappa, which, unlike sensitivity and specificity, allows for the comparison of polychotomous measures beyond chance agreement. Kappa regression identifies potential threats to accuracy. Likelihood of bias, as measured by under-reporting, was examined using logistic regression.Results-Cohen's kappa estimates were 0.443 for pregnant women (N = 724) and 0.705 for nonpregnant women (N = 5,910). Kappa varied by age and race, but was largely unrelated to socioeconomic status, health and health behaviors. Women who visited a physician in the last year or been diagnosed with osteoporosis were more accurate, while women most likely to under-report were older, white, non-Hispanic, and college-educated.Conclusions-Our results suggest substantial agreement between self-reported and measured categories, except for women who are pregnant, above the age of 75 or without physician visits. Under-reporting may be more prevalent in well-educated, white populations than minority populations. KeywordsObesity; Body mass index; Cohen's kappa Obesity is a major public health epidemic and is an important risk factor contributing to morbidity and mortality from diseases such as heart disease, diabetes and cancer [1]. One of the challenges facing epidemiologists studying trends in the obesity epidemic is tracking changes over time. Both epidemiologists and clinicians often rely on self-reported height and weight, which are then used to calculate body mass index (BMI). Many studies have examined the accuracy of self-reported height, weight and BMI in a variety of cohorts [2][3][4][5][6] Fewer studies have examined the accuracy of self-reported height and weight when they are used to determine BMI categories [7][8][9][10]; yet, BMI categories are routinely used in studies of health outcomes [3]. Many of these studies showed significant differences in allocation to BMI categories based on self-reported versus measured height and weight, thus biasing relative risks of diseases associated with increasing BMI [3][4][5][6][7][8].In women, bias in self-reported height and weight may occur due to social desirability, cultural or demographic characteristics or health characteristics (such as pregnancy or osteoporosis) [9]. In general, women tend to under-report weight more than men [2], while men tend to overreport height more than women [6]. It is important to examine the potential threats to accuracy particular to women since under-or over-reporting may affect the prevalence and categorization of BMI differently among women than among men. Understanding of sources of bias among women is important in planning and interpreting e...

ObjectiveAmerican Indian children of pre-school age have disproportionally high obesity rates and consequent risk for related diseases. Healthy Children, Strong Families was a family-based randomized trial assessing the efficacy of an obesity prevention toolkit delivered by a mentor v. mailed delivery that was designed and administered using community-based participatory research approaches.DesignDuring Year 1, twelve healthy behaviour toolkit lessons were delivered by either a community-based home mentor or monthly mailings. Primary outcomes were child BMI percentile, child BMI Z-score and adult BMI. Secondary outcomes included fruit/vegetable consumption, sugar consumption, television watching, physical activity, adult health-related self-efficacy and perceived health status. During a maintenance year, home-mentored families had access to monthly support groups and all families received monthly newsletters.SettingFamily homes in four tribal communities, Wisconsin, USA.SubjectsAdult and child (2–5-year-olds) dyads (n 150).ResultsNo significant effect of the mentored v. mailed intervention delivery was found; however, significant improvements were noted in both groups exposed to the toolkit. Obese child participants showed a reduction in BMI percentile at Year 1 that continued through Year 2 (P<0·05); no change in adult BMI was observed. Child fruit/vegetable consumption increased (P=0·006) and mean television watching decreased for children (P=0·05) and adults (P=0·002). Reported adult self-efficacy for health-related behaviour changes (P=0·006) and quality of life increased (P=0·02).ConclusionsAlthough no effect of delivery method was demonstrated, toolkit exposure positively affected adult and child health. The intervention was well received by community partners; a more comprehensive intervention is currently underway based on these findings.

ADAMS, ALEXANDRA K., RACHEL A. QUINN, AND RONALD J. PRINCE. Low recognition of childhood overweight and disease risk among Native-American caregivers. Obes Res. 2005;13:146 -152. Objectives: Pediatric obesity is a significant and increasing problem in Native-American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. Research Methods and Procedures: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten-through-second grade child-caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. Results: Twenty-six percent of children were overweight (Ն95th percentile), and 19% were at risk for being overweight (Ն85th to Ͻ95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI Ͼ99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity-related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. Discussion: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers' attitudes and beliefs regarding childhood overweight and risk of future disease.

Home food availability, parental diet, and familial eating habits seem to play an important role in the diet quality of children. Interventions targeting family education on healthful dietary habits at home could have a positive impact on children's diet quality and overall health.