Childhood Obesity Surveillance Initiative Research Articles

Disparities in Breastfeeding Patterns Persist Despite Improved Rates: Findings from Irish COSI R6

Abstract Background Breastfeeding is crucial for reducing childhood obesity, recommended exclusively for 6 months by World Health Organisation (WHO). Previous reports have highlighted disparities in breastfeeding patterns between Irish and non-Irish mothers. The Irish Childhood Obesity Surveillance Initiative (COSI) family survey offers insights into breastfeeding rates and patterns in Ireland and their differences between Irish and non-Irish mothers. Aims This study aims to compare the breastfeeding rates in Ireland between COSI Round 6 (R6) and COSI R5, elucidating the differences between Irish and non-Irish mothers. Additionally, it aims to establish the association between breastfeeding pattern and socio-economic factors involved in the Irish households. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on breastfeeding rates and pattern were collected, anonymised, and analysed using SPSS version 29. Results Around 88% of respondents were mothers. The number of children breastfed for at least a month increased in R6 (55.7%) compared to R5 (45.6%). The mean duration of exclusive breastfeeding increased to 5.86 months in R6 from 4.91 months in R5, in line with WHO recommendations. Significant disparities were found in breastfeeding patterns, with higher rates among non-Irish mothers (67.8%) compared to Irish mothers (52.6%) (p < 0.001). Linear regression showed a significant association between breastfeeding duration and maternal birth country. Irish mothers exhibited a negative coefficient (b1=-2.442; 95% CI -4.1 to -0.8; p = 0.004), suggesting shorter breastfeeding durations compared to non-Irish mothers. Conclusions Breastfeeding rates improved in COSI R6 compared to R5. There are significant disparities in breastfeeding pattern between Irish and non-Irish mothers. Key messages • Improved breastfeeding rates indicate good feeding practices in Ireland. • Targeted interventions and policies are necessary to address the disparities between Irish and non-Irish mothers in breastfeeding patterns.

Health disparities continue to report in DEIS schools: Irish COSI Round 6 study

Abstract Background Previous reports have identified clear differences in the prevalence of overweight and obesity among children living with disadvantaged compared to those living in advantaged circumstances. Childhood obesity is influenced by factors in the home environment, including lifestyle behaviours and socio-economic status. The Childhood Obesity Surveillance Initiative (COSI) family survey provides insights into these factors, particularly in children that attend disadvantaged (DEIS) and non-disadvantaged (non-DEIS) schools. Aim This study aims to compare various demographic and socioeconomic factors within the home environment of primary school children across DEIS and non-DEIS schools in Ireland, elucidating the differences in their performance with implications for health policy. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on demographics, diet, transportation, activities, and clinical characteristics of children in Ireland were collected, anonymised and analysed in SPSS, comparing children from DEIS (n = 147) and non-DEIS (n = 1014) schools. Results Around 88% of respondents of returned surveys included in the study (n = 1161) were mothers. Significant disparity in families with diabetes diagnosis or treatment observed between DEIS and non-DEIS schools (10.6% vs. 5.4%, p = 0.016). Breastfeeding rates were higher in non-DEIS schools (57.0% vs. 46.9%, p = 0.015). Children consuming at least 3 portions of fruits and vegetables daily were also higher in non-DEIS schools (58.9% vs. 46.0%, p < 0.001). More children in non-DEIS schools engaged in physical activities outside of school hours (93.7% vs. 74.5%, p < 0.001). Conclusions The findings underscore the significant socioeconomic disparities between families whose children attend DEIS and non-DEIS schools in Ireland. Key messages • Irish COSI R6 reveals disparities in health-related factors between disadvantaged and advantaged schools. • Targeted interventions and policies are necessary to address factors influencing child health.

The impact of the COVID-19 pandemic on physical activity among primary school children in Ireland

Abstract Background The containment measures implemented during COVID-19 to curb the virus’s spread disrupted family life globally and profoundly impacted children’s daily behaviours. A decrease in children’s physical activity during COVID-19 is one such health behaviour change that was observed in many European countries. This study aimed to understand the pandemic’s impact on primary school children’s physical activity in Ireland which is important given the epidemic of childhood obesity and chronic diseases in the long term. Methods All Childhood Obesity Surveillance Initiative (COSI) participating countries (n = 45) could voluntarily implement the COVID study as part of their COSI Round 6 (R6) data collection or separately. The parents of First and Second-class primary school children (n = 2,784) who consented to participate in COSI-Ireland R6 were invited to complete the family survey which included the standardised COVID study. The COVID module assessed children’s lifestyles and health behaviours before and during the pandemic through 12 questions. Consenting parents supplied their email or postal address and completed the survey in hardcopy or electronically using LimeSurvey. Descriptive statistics were then calculated on the cleaned pseudonymised dataset (n = 1,060) using IBM SPSS Statistics 27. Results The time spent playing actively outside school hours remained the same for some children on both weekdays and weekends (24.2% and 37.1%, respectively). An increase rather than a decrease in the time spent in active play was also observed among almost twice as many children across Ireland on both weekdays (47.3% and 24.2% respectively), and weekends (40.10% and 21.80% respectively). Conclusions The positive findings show that the public health messaging from the Irish Government which emphasized the importance of staying active during COVID-19 may have been effective. Further research to assess children’s physical activity during COVID-19 is warranted to inform future pandemics. Key messages • In Ireland, unlike in many European countries, a substantial number of primary school children increased their time spent playing actively during the COVID-19 pandemic. • A unique trend in Irish children’s physical activity levels compared to their European counterparts.

Overweight and obesity prevalence: a pilot implementation of the ‟COSI" methodology in the Republic of Srpska.

Childhood obesity has become a worldwide public health concern over the past decade, counting Bosnia and Herzegovina (BiH). The Childhood Obesity Surveillance Initiative (COSI) was established by the World Health Organization (WHO) to address the lack of standardized surveillance data on childhood obesity. However, BiH and its entity, Republic of Srpska (RS), are failing inclusion in such initiative, which hinders efforts to monitor and address the issue. Henceforth, the objective of this nationally funded study was to gather and analyse data on the prevalence of overweight and obesity among primary-school children in RS by implementing the COSI methodology. Weight, height, and BMI of first, second, and third grade children (aged 6-8), from 11 schools (N = 2,030) in the RS region was analysed according to the standardized COSI protocol. The prevalence rates of overall overweight (OW) and obesity (OB) observed were 14.37% (OW 9.09%, OB 5.21%). No gender-related differences were noted (boys 14.36%, girls 14.88%). These findings highlight a concerning trend of increasing overweight and obesity prevalence with age among primary-school children in the RS.

Assessing Lifestyle Patterns and Their Influence on Weight Status in Students from a High School in Sibiu, Romania: An Adaptation of ISCOLE Questionnaires and the Child Feeding Questionnaire.

The escalation of global obesity is driving research to understand environmental influences on this process, particularly during vulnerable developmental stages such as childhood and adolescence. Efforts include the development of various structured data collection tools. We aimed to adapt a series of previously validated questionnaires from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the Child Feeding Questionnaire, and elements from the World Health Organization Childhood Obesity Surveillance Initiative (COSI) in order to assess local lifestyle patterns among Romanian high school students and their families that may predispose them to obesity. To this goal, an expert committee was formed as part of a research partnership to oversee the questionnaire's translation and adaptation. It consisted of education and school management specialists, clinical research professionals, language experts, and public health experts. The adapted questionnaires were then applied to 114 students enrolled in the 9th and 10th grades attending a high school situated in Sibiu, and their parents. The variables measured were investigated for correlations with overweight and obesity and, as a secondary objective, academic performance. The study revealed several critical findings, including suboptimal sleep durations and physical activity levels among students, a significant amount of screen time, and correlations between weight status and physical activity, sedentary time, and maternal weight status and education levels. The adapted questionnaires proved to be effective tools in capturing the multifaceted factors implicated in adolescent obesity, providing a foundation for targeted interventions and broader public health strategies to address this issue.

STEATOHEPATITIS IN OBESITY CHILDREN

Steatohepatitis is hepatic steatosis with inflammation and, in some cases, hepatocyte balloon degeneration and fibrosis [1]. Steatohepatitis is a form of non-alcoholic fatty liver disease (NAFLD), which includes a wide range of conditions: from non-alcoholic steatosis (NAS) -fat deposition in the liver of more than 5% of the parenchymal mass without signs of damage to hepatocytes to non-alcoholic steatohepatitis (NASH), which progresses with development fibrosis, cirrhosis and, in some patients, hepatocellular carcinoma [1]. The prevalence of steatohepatitis in the pediatric population, according to various sources, varies greatly. Thus, the recommendations of the North American Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (NASPGHAN) indicate that hypertransaminasemia occurs in 29-38% of obese children aged 2-4 years [1]. According to A. Sahota et al. [2], NASH was found in 12% of obese and overweight children. The joint recommendations for the diagnosis, treatment and preventionof obesity in children and adolescents of the Russian Association of Endocrinologists, the Russian Society for the Prevention of Non-Infectious Diseases, and the Association of Pediatric Cardiologists of Russia note that NASH is diagnosed in 12-26% of obese children and adolescents [3]. Obesity and overweight currently affect 25-30% of school-age children [4]. The situation is almost the same for preschool children. The COSI (Childhood Obesity Surveillance Initiative) study, conducted under the WHO programin Moscow in 2017-2018, summing up the dynamics of body weight for the entire preschool period, showed that among children aged 7 years, 27% of boys were overweight and 22% of girls, and obesity -in 10 and 6%, respectively [5]. Another Russian study assessing the physical development of children of middle and school age [6] also demonstrated a significant prevalence of obesity and overweight in this age group in Russian regions. Thus, at 11 years of age, obesity in boys was recorded in 18.6% of cases, ingirls -in 9.2%, and excess body weight -in 15.4 and 14.3%, respectively. At the age of 15, obesity was detected in 10% of cases among boys, in 3.6% of girls, and overweight in 11.5 and 10.5% of cases, respectively [6]. Based on these data, it can be assumed that the incidence of NASH in the pediatric population varies from 0.5 to 3%. It should be noted that the prevalence of obesity, and with it NAFLD, including NASH, is increasing throughout the world due to modern negative trends in the diet and physical activity of children [7].

Changes of anthropometric indicators of lithuanian first-graders in 2008–2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions

IntroductionThe monitoring of children’s growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children’s anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period.MethodsThis study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year.ResultsThe mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008–2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl’s group with obesity aged 8 years according to IOTF cut-offs.ConclusionThe prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children’s growth tendencies.

Impact of COVID-19 pandemic on healthy of children and families in Italy. Qualitative EPaS-ISS study

Abstract Background This study is the qualitative component of a national research carried out in collaboration with the WHO/Europe Childhood Obesity Surveillance Initiative. The aim was to explore the COVID-19 pandemic effects on health behaviours, needs, and psychosocial resources of children and their family in Italy. Methods According to the convergent parallel mixed-method, this qualitative study was carried out simultaneously with the quantitative one. Purposeful sampling was used to recruit parents, teachers, key respondents and children. The data were collected by online focus groups (FG) except the FG with children. FGs transcriptions were analysed through a categorical approach using NVivo. Results Six FGs were conducted between April-May 2022 (65 adults; 14 children). Participants highlight how the pandemic had consequences at multiple levels: individual, family, community and social. At the individual level, data showed how thinning out interpersonal relationships and emotional experiences affected children's psychosocial well-being and learning. As for nutrition, it was observed that food was used as both an emotional comfort (e.g. snack consumption) and an opportunity for family aggregation. The ban on going out and social distancing penalized movement and sport. The lack of physical activity and changes in daily routines also affected sleeping. The screen exposure increased due to distance learning and video calls; parents reported excessive use of video games and a difficulty in limiting screen time. The impact of the closures on foreign children and from deprived backgrounds, including school dropouts, was also an issue. Creative play, care of plants and animals, and activities with the family were some of the resources emerging. Conclusions Qualitative perspective enriches research on changes in children and families’ habits during the pandemic, showing needs and difficulties and suggesting some necessary actions for the health and education systems. Key messages • The COVID-19 pandemic had an impact on children that might persist beyond the pandemic period. • Health and education policies must offer a compensatory response to the children and families’ needs.

School and child participation rates in COSI-Ireland, pre- and post-COVID-19 pandemic

Abstract Background The Childhood Obesity Surveillance Initiative (COSI) is a World Health Organisation (WHO) project established in 2008 to routinely measure trends in overweight and obesity among primary school children in over 40 European countries. This study compares school and child participation rates for COSI-Ireland Round 6 (R6), conducted October 2022 - March 2023, to Round 5 (R5), conducted in 2018, pre-COVID-19. Methods Sentinel schools (n = 187) invited to partake in all previous Irish COSI rounds were again invited by letter and follow-up telephone calls to participate in R6. These schools remain a representative sample of all primary schools in Ireland, including DEIS (Delivering Equality of Opportunity in Schools) schools. Consent was obtained at three levels: school, parent, and child. Parents of children in one randomly selected class of 1st, 2nd, 5th, and 6th classes of each consenting school were invited to participate by letter. Verbal assent was obtained from each child with parental consent before being measured. Results School participation in R6 decreased slightly compared to R5; 65% (n = 121/187) and 73% (n = 135/185), respectively. In total, 79% (n = 33/42) of DEIS schools consented to partake in R6, substantially higher than non-DEIS school participation of 61% (n = 88/145). The R6 DEIS school response rate was also similar to R5 (81%; n = 21/26), despite an increase in the number of DEIS schools following reclassification in 2022. The examination rate of the total cohort in R6 was 55.5% (n = 5,180/9,337), in line with R5 (57.6%). The number of children examined was similar across classes, with slightly more girls (54%) than boys (46%). Conclusions Despite the challenges posed by COVID-19 in conducting this research, COSI-Ireland R6 school participation was well preserved, notably in DEIS schools, demonstrating their commitment to equity in obesity trends. Child examination rates were also remarkably well-maintained relative to the preceding pre-pandemic round. Key messages • COSI-Ireland R6 findings will allow for continued monitoring of obesity in primary school children and inter-European country comparison. • COSI-Ireland R6 findings will inform programme planning and evaluation to address childhood overweight and obesity.

Type of delivery, birthweight, breastfeeding and overweight: the 2019 Italian results

Abstract Introduction According to recent studies, childhood obesity can be affected by type of delivery, birthweight and breastfeeding. The data from the surveillance system OKkio alla SALUTE, coordinated by the Italian National Institute of Health, have been used to investigate this association. OKkio alla SALUTE, promoted by the Italian Ministry of Health, is part of the WHO European Childhood Obesity Surveillance Initiative. Methods The study population are children aged 8 or 9 years in the third grade of all primary schools. A stratified cluster sample design, with class as the sampling unit, was used. Children were weighed and measured by trained local health staff and were classified as overweight or obese using the age and sex-specific International Obesity Task Force cut-offs. Parents of children completed a brief questionnaire to assess risk behavior, including information about the birth and the first few months of life of their child. Results In 2019, the sixth round of data collection involved 47,219 children and 50,370 parents with a response rate higher than 94%. 20.4% (95% CI 19.9-20.9) of 8-9 years old children were overweight and 9.4% (95% CI 9.0-9.7) were obese. The prevalence of obesity has decreased steadily since 2008 to 2019. The prevalence of overweight and obesity was higher for children born by caesarean section (33% vs 27% by vaginal childbirth), increased with birthweight (for birthweight >4,000 kg: 39.4% vs for birthweight<2,500 kg: 25.1%) and among children who had been breastfed never or less than 1 month (33.6% vs breastfeeding 6 months and above: 28.9%). Logistic regression analysis confirms the association between characteristics at birth/breastfeeding and overweight/ obesity. Conclusions Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. Although these results may be affected by recall bias, this is unlikely to materially affect the results. Key messages • Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. • Information on breastfeeding and other characteristics at birth that might be associated with overweight and obesity is essential for tracking progress in countries.

Does Physical Activity Moderate the Relationship between Myopia and Functional Status in Children 9-11 Years of Age?

Although previous studies have reported an association between physical activity (PA) and myopia in school-aged children, little is known about the link between myopia and children’s functional status. The purpose of this study was to investigate dynamic balance control in relation to the daily PA levels of myopic schoolchildren aged 9–11 years (n = 52) versus a non-myopic control group (n = 53). A single leg stance test performed on the instability platform of the Biodex Balance System was used to assess balance control. The overall stability index (OSI), anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI) were analyzed. PA levels were calculated using the World Health Organization European Childhood Obesity Surveillance Initiative family record form. Myopes and non-myopes were separated into three subgroups based on PA level (low, moderate and high). Myopia significantly affected OSI (F = 40.46, p < 0.001), APSI (F = 33.93, p < 0.001) and MLSI (F = 49.51, p < 0.001). There were significant differences (p < 0.001) between myopic and non-myopic children with low and moderate levels of PA, whilst there were no differences between compared children with high levels of PA. High PA levels had a positive impact on balance control in myopes. Our results showed that PA levels moderate the relationship between myopia and children’s functional status.

S02-1 Physical activity and sedentary behaviour of children aged 6-9 in Europe: an analysis within the Childhood Obesity Surveillance Initiative (COSI)

BackgroundChildren are becoming less physically active for a variety of interrelated reasons. The availability of opportunities for safe active playgrounds, recreational activities and active transport has decreased, while time spend on sedentary screen-based activities has increased. This study aimed to evaluate physical activity (PA), sedentary and sleep behaviours of children aged 6-9 years in Europe using data from the WHO Childhood Obesity Surveillance Initiative (COSI).MethodsThe fourth COSI data collection round was conducted in 36 countries from 2015-2018 using a standardized protocol including a family form completed by parents with specific questions about diet and physical activity-related behaviours.ResultsNationally representative data from the 24 countries, who filled in the non-mandatory family record form, were included. Information on PA, screen-time and sleep behaviours of 137,807 children were analysed. Pooled analysis showed that: one in two children walked or cycled to school every day; one in two children were members of a sport or dancing club; around 40 % of children spent at least two hours per day watching TV or using electronic devices; around four in five children were actively or vigorously playing each day; around 88 % of children slept for at least nine hours per night. Country specific analyses showed pronounced differences in prevalence estimates between countries.ConclusionsWhile the severity of the problem varies between countries, physical inactivity and sedentary behaviours are common across the European Region. Policy makers across the Region must do more in order to increase opportunities for young people to participate in daily activities. Furthermore, they should explore solutions to reduce the amount of time spend on sedentary activities, in order to halt the rise in overweight and obesity.

S02 Physical activity surveillance across the life-course: from data to policy

As a major risk factor for non-communicable diseases (NCDs), physical inactivity is a prominent challenge for public health. The purpose of this symposium is to present an overview of physical inactivity prevalence in Europe using data collected through international surveillance initiatives, while highlighting successes and discussing future challenges for utilising data to promote physical activity across the life course.The World Health Organization (WHO) is involved in several physical activity surveillance systems on which discussions during this symposium will be based: 1. The WHO European Childhood Obesity Surveillance Initiative (COSI) is the largest survey of its kind in the world. An overview of results from the most recent round of COSI will be presented focusing on prevalence estimates for physical activity, screen time and sleep. Variations between countries of the socioeconomic determinants of physical inactivity, as well as the impact of the COVID-19 pandemic, will demonstrate the ongoing need for quality data to guide targeted policy actions in support of vulnerable groups throughout the life course.2. The WHO’s STEPwise approach to surveillance (STEPS) survey provides important national level prevalence data on the behavioural and metabolic risk factors for NCDs. For many countries, the STEPS survey has provided the first estimates of physical inactivity and sedentary behaviour in the population and has been essential in raising awareness of the need for national policy actions to increase population levels of physical activity.3. The European Commission, with the support of the WHO Regional Office for Europe, has established the European Union Physical Activity Focal Points Network to monitor implementation of the 23 indicators of the Health-Enhancing Physical Activity (HEPA) monitoring framework on physical activity policy development and implementation.4. Within the European Union Physical Activity Focal Points Network, and during the COVID-19 pandemic, some countries established a survey on physical activity and screen time in children and adolescents.

Clinical-social and psychological-pedagogical approaches in the prevention and treatment of obesity and metabolic syndrome in children

Childhood obesity is an acute problem in the European Region, including countries participating in the World Health Organization's European Childhood Obesity Surveillance Initiative. According to their data, the proportion of overweight children reaches 43%. Overweight and obesity, as well as related diseases, are largely preventable. For this reason, the prevention of childhood obesity should be given top priority. Adolescence obesity has reached epidemic proportions worldwide, with the prevalence of complicated obesity increasing at least fourfold over the past 35 years. Most obese adolescents also have excess body fat mass in adulthood, which increases the risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and psychological health. In modern conditions the prevention of the overweight and obesity formation among schoolchildren is not systemic: no attention is paid to the identification of possible risk factors, no unified approaches exist among specialists of various levels to the methodology for preventing the overweight and obesity formation, rational hygienic measures for preventing obesity are not always implemented, the causes of late diagnostics of overweight and obesity among schoolchildren by pediatricians are not fully analyzed, the motivation of children and parents to change their lifestyle in order to fight overweight are not sufficiently studied. The systemic implementation of such preventive measures could help to reduce the number of overweight schoolchildren and improve the health of the child population.

WHO Europe Childhood Obesity Surveillance Initiative: A 15 years study in 45 European countries

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Prevalence of childhood obesity in Greece: Results from WHO Childhood Obesity Surveillance Initiative 2010-2020

1. Wijnhoven TMA, van Raaij JMA, Spinelli A, et al. WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health. 2014;14:806. doi:10.1186/1471-2458-14-806 CrossRef Google Scholar

Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI).

Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI) has resulted in a surveillance system which provides regular, reliable, timely, and accurate data on children's weight status-through standardized measurement of bodyweight and height-in the WHO European Region. Additional data on dietary intake, physical activity, sedentary behavior, family background, and school environments are collected in several countries. In total, 45 countries in the European Region have participated in COSI. The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI, data are collected according to a common protocol, using standardized instruments and procedures. The systematic collection and analysis of these data enables intercountry 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 potential risk or protective factors and improves the understanding of the development of overweight and obesity in European primary-school children in order to support appropriate and effective policy responses.

Parents’ Perception on Childhood Obesity and its Prevention; a Population-Based Observational Study in Jazan, Saudi Arabia with Intention to Develop Self Instructional Module

Globally, Childhood obesity is one of the most serious public health challenges in the 21st century. In 2017, the Commission on Ending Childhood Obesity (ECHO) reported that worldwide obesity increased 10-fold among children and adolescents during the last 40 years. According to World Health Organization (WHO) &amp; Childhood Obesity Surveillance Initiative (COSI) data, childhood obesity rates are highest in the Southern European Countries in the World. Childhood obesity is one of the most important public concerns due to increased incidence with a high morbidity rate. This study was intended to identify the parent's attitude on causes and its prevention of childhood obesity in Jazan province. With the Stratified Random sampling method, 100 obese children's parents were selected. Initially, personal information was obtained about a child and mother, and then "Google Form" 5-point Likert's scale was administered to assess parents' attitude on obesity and its prevention. It has four domains (General information on obesity - 2 questions, causes of obesity - 14, consequences of obesity - 4, and prevention of obesity - 10) with 30 questions. The results of the study are expressed as mean and standard deviation (mean percentage). The parent’s attitude score was expressed in terms of obesity 5.86 ± 1.27 (58.6%), causes 38.75 ± 6.52 (55.36%), consequences 11.65 ± 2.36 (58.25%) and prevention 29 ± 5.15 (58%). The overall mean score and standard deviation were 86.67 ± 13.81 (54.84%). The parents had an average attitude score (64.57%) on the causes and prevention of childhood obesity. There was no association between attitude scores with the demographic variables, except the variable age associated with attitude scores. Obesity prevention requires effective intervention measures. The research study proposed that family education and impulse are essential for treating childhood obesity. Schools play a significant role in promoting healthy eating habits and physical activity.

Waist circumference and waist-to-height ratio in 7-year-old children-WHO Childhood Obesity Surveillance Initiative.

Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p<0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8±7.36cm boys; 60.3±7.48cm girls), North Macedonia (60.4±7.91cm boys; 59.0±8.01cm girls), and Spain (59.7±6.96cm boys; 58.9±6.77cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.

Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress.

To meet the need for regular and reliable data on the prevalence of overweight and obesity among children in Europe, the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established in 2007. The resulting robust surveillance system has improved understanding of the public health challenge 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 on nutrition and physical activity in the region. This paper describes illustrative examples of how COSI data have fed into national and international policy, but the real scope of COSI's impact is likely to be much broader. In some countries, there are signs that policy responses to COSI data have helped halt the rise in childhood obesity. As the countries of the WHO European Region commit to pursuing United Action for Better Health in Europe in WHO's new European Programme of Work, COSI provides an excellent example of such united action in practice. Further collaborative action will be key to tackling this major public health challenge which affects children throughout the region.