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Background: Self-reported values of height and weight are used increasingly despite warnings that these data-and derived body mass index (BMI) values-might be biased. The present study investigates whether differences between self-reported and measured values are the same for populations from different regions, and the influences of gender and age., Methods: Differences between self-reported and measured weights, heights and resulting BMIs are compared for representative samples of the adult population of Italy, the Netherlands and North America., Results: We observed that weight is under-reported (1.1 ± 2.6 kg for females and 0.4 ± 3.1 kg for males) and height over-reported (1.1 ± 2.2 cm for females and 1.7 ± 2.1 cm for males), in accordance with the literature. This leads to an overall underestimation of BMI values (0.7 ± 1.2 kg/m(2) or 2.8% for females and 0.6 ± 1.1 kg/m(2) or 2.3% for males). When BMI values are assigned to four categories (from 'underweight' to 'obesity'), 11.2% of the females and 12.0% of the males are categorized too low when self-reported weights and heights are used, with an extreme of 17.2% for Italian females. Older people tend to relatively over-report height and under-report weight, but the magnitude differs between countries and gender., Conclusion: We conclude that, apart from a general overestimation of height and underestimation of weight resulting in an underestimation of BMI, substantial differences are observed between countries, between females and males and between age groups.