Abstract Body: Background. Childhood obesity is a driver of cardiovascular disease later in life. Given the importance of childhood obesity and recent advances in electronic capture of survey data, many studies have incorporated parent-proxy reports of child weight and height into their design. Here, we aimed to assess the agreement between parent-reported and electronic health record (EHR)-based BMI within a diverse, urban cohort of children, and whether the agreement varied by child age and sex.

Methods. We utilized participants aged 2-17 in the Young Hearts Study with both parent-reported and EHR-based BMI data available at baseline. Parent-reported height and weight for their child were collected through electronic surveys and were used to calculate age- and sex-specific BMI percentiles. EHR-based weights, heights, and BMI percentiles were abstracted from the encounter closest in time to the survey completion date. Overweight or obesity was defined as BMI ≥85th percentile. Agreement for BMI percentile was assessed via Pearson correlation, and for classification as overweight or obese via the Kappa statistic.

Results. Data from 660 children were included in this study, of whom 319 (48.3%) were female, 166 (25.2%), 263 (39.8%), and 167 (25.3%) were non-Hispanic Black, non-Hispanic White, and Hispanic, and 184 (27.9%), 234 (35.5%), and 242 (36.7%) were aged 2-7, 8-12, and 13-17 years. Overall, the mean parent-reported BMI percentile was 64.9 (SD 32.3) in girls and 63.4 (SD 34.1) in boys; these were slightly higher than the EHR at 70.5 (SD 28.8) in girls and 66.7 (SD 32.3) in boys. Agreement of parent report of BMI percentile with EHR-based BMI percentile increased with child age. For girls, age group-specific correlations were r_2-7 = 0.40, r_8-12=0.61, and r_13-17=0.83, and for boys they were r_2-7 = 0.53, r_8-12=0.69, and r_13-17=0.75. Agreement for classification as overweight or obese also increased from poor to moderate with age; for girls, age-specific agreement was k_2-7=0.30, k_8-12=0.63, and k_13-17=0.67, and for boys it was k_2-7=0.43, k_8-12=0.62, and k_13-17=0.72.

Discussion. Our results suggest slight under-reporting of child BMI by parents overall, with agreement between parent report and EHR BMI percentile increasing with child age. Remote collection of BMI may be a valid supplement to in-clinic assessment for use in research, particularly for teenagers, which may facilitate cheaper and more timely capture of data.