title: Pictogram use was validated for estimating individual's body mass index.
abstract: OBJECTIVE
  We designed this study to assess the validity and reliability of pictogram for estimating body mass index (BMI).
  
  
  METHODS
  Participants of Golestan cohort study during 2000-2004 were recruited in this study. Demographic and anthropometric information (weight, height, and BMI) were collected on all participants. A set of drawings (pictogram) ranging from very lean to obese were used to assess the individual's perception of their body size. Sensitivity and specificity of each pictogram score were calculated and cutoff points were determined using sensitivity/specificity plots. We used receiver operating characteristic curves to assess the validity of pictogram scores.
  
  
  RESULTS
  Of the 15,437 subjects enrolled in the study, 6,574 (42.6%) were males and 8,863 (57.4%) were females. Their mean+/-standard deviation age was 52.58+/-9.28 years. Pictogram scores 1, 2, and 3 were assigned to normal participants; pictogram score 4 was selected by overweight subjects, and finally, pictogram scores equal or higher than 5 were selected by obese ones (area under curve: 0.83-0.85).
  
  
  CONCLUSIONS
  According to our results, pictogram is a valid measure for discriminating obese or overweight from normal individuals, and for distinguishing obese from overweight or normal individuals. So it can be concluded that body image pictogram is valid for discriminating normal and obese individuals.
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Keshtkar
authors.forename: Shahryar
authors.initials: S
authors.lastname: Semnani
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.forename: Hooman
authors.initials: H
authors.lastname: Khademi
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Roshandel
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000886:Anthropometry / Q000379:methods*; D001823:Body Composition; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009765:Obesity / Q000175:diagnosis*; D015203:Reproducibility of Results