Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988-1994

Abstract

Objective: To compare self-reported to measured heights and weights of adults examined in the Third National Health and Nutrition Examination Survey (NHANES III), and to determine to what extent body mass index (BMI) calculated from self-reported heights and weights affects estimates of overweight prevalence compared with BMI calculated from measured values.

Design: A complex sample design was used in NHANES III to obtain a nationally representative sample of the US civilian, noninstitutionalized population. During household interviews, survey respondents were asked their height and weight. Trained health technicians subsequently measured height and weight using standardized procedures and equipment.

Subjects: The analytical sample consisted of 7,772 men and 8,801 women 20 years old and older.

Statistical analyses performed: Only persons with measured and self-reported heights and weights were included in the analysis, and statistical sampling weights were applied. t Tests, Pearson product moment correlation coefficients, sensitivity, and specificity analyses were used to determine the validity of self-reported measurements and prevalence estimates of overweight, defined as BMI of 25 or greater.

Results: Age is an important factor in classifying weight, height, BMI, and overweight from self-reports. Statistically significant differences were found for the mean error (measured-self-reported values) for height and BMI that were notably larger for older age groups. For example, the mean error for height ranged from 2.92 to 4.50 cm for women and from 3.06 to 4.29 cm for men, 70 years and older. Despite the high correlation between measured and self-reported data, the prevalence of overweight calculated from measured values was higher than that calculated from self-reported values among older adults. When calculated with self-reported height, BMI was one unit lower than when calculated from measured height for persons > or = 70 years. Specificity was high but sensitivity decreased with increasing age cohorts. Regression equations are provided to determine actual height from self-reported values for older adults. CONCLUSION/APPLICATIONS: Self-reported heights and weights can be used with younger adults, but they have limitations for older adults, ages > or = 60 years. In research studies and in clinical settings involving older adults, failure to measure height and weight can result in subsequent misclassification of overweight status. Therefore, registered dietitians are encouraged to obtained a measured weight and height using a calibrated scale and stadiometer.