Browsing by Author "Buoncristiano, Marta"
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- Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017Publication . Rito, Ana Isabel; Buoncristiano, Marta; Spinelli, Angela; Salanave, Benoit; Kunešová, Marie; Hejgaard, Tatjana; García Solano, Marta; Fijałkowska, Anna; Sturua, Lela; Hyska, Jolanda; Kelleher, Cecily; Duleva, Vesselka; Musić Milanović, Sanja; Farrugia Sant’Angelo, Victoria; Abdrakhmanova, Shynar; Kujundzic, Enisa; Peterkova, Valentina; Gualtieri, Andrea; Pudule, Iveta; Petrauskienė, Aušra; Tanrygulyyeva, Maya; Sherali, Rakhmatulloev; Huidumac-Petrescu, Constanta; Williams, Julianne; Ahrens, Wolfgang; Breda, JoãoBackground: In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity. Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children. Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children’s standardized weight and height measurements followed a common WHO protocol. Information on the children’s birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed. Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16–1.28] and 1.12 [1.07–1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17–1.36] and 1.05 [0.99–1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies. Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
- Childhood overweight and obesity in Europe: Changes from 2007 to 2017Publication . Buoncristiano, Marta; Spinelli, Angela; Williams, Julianne; Nardone, Paola; Rito, Ana Isabel; García‐Solano, Marta; Grøholt, Else Karin; Gutiérrez‐González, Enrique; Klepp, Knut Inge; Starc, Gregor; Petrauskienė, Aušra; Kunešová, Marie; Hassapidou, Maria; Pérez‐Farinós, Napoleón; Pudule, Iveta; Kelleher, Cecily C.; Duleva, Vesselka; Rakovac, Ivo; Chatterjee, Saion; Breda, JoãoThe Childhood Obesity Surveillance Initiative (COSI) routinely measures height andweight of primary school children aged 6–9 years and calculates overweight andobesity prevalence within the World Health Organization (WHO) European Regionusing a standard methodology. This study examines the trends in the prevalence ofoverweight and obesity from the first round of COSI carried out in 2007/2008 to thelatest of 2015/2017 in 11 European countries in which data were collected for atleast three rounds. In total 303,155 children were measured. In general, the preva-lence of overweight and obesity among boys and girls decreased in countries withhigh prevalence (Southern Europe) and remained stable or slightly increased in North-ern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in theproportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to12.2%). The trends were similar for boys and girls in most countries. Several countriesin Europe have successfully implemented policies and interventions to counteract theincrease of overweight and obesity, but there is still much to be done.
- Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity-WHO European Childhood Obesity Surveillance Initiative (COSI 2015⁻2017)Publication . Bel-Serrat, Silvia; Ojeda-Rodríguez, Ana; Heinen, Mirjam; Buoncristiano, Marta; Abdrakhmanova, Shynar; Duleva, Vesselka; Sant’Angelo, Victoria; Fijałkowska, Anna; Hejgaard, Tatjana; Huidumac, Constanta; Hyska, Jolanda; Kujundzic, Enisa; Milanović, Sanja; Ovezmyradova, Guljemal; Pérez-Farinós, Napoleón; Petrauskiene, Ausra; Rito, Ana; Shengelia, Lela; Braunerová, Radka; Rutter, Harry; Murrin, Celine; Kelleher, Cecily; Breda, JoãoIt is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.
- Impact of the COVID-19 pandemic on the eating habits, physical activity and sedentary behaviours of school-aged children in 13 countries within the WHO European Region: “COSI COVID” Study, 2020-2022Publication . Rito, Ana; Buoncristiano, Marta; Mendes, Sofia; Figueira, Ines; Abdrakhmanova, Shynar; Akhmedova, Dilorom; Ciardullo, Silvia; Fijałkowska, Anna; Gualtieri, Andrea; Huidumac‐Petrescu, Constanta; Kakutia, Natia; Kujundžić, Enisa; Musić-Milanović, Sanja; Seyidov, Nabil; Tabona, Lorraine; Tichá, Ľubica; Heinen, Mirjam M.; Whiting, Steve; Williams, Julianne; Rakovac, Ivo; Wickramasinghe, KremlinIntroduction: In 2020, the world population was hit by a global pandemic caused by a new coronavirus (SARS-Cov2), with rapid human-to-human transmission. To limit the spread of the virus and minimize its impact, governments around the world implemented containment measures, leading to many changes in the lifestyle of millions of people. Although children and adolescents were, generally, at low risk of infection and less affected by mortality1, this unprecedented situation led to significant impacts in their daily routines/habits and had a profound effect on their health and well-being2-3. We aimed to understand the impact of the COVID-19 pandemic on the daily routine and behaviours of school aged children, within the WHO/COSI European study. Methods: 13 COSI countries participated in the study: Azerbaijan, Croatia, Georgia, Italy, Kazakhstan, Malta, Montenegro, Poland, Portugal, Romania, San Marino, Slovakia and Uzbekistan. Countries could decide to implement the study together with the 6th round of COSI/WHO Europe in the 2021/2021 school year. A common methodological protocol was designed for this study. Information on children’s behaviors regarding eating habits and physical activity/inactivity before and during the COVID-19 confinement periods, was collected through the “Family COSI-COVID Form” with 12 questions. This form was completed on a voluntary basis by the parents/care givers of participating children. Results: This study included 42 731 children (6-10 years old). Preliminary results suggested that sweets and savory snacks increased during the pandemic in comparison to pre-pandemic period (15.7% and 13,2%, respectively). As for children’s sedentary behaviours, 36.7% of the children increased their time spent watching TV, playing video/computer games, or using social media for non-educational purposes on weekdays and 34.4% on weekends, during the pandemic period. In addition, the time spent learning at home also increased (35.5%). Regarding physical activity, the opposite was reported, showing a decrease in the time children spent being active outside school hours, both on weekdays (26.6%) and weekends (22.0%). Conclusion: These preliminary results are important to better understand the impact of COVID-19 on children’s lifestyles behaviours. These findings may be useful for future public health interventions as countries recover from the pandemic and take measures to address childhood obesity.
- Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI)Publication . Breda, João; McColl, Karen; Buoncristiano, Marta; Williams, Julianne; Abdrakhmanova, Shynar; Abdurrahmonova, Zulfiya; Ahrens, Wolfgang; Akhmedova, Dilorom; Bakacs, Márta; Boer, Jolanda M.A.; Boymatova, Khadichamo; Brinduse, Lacramioara Aurelia; Cucu, Alexandra; Duleva, Vesselka; Endevelt, Ronit; Sant'Angelo, Victoria Farrugia; Fijałkowska, Anna; Hadžiomeragić, Aida Filipović; García‐Solano, Marta; Grøholt, Else Karin; Gualtieri, Andrea; Hassapidou, Maria; Hejgaard, Tatjana; Hyska, Jolanda; Kelleher, Cecily C.; Kujundžić, Enisa; Mäki, Päivi; Markidou Ioannidou, Eliza; Melkumova, Marina; Moyersoen, Isabelle; Milanović, Sanja Musić; Nurk, Eha; Ostojic, Sergej M.; Peterkova, Valentina; Petrauskienė, Aušra; Pudule, Iveta; Rito, Ana Isabel; Russell Jonsson, Kenisha; Rutter, Harry; Salanave, Benoît; Seyidov, Nabil; Shengelia, Lela; Silitrari, Natalia; Spinelli, Angela; Spiroski, Igor; Starc, Gregor; Stojisavljević, Dragana; Tanrygulyyeva, Maya; Tichá, Ľubica; Usupova, Zhamilya; Weghuber, Daniel; Yardim, Nazan; Zamrazilová, Hana; Zbanatskyi, Vladyslav; Branca, Francesco; Weber, Martin; Rakovac, IvoEstablishment of the WHO European Childhood Obesity Surveillance Initiative (COSI)has resulted in a surveillance system which provides regular, reliable, timely, andaccurate data on children's weight status—through standardized measurement ofbodyweight and height—in the WHO European Region. Additional data on dietaryintake, physical activity, sedentary behavior, family background, and schoolenvironments are collected in several countries. In total, 45 countries in the EuropeanRegion have participated in COSI. The first five data collection rounds, between 2007and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI,data are collected according to a common protocol, using standardized instrumentsand procedures. The systematic collection and analysis of these data enables inter-country comparisons and reveals differences in the prevalence of childhood thinness,overweight, normal weight, and obesity between and within populations. Furthermore,it facilitates investigation of the relationship between overweight, obesity, and poten-tial risk or protective factors and improves the understanding of the development ofoverweight and obesity in European primary-school children in order to supportappropriate and effective policy responses.
- Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progressPublication . Breda, João; Farrugia Sant'Angelo, Victoria; Duleva, Vesselka; Galeone, Daniela; Heinen, Mirjam M.; Kelleher, Cecily C.; Menzano, Maria Teresa; Musić Milanović, Sanja; Mitchell, Lachlan; Pudule, Iveta; Rito, Ana Isabel; Shengelia, Lela; Spinelli, Angela; Spiroski, Igor; Yardim, Nazan; Buoncristiano, Marta; Williams, Julianne; Rakovac, Ivo; McColl, KarenTo meet the need for regular and reliable data on the prevalence of overweight andobesity among children in Europe, the World Health Organization (WHO) EuropeanChildhood Obesity Surveillance Initiative (COSI) was established in 2007. Theresulting robust surveillance system has improved understanding of the public healthchallenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action onnutrition and physical activity in the region. This paper describes illustrative examplesof how COSI data have fed into national and international policy, but the real scopeof COSI's impact is likely to be much broader. In some countries, there are signs thatpolicy responses to COSI data have helped halt the rise in childhood obesity. As thecountries of the WHO European Region commit to pursuing United Action for BetterHealth in Europe in WHO's new European Programme of Work, COSI provides anexcellent example of such united action in practice. Further collaborative action willbe key to tackling this major public health challenge which affects children through-out the region
- Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017Publication . Ramos Salas, Ximena; Buoncristiano, Marta; Williams, Julianne; Kebbe, Maryam; Spinelli, Angela; Nardone, Paola; Rito, Ana; Duleva, Vesselka; Musić Milanović, Sanja; Kunesova, Marie; Braunerová, Radka Taxová; Hejgaard, Tatjana; Rasmussen, Mette; Shengelia, Lela; Abdrakhmanova, Shynar; Abildina, Akbota; Usuopva, Zhamyila; Hyska, Jolanda; Burazeri, Genc; Petrauskiene, Aušra; Pudule, Iveta; Sant’Angelo, Victoria Farrugia; Kujundzic, Enisa; Fijałkowska, Anna; Cucu, Alexandra; Brinduse, Lacramioara Aurelia; Peterkova, Valentina; Bogova, Elena; Gualtieri, Andrea; Solano, Marta García; Gutiérrez-González, Enrique; Rakhmatullaeva, Sanavbar; Tanrygulyyeva, Maya; Yardim, Nazan; Weghuber, Daniel; Mäki, Päivi; Russell Jonsson, Kenisha; Starc, Gregor; Juliusson, Petur Benedikt; Heinen, Mirjam M.; Kelleher, Cecily; Ostojic, Sergej; Popovic, Stevo; Kovacs, Viktoria Anna; Akhmedova, Dilorom; Farpour-Lambert, Nathalie J.; Rutter, Harry; Li, Bai; Boymatova, Khadichamo; Rakovac, Ivo; Wickramasinghe, Kremlin; Breda, JoãoIntroduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
- Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015–2017Publication . Whiting, Stephen; Buoncristiano, Marta; Gelius, Peter; Abu-Omar, Karim; Pattison, Mary; Hyska, Jolanda; Duleva, Vesselka; Musić Milanović, Sanja; Zamrazilová, Hana; Hejgaard, Tatjana; Rasmussen, Mette; Nurk, Eha; Shengelia, Lela; Kelleher, Cecily C.; Heinen, Mirjam M.; Spinelli, Angela; Nardone, Paola; Abildina, Akbota; Abdrakhmanova, Shynar; Aitmurzaeva, Gulmira; Usuopva, Zhamyila; Pudule, Iveta; Petrauskiene, Aušra; Sant’Angelo, Victoria Farrugia; Kujundzic, Enisa; Popovic, Stevo; Fismen, Anne-Siri; Bergh, Ingunn Holden; Fijalkowska, Anna; Rito, Ana Isabel; Cucu, Alexandra; Brinduse, Lacramioara Aurelia; Peterkova, Valentina; Gualtieri, Andrea; García-Solano, Marta; Gutiérrez-González, Enrique; Abdurrahmonova, Zulfinissio; Boymatova, Khadichamo; Yardim, Nazan; Tanrygulyyeva, Maya; Weghuber, Daniel; Schindler, Karin; Stojisavljević, Dragana; Filipović Hadžiomeragić, Aida; Markidou Ionnaidu, Eliza; Ahrens, Wolfgang; Hassapidou, Maria; Kovacs, Viktoria Anna; Ostojic, Sergej M.; Ticha, Lubica; Starc, Gregor; Russell Jonsson, Kenisha; Spiroski, Igor; Rutter, Harry; Mendes, Romeu; Williams, Julianne; Rakovac, Ivo; Breda, JoãoBackground: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
- Prevalence of Severe Obesity among Primary School Children in 21 European CountriesPublication . Spinelli, Angela; Buoncristiano, Marta; Kovacs, Viktoria Anna; Yngve, Agneta; Spiroski, Igor; Obreja, Galina; Starc, Gregor; Pérez, Napoleón; Rito, Ana Isabel; Kunešová, Marie; Sant'Angelo, Victoria Farrugia; Meisfjord, Jørgen; Bergh, Ingunn Holden; Kelleher, Cecily; Yardim, Nazan; Pudule, Iveta; Petrauskiene, Ausra; Duleva, Vesselka; Sjöberg, Agneta; Gualtieri, Andrea; Hassapidou, Maria; Hyska, Jolanda; Burazeri, Genc; Petrescu, Constanta Huidumac; Heinen, Mirjam; Takacs, Hajnalka; Zamrazilová, Hana; Bosi, Tulay Bagci; Sacchini, Elena; Pagkalos, Ioannis; Cucu, Alexandra; Nardone, Paola; Gately, Paul; Williams, Julianne; Breda, JoãoThe World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published.
- A Snapshot of European Children’s Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI)Publication . Williams, Julianne; Buoncristiano, Marta; Nardone, Paola; Rito, Ana Isabel; Spinelli, Angela; Hejgaard, Tatjana; Kierkegaard, Lene; Nurk, Eha; Kunešová, Marie; Musić Milanović, Sanja; García-Solano, Marta; Gutiérrez-González, Enrique; Brinduse, Lacramioara Aurelia; Cucu, Alexandra; Fijałkowska, Anna; Farrugia Sant’Angelo, Victoria; Abdrakhmanova, Shynar; Pudule, Iveta; Duleva, Vesselka; Yardim, Nazan; Gualtieri, Andrea; Heinen, Mirjam; Bel-Serrat, Silvia; Usupova, Zhamyla; Peterkova, Valentina; Shengelia, Lela; Hyska, Jolanda; Tanrygulyyeva, Maya; Petrauskiene, Ausra; Rakhmatullaeva, Sanavbar; Kujundzic, Enisa; Ostojic, Sergej M.; Weghuber, Daniel; Melkumova, Marina; Spiroski, Igor; Starc, Gregor; Rutter, Harry; Rathmes, Giulia; Bunge, Anne Charlotte; Rakovac, Ivo; Boymatova, Khadichamo; Weber, Martin; Breda, JoãoConsuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.