title: Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity.
abstract: Body-mass index (BMI) has become the standard proxy for obesity in social science research. This study deals with the potential problems related to, first, relying on self-reported weight and height to calculate BMI (misreporting), and, second, the concern that BMI is a deficient measure of body fat (misclassification). Using a regional Swedish sample, we analyze whether socioeconomic disparities in BMI are biased because of misreporting, and whether socioeconomic disparities in the risk of obesity are sensitive to whether BMI or waist circumference is used to define obesity. Education and income are used as socioeconomic indicators. The overall conclusion is that misreporting and misclassification may indeed matter for estimated educational and income disparities in BMI and obesity. In the misreporting part we find that women with higher education misreport less than those with lower education, leading to underestimation of the education disparity when using self-reported information. In the misclassification part we find that the probability of being misclassified decreases with income, for both men and women. Among women, the consequence is a steeper income gradient when obesity is defined using waist circumference instead of BMI. Among men the income gradient is statistically insignificant irrespective of how obesity is defined, but when estimating the probability of obesity defined by waist circumference, an educational gradient, which is not present when classifying men using BMI, arises.
authors.affiliation: Department of Economics, Lund University, P.O. Box 7082, 220 07, Lund, Sweden, asa.ljungvall@nek.lu.se.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Ljungvall
authors.forename: Ulf G
authors.initials: UG
authors.lastname: Gerdtham
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001837:Body Weights and Measures; D003625:Data Collection / Q000592:standards; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015203:Reproducibility of Results; D057566:Self Report / Q000592:standards*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden; D055815:Young Adult