Abstract
Background. The World Health Organization European Childhood Obesity Surveillance Initiative (COSI) conducted examinations in 6–9-year-old children from 16 countries in the first two rounds of data collection. Allowing participating countries to adhere to their local legal requirements or adapt to other circumstances required developing a flexible protocol for anthropometric procedures. Objectives. (1) Review intercountry variation in types of clothing worn by children during weight and height measurements, clothes weight adjustments applied, timing of the survey, and duration of data collection; (2) assess the impact of the observed variation in these practices on the children’s weight or body mass index (BMI) outcome measures. Results. The relative difference between countries’ unadjusted and clothes-adjusted prevalence estimates for overweight was 0.3–11.5%; this figure was 1.4–33.3% for BMI-for-age Z-score values. Monthly fluctuations in mean BMI-for-age Z-score values did not show a systematic seasonal effect. The majority of the monthly BMI-for-age Z-score values did not differ statistically within a country; only 1–3 monthly values were statistically different within some countries. Conclusions. The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and thus do not necessitate a revision of the COSI protocol.
Highlights
In 2013, 42 million children under five years old were overweight or obese, and, in 2014, more than 1.9 billion adults aged 18 years and older were overweight or obese, according to the World Health Organization’s (WHO) global estimates [1]
The WHO European Childhood Obesity Surveillance Initiative (COSI) was established in 2006 with the aim to set up a harmonized surveillance system across the WHO European Region in order to monitor the progress of the obesity epidemic and to make intercountry comparisons within the Region [5]
If the results suggest a possible impact that could not be corrected in the data analyses, we would need to revise the protocol in order to minimize intercountry variations in future COSI rounds
Summary
In 2013, 42 million children under five years old were overweight or obese, and, in 2014, more than 1.9 billion adults aged 18 years and older were overweight or obese, according to the World Health Organization’s (WHO) global estimates [1]. In order to monitor the magnitude of this public health problem at the population level and to interpret and compare prevalence estimates of overweight and obesity across countries in a meaningful way, valid anthropometric measurements, such as body weight and height, are crucial [3]. The system includes weight and height measurements of primary-school children aged 6–9 years whereby each participating country ensures that data are collected according to the common COSI protocol [6, 7]. To enable countries to adhere to the protocol according to country-specific legal and ethical requirements (e.g., those that prohibit the collection of entire birth dates of children or those that require active written parental consent) or to adapt to other local circumstances (e.g., schools that do not provide education in the morning), some intercountry variation in data collection procedures has been permitted. The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and do not necessitate a revision of the COSI protocol
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