Peer Reviewed

Comparison of two measures of past body size

Danja Sarink1,2, Lin Fritschi1,3, Jennifer Girschik1,4, Jane Heyworth4, Renate Winkels2, Susan Peters1,4
1. Epidemiology Group, Centre for Medical Research, University of Western Australia, Australia
2. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
3. School of Public Health, Curtin University, Australia
4. School of Population Health, University of Western Australia, Australia
Email: d.sarink@dkfz-heidelberg.de

Abstract

interest. Elapsed time may make recall of weight more

difficult, resulting in missing data. For example, BMI at ages

Introduction

20 and 40 years needed to be imputed for 8% of the

We investigated an alternative for self-reported past adult

participants in a colorectal cancer case-control study.5

body weight resulting in less missing data, but still providing

a valid measure for ranking participants.

Few alternatives for past recalled weight have been evaluated.

Methods

moderate correlation with self-reported BMI, whereas

For example, clothing size at 20 years of age showed a

We collected information from 2,647 women aged 45 years

on their height and weight (to calculate body mass index
(BMI)) when they were in their early thirties. Participants

comparative body size in childhood (thinner than average,

average, plumper than average) was in overall good
correlation with measured data.6

were also asked how their weight in their early thirties

We investigated if comparative weight could provide an

compared with that of other women of the same age and

alternative for self-reported past adult body weight resulting

height (comparative weight), categorised as a lot less, a little

in less missing data, but still providing a valid measure for

less, about the same, a little more and a lot more. These

ranking participants.

two weight measures were compared using a Spearman rank

correlation coefficient.

Results
Data was missing less often for comparative weight (1.2%)
than self-reported weight (12.5%). Of the 2,304 women with
both BMI and comparative weight data, the two measures fell
in the same category for 54.3%. Comparative weight
underestimated self-reported BMI for 36.4%. The correlation
coefficient was 0.64 (0.610.66), indicating that comparative
weight is in overall good correlation with past BMI.

Methods
As part of a case-control study on breast cancer, 2,647
women aged 45 years completed a questionnaire
containing questions on height (current) and weight in their
early thirties. The study has been described in detail
elsewhere.7 Participants were also asked how their weight in
their early thirties compared with that of other women of the
same age and height (comparative weight), using the answer
categories a lot less, a little less, about the same, a little
more and a lot more.

Conclusion

BMI (underweight <18.5 kg/m2; healthy weight 18.524.9 kg/m2;

We showed that measurement of past comparative weight (1)

overweight 2529.9 kg/m2; 30 kg/m2) and comparative

reduced missing data compared to recalled BMI, and (2) a good

weight were visually compared. For this purpose we assumed

correlation between measures indicating that comparative

that, on a population level, the category about the same

weight may be a useful alternative for ranking on self-reported

would estimate healthy weight. Thus, the categories a lot less

past BMI.

and a little less were merged to evaluate agreement with the

underweight category. In addition, the Spearman correlation
coefficient was used to compare continuous BMI (kg/m2) and

Introduction
Body mass index (BMI) based on self-reported weight and
height is often used as a measure of body size in
epidemiological studies. Although underreporting of BMI
occurs mainly among overweight persons, elderly and

comparative weight (a lot less; a little less; about the same; a

little more; a lot more). 95% condence limits were calculated
using Fishers Z. Sensitivity analysis by case-control status
and age were performed. Analyses were done in SAS 9.3 (SAS
Institute Inc., Cary, NC, USA).

females13, self-reported BMI was found to be highly

The study was approved by the Human Research Ethics

correlated with measured BMI.4 In retrospective case-studies,

Committees of the Western Australian Department of Health

weight at a certain point in the past is often the exposure of

and The University of Western Australia.

Results
The mean age of the study participants was 60.3 years, with 39.3% self-reporting a healthy current BMI and just over half
currently self-reporting overweight or obesity (Table 1). Fifty-six per cent of women had never smoked, 16.6% had at least a
university education, and 83.2% were post-menopausal. There were no substantial differences between cases and controls.

Table 1. Characteristics of cases and controls in the Breast Cancer Environment and Employment Study.

Characteristics

Cases
n = 1,037

Controls
n = 1,610

All persons
n = 2,647

Age, mean (SD)

60.3 (9.3)

60.4 (8.5)

60.3 (8.8)

17 (1.6%)

29 (1.8%)

46 (1.7%)

Healthy weight (18.525kg/m2)

400 (38.6%)

639 (39.7%)

1,039 (39.3%)

Overweight (2530kg/m2)

350 (33.8%)

531 (33.0%)

881 (33.3%)

Obese (>30kg/m2)

245 (23.6%)

372 (23.1%)

617 (23.3%)

25 (2.4%)

39 (2.4%)

64 (2.4%)

Current smoker

76 (7.3%)

136 (8.5%)

212 (8.0%)

Former smoker

399 (38.5%)

543 (33.7%)

942 (35.6%)

Never smoker

558 (53.8%)

925 (57.5%)

1,483 (56.0%)

4 (0.4%)

6 (0.4%)

10 (0.4%)

University education, n (%)

198 (19.1%)

242 (15.0%)

440 (16.6%)

Menopausal status (post-menopausal), n (%)

835 (80.5%)

1,366 (84.8%)

2,201 (83.2%)

Current BMI, n (%)

Underweight (<18.5kg/m2)

Missing
Smoking status, n (%)

Missing

Abbreviations: SD standard deviation BMI Body Mass Index

Table 2 shows that data were missing less often for comparative weight (1.2%) than self-reported weight (12.5%). Of the 2,304
women who reported both BMI and comparative weight in their early thirties, the two measures fell in the same category for
54.3%. For 36.4% their comparative weight underestimated self-reported BMI, and for 9.3% comparative weight overestimated
self-reported BMI. A similar pattern of over- and underestimation was seen among both cases and controls (data not shown).

Table 2. Comparison of self-reported BMI and comparative weight in early thirties, for women aged 45 years at time
of data collection.
Body mass index (BMI)
Underweight
N (%)

Healthy weight
N (%)

Overweight
N (%)

Obese
N (%)

Missing
N (%)

Total
N (%)

153 (5.8)

636 (24.0)

16 (0.6)

3 (0.1)

61 (2.3)

869 (26.7)

About the same

46 (1.7)

897 (33.9)

125 (4.7)

9 (0.3)

172 (6.5)

1,249 (47.2)

A little more

1 (0.0)

139 (5.3)

153 (5.8)

49 (1.9)

63 (2.4)

405 (15.3)

A lot more

0 (0.0)

6 (0.2)

22 (0.8)

49 (1.9)

14 (0.5)

91 (3.4)

Missing

2 (0.1)

6 (0.2)

3 (0.1)

0 (0.0)

22 (0.8)

33 (1.2)

202 (7.6)

1,684 (63.6)

319 (12.1)

110 (4.2)

332 (12.5)

2,647 (100)

Comparative weight
Less

Total

The coefficient of the correlation between comparative

weight and BMI was 0.64 (95% CI: 0.610.66; <0.0001),
indicating that comparative weight is in overall good
correlation with past BMI. The correlation between the two
measures was slightly better among controls (0.67, 95% CI:
0.640.69, <0.0001) than among cases (0.60, 95% CI:

Acknowledgments
The authors would like to thank the BCEES study team for
their assistance.

Funding

0.550.64, <0.0001). Additionally, the correlation between

The Breast Cancer Environment and Employment Study was

measures worsened with age, with a correlation coefficient

funded by a National Health and Medical Research Council

of 0.68 (95% CI: 0.650.70, <0.0001) among women aged

Australia (NHMRC) project grant #572530 and by a grant

<65 years and 0.56 (95% CI: 0.510.61, <0.0001) among those

from the Cancer Council Western Australia. Lin Fritschi is

aged >65 years. The proportion of missing data increased

supported by fellowships from the NHMRC and the Cancer

with age, but equally between the measures (data not shown).

Council Western Australia.

Discussion

References

This study among Western Australian women found a good

correlation between self-reported past comparative body
weight and BMI. Despite the tendency for underreporting,
BMI based on self-reported data has been shown to accurately
rank participants4, making self-reported BMI a useful
measure for epidemiological studies. Our study suggests that
self-assessment of comparative weight in ones early thirties
might be subject to some of the same reporting errors as BMI,
as the comparative weight was more likely to underestimate
BMI category than to overestimate it. The majority of the
participants were in their early thirties in the 1980s when
roughly 70% of women had a healthy BMI (18.524.9kg/m2)8,
indicating that our assumption that a normal BMI equates to
a comparative weight of about the same may be reasonable.
However, as social norms may determine what a person

1. Ng SP, Korda R, Clements M, Latz I, Bauman A, Bambrick H, et al. Validity of

self-reported height and weight and derived body mass index in middle-aged
and elderly individuals in Australia. Australian and New Zealand Journal of
Public Health. 2011;35(6):557-63.
2. 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. Obesity Reviews: An Official Journal of the International
Association for the Study of Obesity. 2007;8(4):307-26.
3. Kyulo NL, Knutsen SF, Tonstad S, Fraser GE, Singh PN. Validation of recall
of body weight over a 26-year period in cohort members of the Adventist
Health Study 2. Ann Epidemiol. 2012;22(10):744-6.
4. McAdams MA, Van Dam RM, Hu FB. Comparison of self-reported and
measured BMI as correlates of disease markers in US adults. Obesity (Silver
Spring). 2007;15(1):188-96.
5. Boyle T, Fritschi L, Heyworth J, Bull F. Long-term sedentary work and the
risk of subsite-specic colorectal cancer. American Journal of Epidemiology.
2011;173(10):1183-91.
6. Cairns BJ, Liu B, Clennell S, Cooper R, Reeves GK, Beral V, et al. Lifetime
body size and reproductive factors: comparisons of data recorded
prospectively with self reports in middle age. Bmc Med Res Methodol. 2011;11.
7. Girschik J, Heyworth J, Fritschi L. Self-reported sleep duration, sleep quality,
and breast cancer risk in a population-based case-control study. Am J
Epidemiol. 2013;177(4):316-27.

to compare their body size to others may have introduced

8. Dixon T, Waters, AM, cartographer A growing problem: trends and patterns

in overweight and obesity among adults in Australia, 1980 to 2001. Canberra:
AIHW; 2003.

additional perceptual error into the measurement. Additionally,

9. Johnson WG, Stewart R, Pusser AT. The perceptual threshold for

overweight. Eating Behaviors. 2012;13(3):188-93.

considers a healthy or normal weight9, asking participants

cases completed the questionnaire at a minimum of three

months after their breast cancer diagnosis. This is likely a
turbulent period, and may explain the poorer correlation
between weight measures observed among cases compared
to healthy controls. Previous research on this topic is limited.
Cairns and colleagues found that relative body size at age ten
(thinner than average, average, plumper than average)
correlated moderately to measured continuous BMI.6 We
observed a good correlation between comparative weight and
BMI at age 30, but found that the correlation between measures
decreased with age, suggesting that a longer recall period may
negatively affect the estimation comparative body weight.
There was substantially fewer missing data for comparative
weight than for height and past weight, indicating that
comparative weight may have been easier to recall than exact
past weight. Alternatively, participants may have been more
willing or able to estimate their weight categorically.
We observe fewer missing data, as well as a good correlation
of comparative weight in early thirties compared to selfreported BMI. While further research is needed to conrm
these ndings, comparative weight may be a useful
alternative to self-reported past BMI for ranking participants.