Browsing by Author "Hejgaard, Tatjana"
Now showing 1 - 10 of 11
Results Per Page
Sort Options
- 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.
- 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.
- 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.
- 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.
- 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.
- Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)Publication . Fismen, Anne‐Siri; Buoncristiano, Marta; Williams, Julianne; Helleve, Arnfinn; Abdrakhmanova, Shynar; Bakacs, Márta; Bergh, Ingunn Holden; Boymatova, Khadichamo; Duleva, Vesselka; Fijałkowska, Anna; García‐Solano, Marta; Gualtieri, Andrea; Gutiérrez‐González, Enrique; Hejgaard, Tatjana; Huidumac‐Petrescu, Constanta; Hyska, Jolanda; Kelleher, Cecily C.; Kierkegaard, Lene; Kujundžić, Enisa; Kunešová, Marie; Milanović, Sanja Musić; Nardone, Paola; Nurk, Eha; Ostojic, Sergej M.; Ozcebe, Lütfiye Hilal; Peterkova, Valentina; Petrauskiene, Ausra; Pudule, Iveta; Rakhmatulleoeva, Sanavbar; Rakovac, Ivo; Rito, Ana Isabel; Rutter, Harry; Sacchini, Elena; Stojisavljević, Dragana; Farrugia Sant'Angelo, Victoria; Shengelia, Lela; Spinelli, Angela; Spiroski, Igor; Tanrygulyyeva, Maya; Usupova, Zhamilya; Weghuber, Daniel; Breda, JoãoBackground: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.
- Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European regionPublication . Musić Milanović, Sanja; Buoncristiano, Marta; Križan, Helena; Rathmes, Giulia; Williams, Julianne; Hyska, Jolanda; Duleva, Vesselka; Zamrazilová, Hana; Hejgaard, Tatjana; Jørgensen, Maja Bæksgaard; Salanave, Benoît; Shengelia, Lela; Kelleher, Cecily C.; Spinelli, Angela; Nardone, Paola; Abdrakhmanova, Shynar; Usupova, Zhamilya; Pudule, Iveta; Petrauskiene, Ausra; Farrugia Sant'Angelo, Victoria; Kujundžić, Enisa; Fijałkowska, Anna; Rito, Ana Isabel; Cucu, Alexandra; Brinduse, Lacramioara Aurelia; Peterkova, Valentina; Gualtieri, Andrea; García‐Solano, Marta; Gutiérrez‐González, Enrique; Boymatova, Khadichamo; Yardim, Mahmut S.; Tanrygulyyeva, Maya; Melkumova, Marina; Weghuber, Daniel; Nurk, Eha; Mäki, Päivi; Bergh, Ingunn Holden; Ostojic, Sergej M.; Russell Jonsson, Kenisha; Spiroski, Igor; Rutter, Harry; Ahrens, Wolfgang; Rakovac, Ivo; Whiting, Stephen; Breda, JoãoPhysical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.
- Socioeconomic inequalities in overweight and obesity among 6‐ to 9‐year‐old children in 24 countries from the World Health Organization European regionPublication . Buoncristiano, Marta; Williams, Julianne; Simmonds, Philippa; Nurk, Eha; Ahrens, Wolfgang; Nardone, Paola; Rito, Ana Isabel; Rutter, Harry; Bergh, Ingunn Holden; Starc, Gregor; Jonsson, Kenisha Russell; Spinelli, Angela; Vandevijvere, Stefanie; Mäki, Päivi; Milanović, Sanja Musić; Salanave, Benoît; Yardim, Mahmut S.; Hejgaard, Tatjana; Fijałkowska, Anna; Abdrakhmanova, Shynar; Abdurrahmonova, Zulfiya; Duleva, Vesselka; Farrugia Sant'Angelo, Victoria; García‐Solano, Marta; Gualtieri, Andrea; Gutiérrez‐González, Enrique; Huidumac‐Petrescu, Constanta; Hyska, Jolanda; Kelleher, Cecily C.; Kujundžić, Enisa; Peterkova, Valentina; Petrauskiene, Ausra; Pudule, Iveta; Sacchini, Elena; Shengelia, Lela; Tanrygulyyeva, Maya; Taxová Braunerová, Radka; Usupova, Zhamilya; Maruszczak, Katharina; Ostojic, Sergej M.; Spiroski, Igor; Stojisavljević, Dragana; Wickramasinghe, Kremlin; Breda, JoãoChildhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6–9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.
- Thinness, overweight, and obesity in 6‐ to 9‐year‐old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative - COSI 2015-2017Publication . Spinelli, Angela; Buoncristiano, Marta; Nardone, Paola; Starc, Gregor; Hejgaard, Tatjana; Júlíusson, Petur Benedikt; Fismen, Anne‐Siri; Weghuber, Daniel; Musić Milanović, Sanja; García‐Solano, Marta; Rutter, Harry; Rakovac, Ivo; Cucu, Alexandra; Brinduse, Lacramioara Aurelia; Rito, Ana Isabel; Kovacs, Viktoria Anna; Heinen, Mirjam M.; Nurk, Eha; Mäki, Päivi; Abdrakhmanova, Shynar; Rakhmatulleoeva, Sanavbar; Duleva, Vesselka; Farrugia Sant'Angelo, Victoria; Fijałkowska, Anna; Gualtieri, Andrea; Sacchini, Elena; Hassapidou, Maria; Hyska, Jolanda; Kelleher, Cecily C.; Kujundžić, Enisa; Kunešová, Marie; Markidou Ioannidou, Eliza; Ostojic, Sergej M.; Peterkova, Valentina; Petrauskienė, Aušra; Popović, Stevo; Pudule, Iveta; Russell Jonsson, Kenisha; Dal‐Re Saavedra, Maria Ángeles; Salanave, Benoît; Shengelia, Lela; Spiroski, Igor; Tanrygulyyeva, Maya; Tichá, Ľubica; Usupova, Zhamilya; Ozcebe, Lütfiye Hilal; Abildina, Akbota; Schindler, Karin; Weber, Martin W.; Filipović Hadžiomeragić, Aida; Melkumova, Marina; Stojisavljević, Dragana; Boymatova, Khadichamo; Williams, Julianne; Breda, JoãoIn 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6–9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.