Academy of Medical Sciences of I.R. Iran Archives of Iranian Medicine 1029-2977 25 12 2022 12 01 Validity of Body Image Pictogram to Determine Overweight/Obesity in Adults from Less Developed Populations: Results From Pars Cohort Study 779 787 10.34172/aim.2022.123 EN Somayeh Bazdar https://orcid.org/0000-0002-8266-8156 Mohammad Hossein Sharifi Hossein Puostchi Abdullah Gandomkar Reza Malekzadeh Fatemeh Malekzadeh Hossein Molavi Vardanjani https://orcid.org/0000-0001-7024-8894 Journal Article 10.34172/aim.2022.123 2021 07 10 2022 01 08 Background: Despite the evidence for validity of body image pictogram (BIP) to discriminate overweight, obese, and normal individuals, there is little evidence on the probable effect of socio-demographic variables on its validity. To investigate the effects of socioeconomic status (SES), age, ethnicity, and educational level on the validity of BIP to discriminate normal weight, overweight, and obese people. Methods: We used the Pars Cohort Study (PCS) data. Stunkard’s BIP score was used as test measure. Participants were classified as normal (body mass index [BMI]<25), overweight (BMI=25 to 29.9), and obese (BMI≥29.9) based on their BMI (kg/m2 ). Area under curve (AUC) and its 95% CI were estimated and compared. Optimal cutoff points and their sensitivity, specificity, and likelihood ratio were reported. Results: A total of 9232 participants with a female/male ratio of 1.03 were included. The prevalence of overweight and obesity was 37.4% and 18.2%, respectively. Regardless of socio-demographic levels, the optimal cut-points to discriminate normal BMI from overweight, and overweight from obese participants were BIP score of four and five, respectively. Estimated AUC correlated with ethnicity (P<0.001) for both genders, and with SES for females (P<0.05). Conclusion: Although BIP may be a valid measure to categorize the general adult population into normal, overweight and obese, its validity depends on SES and ethnicity. BIP may be available as a proxy measure for BMI categories in socio-demographically homogeneous populations but not in heterogeneous populations.