Background: Studies of trends in excess weight among European children over the last few decades rendered somewhat mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, covered narrow age groups, and included only a few European countries. Thus, this study assessed the trends in prevalence of measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology. Methods: We searched the MEDLINE, EMBASE, CINAHL, and Web of Science databases from their inception until May 2018. Moreover, searches in websites from health institutions were conducted to identify studies not published in scientific journals. Overweight and obesity were defined according to the International Obesity Task Force criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimate and its 95% confidence interval (95% CI) whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, we used the DerSimonian and Laird random-effects method. Subgroup analyses by study year, country, or European region were conducted. Results: A total of 107 studies (n=479,031 children aged 2 to 13 years old) with data from 28 countries were included. Overall, the combined prevalence of overweight and obesity in children (aged 2-13 years) decreased from 22·7% (95% CI: 21·3-24·0) during 1999-2006 to 18·1% (95% CI: 17·3-18·9) during 2011-2016; however, the prevalence of obesity increased from 4·4% (95% CI: 4·1-4·7) to 5·5% (95% CI: 5·0-6·0) during the same time period. The combined prevalence of overweight and obesity in Spain and Portugal tended to decrease, from 30·3% (95% CI: 28·3-32·3) to 26·4% (95%CI: 20·4-34·2), but an overall increase was observed in the Mediterranean region (excluding Spain and Portugal) from 22·2% (95% CI: 17·7-27.8) to 28·7% (95% CI: 24·8-33·0). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18·3% (95% CI: 14·0-23·9) to 19.3% (95%CI: 17·7-20·8), and from 15·8% (95% CI: 13·4-18·5) to 15·3% (95% CI: 11·6-20·3), respectively. Sex differences in levels and trends of excess weight were generally small. Conclusions: The prevalence of childhood overweight and obesity is very high, but trends have plateaued in most European countries. There are substantial between country differences in current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome. Funding Statement: MG-M and CA-B are supported by grants from the Ministerio de Educacion, Cultura y Deporte, (FPU15/03847 and FPU13/03137, respectively). IC-R is supported by a grant from the Universidad de Castilla-La Mancha (FPI13/01582). Declaration of Interests: None declared. Ethics Approval Statement: The systematic review and meta-analysis were conducted according to the meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement (Figure 1). We have registered and published this review on the Prospero database (Registration number: CRD42017056924), and its protocol has been published elsewhere.
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