title: BMI may overestimate the prevalence of obesity among women of lower socioeconomic status.
abstract: OBJECTIVE
  Our objective was to examine gender differences in height and weight associated with socioeconomic status (SES) and the consequent effect on body mass index in a multiethnic society.
  
  
  METHODS
  A cross-sectional study, the First Israeli National Health and Nutrition Survey, was performed on a representative population sample of 3246 adults 25 to 64 years of age, between the years 1999 to 2001. Height and weight were measured, and BMI and other weight-height indices were calculated. SES was assessed by income and education.
  
  
  RESULTS
  Age-adjusted height was significantly lower at lower levels of SES among both women and men (p<0.001). As opposed to men, women of lower SES were heavier than those of higher SES, and the mean age-adjusted weight was 4.6 kg higher among those of lower SES (p<0.001). Thus, using the standard index of BMI, the prevalence of obesity was significantly higher among shorter women.
  
  
  CONCLUSIONS
  In this group of Israeli adults, the unfavorable effect of low SES on BMI was evident among women, partly due to their decreased height combined with increased weight common in this socioeconomic sector. Since BMI is only partly independent of height, it may overestimate the prevalence of obesity among women of lower SES. Alternative measures for classifying obesity in the lower SES groups that put less emphasis on height may be considered and studied.
authors.affiliation: Public Health Services, Israeli Center for Disease Control, Ministry of Health, Gertner Institute, Sheba Medical Center, Israel 52621.
authors.forename: Dorit Nitzan
authors.initials: DN
authors.lastname: Kaluski
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.forename: Felicia
authors.initials: F
authors.lastname: Stern
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
authors.forename: Alex
authors.initials: A
authors.lastname: Leventhal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Goldsmith
authors.forename: Ayelet
authors.initials: A
authors.lastname: Chinich
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Berry
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004493:Education; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D007557:Israel; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011203:Poverty; D015995:Prevalence; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires