title: Validation of self-reported figural drawing scales against anthropometric measurements in adults.
abstract: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.
  
  
  
  Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.
  
  
  
  Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.
  
  
  
  Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).
  
  
  
  Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.
  
  
  
  Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.
authors.affiliation: 1Department of Epidemiology and Public Health,Swiss Tropical and Public Health Institute,Socinstrasse 57,PO Box 4002,Basel,Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Dratva
authors.affiliation: 3Department of Occupational Medicine,Haukeland University Hospital,Bergen,Norway.
authors.forename: Randi
authors.initials: R
authors.lastname: Bertelsen
authors.affiliation: 4Department of Medical Sciences,Uppsala University,Uppsala,Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
authors.affiliation: 3Department of Occupational Medicine,Haukeland University Hospital,Bergen,Norway.
authors.forename: Ane
authors.initials: A
authors.lastname: Johannessen
authors.affiliation: 6Department of Allergy,Respiratory Medicine and Sleep,Landspitali University Hospital,Reykjavik,Iceland.
authors.forename: Bryndis
authors.initials: B
authors.lastname: Benediktsdóttir
authors.affiliation: 7Occupational and Environmental Medicine,Department of Public Health and Clinical Medicine,Umeå University,Umeå,Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Bråbäck
authors.affiliation: 8Allergy and Lung Health Unit,Centre for Epidemiology and Biostatistics,Melbourne School of Population and Global Health,University of Melbourne,Melbourne,Australia.
authors.forename: Shyamali C
authors.initials: SC
authors.lastname: Dharmage
authors.affiliation: 7Occupational and Environmental Medicine,Department of Public Health and Clinical Medicine,Umeå University,Umeå,Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.affiliation: 6Department of Allergy,Respiratory Medicine and Sleep,Landspitali University Hospital,Reykjavik,Iceland.
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Gislason
authors.affiliation: 9Faculty of Medicine,National Heart & Lung Institute,Imperial College,London,UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Jarvis
authors.affiliation: 10Lung Clinic,Foundation Tartu University Clinics,Tartu,Estonia.
authors.forename: Rain
authors.initials: R
authors.lastname: Jogi
authors.affiliation: 4Department of Medical Sciences,Uppsala University,Uppsala,Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Lindberg
authors.affiliation: 4Department of Medical Sciences,Uppsala University,Uppsala,Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Norback
authors.affiliation: 5Department of Clinical Sciences,University of Bergen,Bergen,Norway.
authors.forename: Ernst
authors.initials: E
authors.lastname: Omenaas
authors.affiliation: 3Department of Occupational Medicine,Haukeland University Hospital,Bergen,Norway.
authors.forename: Trude D
authors.initials: TD
authors.lastname: Skorge
authors.affiliation: 12Department of Public Health,Aarhus University,Aarhus,Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: 13Occupational and Environmental Medicine,Sahlgrenska Academy,University of Gothenburg,Gothenburg,Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Toren
authors.affiliation: 5Department of Clinical Sciences,University of Bergen,Bergen,Norway.
authors.forename: Marie
authors.initials: M
authors.lastname: Waatevik
authors.affiliation: 4Department of Medical Sciences,Uppsala University,Uppsala,Sweden.
authors.forename: Gundula
authors.initials: G
authors.lastname: Wieslander
authors.affiliation: 12Department of Public Health,Aarhus University,Aarhus,Denmark.
authors.forename: Vivi
authors.initials: V
authors.lastname: Schlünssen
authors.affiliation: 3Department of Occupational Medicine,Haukeland University Hospital,Bergen,Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Svanes
authors.affiliation: 5Department of Clinical Sciences,University of Bergen,Bergen,Norway.
authors.forename: Francisco Gomez
authors.initials: FG
authors.lastname: Real
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis; D050177:Overweight / Q000175:diagnosis; D012016:Reference Values; D057566:Self Report; D055105:Waist Circumference
keywords: Anthropometric; BMI; Figural scale; Figural stimuli; Obesity; Observational study; Overweight; Validation; Waist circumference