Deakin University
strugnell-activeoptin-2018.pdf (2.56 MB)

Active (Opt-In) consent underestimates mean BMI-z and the prevalence of overweight and obesity compared to passive (Opt-Out) consent. Evidence from the healthy together victoria and childhood obesity study

Download (2.56 MB)
Version 3 2024-06-18, 08:00
Version 2 2024-06-04, 04:17
Version 1 2018-05-29, 14:52
journal contribution
posted on 2024-06-18, 08:00 authored by Claudia StrugnellClaudia Strugnell, Liliana OrellanaLiliana Orellana, Josh HaywardJosh Hayward, L Millar, B Swinburn, Steven AllenderSteven Allender
Background: Tracking population trends in childhood obesity and identifying target areas for prevention requires accurate prevalence data. This study quantified the magnitude of non-participation bias for mean Body Mass Index-z scores and overweight/obesity prevalence associated with low (opt-in) compared to high (opt-out) participation consent methodologies. Methods: Data arose from all Local Government Areas (LGAs) participating in the Healthy Together Victoria Childhood Obesity Study, Australia. Primary schools were randomly selected in 2013 and 2014 and all Grades 4 and 6 students (aged approx. 9-12 years) were invited to participate via opt-in consent (2013) and opt-out consent (2014). For the opt-in wave N = 38 schools (recruitment rate (RR) 24.3%) and N = 856 students participated (RR 36.3%). For the opt-out wave N = 47 schools (RR 32%) and N = 2557 students participated (RR 86.4%). OUTCOMES: differences between opt-in and opt-out sample estimates (bias) for mean BMI-z, prevalence of overweight/obesity and obesity (alone). Standardized bias (Std bias) estimates defined as bias/standard error are reported for BMI-z. Results: The results demonstrate strong evidence of non-participation bias for mean BMI-z overall (Std bias = -4.5, p < 0.0001) and for girls (Std bias = -5.4, p < 0.0001), but not for boys (Std bias = -1.1, p = 0.15). The opt-in strategy underestimated the overall population prevalence of overweight/obesity and obesity by -5.4 and -4.5 percentage points respectively (p < 0.001 for both). Significant underestimation was seen in girls, but not for boys. Conclusions: Opt-in consent underestimated prevalence of childhood obesity, particularly in girls. Prevalence, monitoring and community intervention studies on childhood obesity should move to opt-out consent processes for better scientific outcomes.



International Journal of Environmental Research and Public Health



Article number

ARTN 747



Open access

  • Yes







Publication classification

C Journal article, C1 Refereed article in a scholarly journal

Copyright notice

2018, by the authors