Background: Overweight and obesity are mostly monitored via the Body Mass Index (BMI), based on self-reported or measured height and weight. Previous studies have shown that BMI as a measure of obesity can introduce important misclassification problems. The aim of this study was to assess the validity of overweight and obesity classification based on self-reported and on measured height and weight versus the proportion of body fat as the criterion. Methods: We used data on 782 adolescents (mean age = 13.5, 55.8% boys) from the Health Behaviour in School-Aged Children (HBSC) study conducted in 2018 in Slovakia. We obtained self-reported (height and weight) and objective measures (height, weight) and the proportion of fat (as the criterion measure) measured via bioimpedance body composition analysis (BIA) with an InBody 230 from the adolescents. Results: Both measured and self-reported BMI indicated overweight and obesity with relatively low sensitivity (66-82%), but high specificity (90-92%). The superior accuracy of measured BMI in comparison to self-reported BMI was confirmed by the area under the curve (AUC) based on the receiver operating characteristics (ROC) curves (AUC measured/self-reported: 0.94/0.89; p < 0.001). The misclassification of overweight and obesity was significantly higher when using self-reported BMI than when using measured BMI. Conclusion: Both self-reported and measured BMI as indicators of overweight and obesity underestimate the prevalence of adolescents with overweight and obesity.

Department of Community and Occupational Medicine University Medical Center Groningen University of Groningen 9713AV Groningen The Netherlands

Department of Health Psychology and Research Methodology Faculty of Medicine P J Safarik University in Kosice 040 01 Kosice Slovakia

Department of Natural Sciences in Kinanthropology Faculty of Physical Culture Palacky University in Olomouc 771 11 Olomouc Czech Republic

Graduate School Kosice Institute for Society and Health P J Safarik University in Kosice 040 01 Kosice Slovakia

Institute of Mathematics Faculty of Natural Sciences P J Safarik University in Kosice 040 01 Kosice Slovakia

Olomouc University Social Health Institute Palacky University in Olomouc 771 11 Olomouc Czech Republic

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Inchley J., Currie D., Young T., Samdal O., Torsheim T., Augustson L., editors. Health Policy for Children and Adoles. WHO Regional Office for Europe; Copenhagen, Denmark: 2016. Growing up unequal: Gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: International report from the 2013/2014 survey. No. 7.

World Health Organization . Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. World Health Organization; Geneva, Switzerland: 2018.

NCD Risk Factor Collaboration Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–2642. doi: 10.1016/S0140-6736(17)32129-3. PubMed DOI PMC

WHO Facts and Figures on Childhood Obesity. Commission on Ending Childhood Obesity. [(accessed on 6 June 2020)];2019 :14–16. Available online: http://www.who.int/end-childhood-obesity/facts/en/

Lobstein T., Jackson-Leach R. Planning for the worst: Estimates of obesity and comorbidities in school-age children in 2025. World Obesity. Pediatric Obes. 2016;11:321–325. doi: 10.1111/ijpo.12185. PubMed DOI

Ng M., Fleming T., Robinson M., Thomson B., Graetz N., Margono C., Mullany E.C., Biryukov S., Abbafati C., Abera S.F., et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–781. doi: 10.1016/S0140-6736(14)60460-8. PubMed DOI PMC

Fonseca H., Silva A.M., Matos M.G., Esteves I., Costa P., Guerra A., Gomes P.J. Validity of BMI based on self-reported weight and height in adolescents. Acta Paediatr. 2010;99:83–88. doi: 10.1111/j.1651-2227.2009.01518.x. PubMed DOI

Gosse M. How accurate is self-reported BMI? Nutr. Bull. 2014;39:105–114. doi: 10.1111/nbu.12075. DOI

Elgar F.J., Stewart J.M. Validity of self-report screening for overweight and obesity. Evidence from the Canadian Community Health Survey. Can. J. Public Health. 2008;99:423–427. doi: 10.1007/BF03405254. PubMed DOI PMC

Galfo M., Censi L., D’Addezio L., Martone D., Roccaldo R. Validity of self-reported weight, height and BMI in Italian adolescents for assessing prevalence of overweight/obesity. Clin. Nutr. Metab. 2018;1 doi: 10.15761/CNM.1000101. DOI

Wang Z., Patterson C., Hills A. A Comparison of Self-Reported and Measured Height, Weight and BMI in Australian Adolescents. Aust. N. Z. J. Public Health. 2002;26:473–478. doi: 10.1111/j.1467-842X.2002.tb00350.x. PubMed DOI

He J., Cai Z., Fan X. How accurate is the prevalence of overweight and obesity in children and adolescents derived from self-reported data? A meta-analysis. Public Health Nutr. 2018;21:1865–1873. doi: 10.1017/S1368980018000368. PubMed DOI PMC

Markey C.N. Why body image is important to adolescent development. J. Youth Adolesc. 2010;39:1387–1391. doi: 10.1007/s10964-010-9510-0. PubMed DOI

Jones D., Vigfusdottir T., Lee Y. Body image and the appearance culture among adolescent boys and girls: An examination of friend conversations, peer criticism, appearance magazines, and the internalization of appearance ideals. J. Adolesc. Res. 2004;19:323–339. doi: 10.1177/0743558403258847. DOI

Robinson E. Overweight but unseen: A review of the underestimation of weight status and a visual normalization theory. Obes. Rev. 2017;18:1200–1209. doi: 10.1111/obr.12570. PubMed DOI PMC

Rothman K. BMI-related errors in the measurement of obesity. Int. J. Obes. 2008;32:56–59. doi: 10.1038/ijo.2008.87. PubMed DOI

Williams D., Going S., Lohman T. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am. J. Public Health. 1992;82:358–363. doi: 10.2105/AJPH.82.3.358. PubMed DOI PMC

Sweeting H. Measurement and Definitions of Obesity in Childhood and Adolescence: A field guide for the uninitiated. Nutr. J. 2007 doi: 10.1186/1475-2891-6-32. PubMed DOI PMC

Radley D., Gately P.J., Cooke C.B., Carroll S., Oldroyd B., Truscott J.G. Percentage Fat in Overweight and Obese Children: Comparison of DXA and Air Displacement Plethysmography. Obes. Res. 2005;13:75–85. doi: 10.1038/oby.2005.10. PubMed DOI

Costa-Urrutia P., Vizuet-Gámez A., Ramirez-Alcántara M. Obesity measured as percent body fat, relationship with body mass index, and percentile curves for Mexican pediatric population. PLoS ONE. 2019:e0212792. doi: 10.1371/journal.pone.0212792. PubMed DOI PMC

Cole T.J., Bellizzi M.C., Flegal K.M., Dietz W.H. Establishing a standard definition for child overweight and obesity worldwide: International survey. Br. Med. J. 2000;320:1240–1243. doi: 10.1136/bmj.320.7244.1240. PubMed DOI PMC

Kopecky M., Krejcovsky L., Svarc M. Anthropometric Instrumentation and Methodology of Measurement for Anthropometric Parameters. Palacky University in Olomouc; Olomouc, Czech Republic: 2013.

InBody 230 User’s Manual. [(accessed on 2 May 2020)]; Available online: https://inbodyusa.zendesk.com/hc/en-us.

Elgar F.J., Pförtner T.K., Moor I., De Clercq B., Stevens G.W., Currie C. Socioeconomic inequalities in adolescent health 2002–2010: A time-series analysis of 34 countries participating in the health behaviour in school-aged children study. Lancet. 2015;385:2088–2095. doi: 10.1016/S0140-6736(14)61460-4. PubMed DOI

de Onis M., Onyango A.W., Borghi E., Siyam A., Nishida C., Siekmann J. Development of a WHO Growth Reference for School-aged Children and Adolescents. Bull. World Health Organ. 2007;85:660–667. doi: 10.2471/BLT.07.043497. PubMed DOI PMC

Youden W.J. Index for rating diagnostic tests. Cancer. 1950;3:32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3. PubMed DOI

Rowland M.L. Self-reported weight and height. Am. J. Clin. Nutr. 1990;52:1125–1133. doi: 10.1093/ajcn/52.6.1125. PubMed DOI

Spencer E.A., Appleby P.N., Davey G.K., & Key T.J. Validity of self-reported height and weight in 4808 EPIC–Oxford participants. Public Health Nutr. 2002;5:561–565. doi: 10.1079/PHN2001322. PubMed DOI

Wilson O.W.A., Bopp C.M., Papalia Z., & Bopp M. Objective vs self-report assessment of height, weight and body mass index: Relationships with adiposity, aerobic fitness and physical activity. Clin. Obes. 2019;9 doi: 10.1111/cob.12331. PubMed DOI

Crocker M.K., Stern E.A., Sedaka N.M., Shomaker L.B., Brady S.M., Yanovski J.A. Sexual dimorphisms in the associations of BMI and body fat with indices of pubertal development in girls and boys. J. Clin. Endocrinol. Metab. 2014;99 doi: 10.1210/jc.2014-1384. PubMed DOI PMC

Mills T.C., Gallagher D., Wang J., Heshka S. Modelling the relationfship between body fat and the BMI. Int. J. Body Compos. Res. 2007;5:73–79. PubMed PMC

Javed A., Jumean M., Murad M., Okorodudu D., Kumar S., Somers V.K., Sochor O., Lopez-Jimenez F. Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: A systematic review and meta-analysis. Pediatric Obes. 2015;10:234–244. doi: 10.1111/ijpo.242. PubMed DOI

Prentice A.M., Jebb S.A. Beyond body mass index. Obes. Rev. 2001 doi: 10.1046/j.1467-789x.2001.00031.x. PubMed DOI

Reilly J.J., Dorosty A.R., & Emmett P.M. Identification of the obese child: Adequacy of the body mass index for clinical practice and epidemiology. Int. J. Obes. 2000;24:1623–1627. doi: 10.1038/sj.ijo.0801436. PubMed DOI

Romero-Corral A., Somers V.K., Sierra-Johnson J., Thomas R.J., Collazo-Clavell M.L., Korinek J., Lopez-Jimenez F. Accuracy of body mass index in diagnosing obesity in the adult general population. Int. J. Obes. 2008;32:959–966. doi: 10.1038/ijo.2008.11. PubMed DOI PMC

Kaplowitz P. Link between body fat and the timing of puberty. Pediatrics. 2008 doi: 10.1542/peds.2007-1813F. PubMed DOI

Reinehr T., Roth C. Is there a causal relationship between obesity and puberty? Lancet. Child. Adolesc. Health. 2019 doi: 10.1016/S2352-4642(18)30306-7. PubMed DOI

Pinto I.S., Arruda I.K., Diniz A.S., Cavalcanti A.M. Prevalence of overweight and abdominal obesity according to anthropometric parameters and the association with sexual maturation in adolescent schoolchildren. Cad Saude Publica. 2010;26:1727–1737. doi: 10.1590/S0102-311X2010000900006. PubMed DOI

Deurenberg P., Andreoli A., Borg P., Kukkonen-Harjula K., de Lorenzo A., van Marken Lichtenbelt W.D., Testolin G., Vigano R., Vollaard N. The validity of predicted body fat percentage from body mass index and from impedance in samples of five European populations. Eur. J. Clin. Nutr. 2001;55:973–979. doi: 10.1038/sj.ejcn.1601254. PubMed DOI

Adolescents' health literacy is directly associated with their physical activity but indirectly with their body composition and cardiorespiratory fitness: mediation analysis of the Slovak HBSC study data

Associations of accelerometer measured school- and non-school based physical activity and sedentary time with body mass index: IPEN Adolescent study

Associations of novel 24-h accelerometer-derived metrics with adiposity in children and adolescents