Parent-Reported Height and Weight as Sources of Bias in Survey Estimates of Childhood Obesity

Abstract

Parental reporting of height and weight was evaluated for US children aged 2-13 years. The prevalence of obesity (defined as a body mass index value (calculated as weight (kg)/height (m)(2)) in the 95th percentile or higher) and its height and weight components were compared in child supplements of 2 nationally representative surveys: the 1996-2008 Children of the National Longitudinal Survey of Youth 1979 Cohort (NLSY79-Child) and the 1997 Child Development Supplement of the Panel Study of Income Dynamics (PSID-CDS). Sociodemographic differences in parent reporting error were analyzed. Error was largest for children aged 2-5 years. Underreporting of height, not overreporting of weight, generated a strong upward bias in obesity prevalence at those ages. Frequencies of parent-reported heights below the Centers for Disease Control and Prevention's (Atlanta, Georgia) first percentile were implausibly high at 16.5% (95% confidence interval (CI): 14.3, 19.0) in the NLSY79-Child and 20.6% (95% CI: 16.0, 26.3) in the PSID-CDS. They were highest among low-income children at 33.2% (95% CI: 22.4, 46.1) in the PSID-CDS and 26.2% (95% CI: 20.2, 33.2) in the NLSY79-Child. Bias in the reporting of obesity decreased with children's age and reversed direction at ages 12-13 years. Underreporting of weight increased with age, and underreporting of height decreased with age. We recommend caution to researchers who use parent-reported heights, especially for very young children, and offer practical solutions for survey data collection and research on child obesity.

Body Mass Index Accuracy in Preadolescents: Can We Trust Self-Report or Should We Seek Parent Report?

“…[13][14][15][16] The association between objective and subjective measures of weight, height, and BMI was strong, which is consistent with findings from some previous studies. 16,17 Besides, as in other studies, 13,16,[18][19][20][21][22] underestimation of weight and height based on subjective data was observed. In the present study, this underestimation can be considered small, as mean differences of less than 1 kg for weight and of less than 1 cm for height were observed for children.…”

Racial and Ethnic Disparities in Dietary Intake among California Children

“…In addition, height and weight were based on caregiver report, which may bias our estimates; however, many national studies continue to use this method of survey data collection. 58 There was a significant amount of missing height and weight data particularly for non-English interviewed Latinos and Asians that could have biased our estimates. The large amount of missing data for these populations may be due to low health literacy levels or confusion regarding height and weight metrics as many Latin American and Asian countries use the International System of Units (i.e.…”

Accumulation of childhood poverty on young adult overweight or obese status: race/ethnicity and gender disparities

“…Childhood BMI in the present survey is based on either direct assessment or mother's self-reported data. Recent research that analysed parental reports of children's height and weight from this survey indicates varying degrees of under-reporting depending on the age of the child and income status of the household 38. The combination of direct assessment and unreliable self-reported data into one measure presents multiple sources of bias, and this inconsistency could contribute to inaccurate BMI classifications.…”