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Childhood Obesity Surveillance Initiative
COSIFACTSHEET
Childhood Obesity Surveillance Initiative
HIGHLIGHTS 2015-17
COSI
© WHO 2016
CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
The COSI system is simple to implement and does not consume many resources. The COSI protocol and manual of procedures allow each participating country to develop a system that fits its local circumstances. Each country is responsible for national data collection and analysis - an institute in each country is in charge of overall national coordination and management. The methodology is standardized, allowing comparisons between
countries and over time. Data are analysed both at national level and by the surveillance initiative team at WHO/Europe, which conducts common cross-country analyses of the pooled dataset. The data management process is completed in collaboration with in-country teams and the information is disseminated through reports and scientific publications.
Childhood Obesity Surveillance Initiative About COSIThe WHO European Childhood Obesity Surveillance Initiative (or COSI) is a unique system that for over 10 years has measured trends in overweight and obesity among primary school aged children. COSI involves taking standardized weight and height measurements from over 300 000 children across the WHO European Region every three years. This provides nationally representative data for participating
countries, as well as a large Region-wide data set for analysis of the determinants of childhood overweight and obesity. This vital collaboration between the World Health Organisation and research institutions from across Europe provides high-quality data that is needed to inform policy and practice in response to the problem of childhood overweight and obesity.
Round 1 2007/08 Round 2 2009/10 Round 3 2012/13 Round 4 2015/16 For Russian Federation only Moscow
A Growing Initiative
The study approach
© WHO 2016
COSI CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
a Based on the 2007 WHO recommended growth reference for school-age children and adolescents (de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 2007; 85(9): 660-667). Children with a BMI/A Z-score < -5 or > +5 are excluded.
Figures refer to children belonging to the following age groups: 7-year-olds: Bulgaria (BUL); Czechia (CZH); Denmark (DEN); Estonia (EST); Finland (FIN); Georgia (GEO); Greece (GRE); Hungary (HUN); Ireland (IRE); Lithuania (LTU); Latvia (LVT); Malta (MAT); The former Yugoslav Republic of Macedonia (MKD); Montenegro (MNE); Moscow city (RUS); Portugal (POR); Spain (SPA); Serbia (SRB); Slovakia (SVK); Slovenia (SVN); Tajikistan (TJK); Turkmenistan (TKM); Turkey (TUR) – 8-year-olds: Albania (ALB); Austria (AUT); Croatia (CRO); France (FRA); Italy (ITA); Norway (NOR); Poland (POL); Romania (ROM); San Marino (SMR); Sweden (SWE) – 9-year-olds: Cyprus (CYP); Kazakhstan (KAZ).
b CZH, IRE, ITA, LTU, LVA, NOR, POR, SVN participated in all rounds; BUL in rounds 1, 3 and 4; BEL in rounds 1, 2, 3; GRE and SPA in rounds 2, 3, 4. Comparisons over time refer to the following age groups: 7-year-olds in BEL, BUL, CZH, GRE, IRE, LTU, LVT, POR, SPA, SVN – 8-year-olds: ITA, NOR.
c Above-mentioned differences are not statistically significant in BUL, LTU, LVA, IRE, SPA.
Overweight & Obesity 2016/17Overweight and obesity among children aged 6-9 yearsObesity in children remains an important public health problem in the WHO European Region and it is unequally distributed within and between countries and population groups.
Childhood obesity is a multifactorial disease associated with a wide range of serious health and social consequences including a higher risk of premature death and disability in adulthood.
5 6 11 6 10 19 5 8 9 6 7 14 11 5 14 6 8 6 15 13 9 5 10 11 9 6 9 17 8 10 8 7 1 2 9
16
22
29
19
28
43
2023
2723 22
38
28
20
38
2023
21
35
29 29
22
2932
2622
32
41
29
23 24
28
5
11
25
ALB
AUT
BUL
CZH
CRO
CYP
DEN ES
T
FIN
FRA
GEO GRE
HU
N
IRE
ITA
KA
Z
LTU
LVA
MAT
MKD
MN
E
NO
R
POL
POR
ROM
RUS
SMR
SPA
SRB
SVK
SVN
SWE
TJK
TKM
TUR
11 12 16 10 16 21 5 11 11 9 10 20 14 9 21 5 12 9 18 16 19 7 14 12 15 10 19 19 17 12 10 10 2 4 13
23
30 30
23
37
43
18
29 28
2526
42
28 27
42
17
28
25
37
31
37
24
3229
3127
3942
36
30
2427
911
27
ALB
AUT
BUL
CZH
CRO
CYP
DEN ES
T
FIN
FRA
GEO GRE
HU
N
IRE
ITA
KA
Z
LTU
LVA
MAT
MKD
MN
E
NO
R
POL
POR
ROM
RUS
SMR
SPA
SRB
SVK
SVN
SWE
TJK
TKM
TUR
Overweight (boys) %
Obesity (boys) %
Overweight (girls) %
Obesity (girls) %
Overweight and obesity prevalence values based on WHO definition a (%) – COSI 2015-2017
Changes over time: 10 years of COSISince COSI started in 2007, 12 countries have participatedin at least 3 rounds of data collection b. A significant decrease in the prevalence of both overweight and obesity was recorded in Greece, Italy, Portugal and Slovenia. A decreasing tendency was also observed in Ireland
and Spain. Belgium, Czechia and Norway have stable prevalences; whereas the picture is less definite in Bulgaria, Latvia and Lithuania. An increasing tendency in obesity was observed among Latvian girls and Bulgarian boys. A similar pattern has been recorded among Lithuanian boys for both overweight and obesity c.
COSI
© WHO 2016
CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
ALBBULCROCZHDENFRAGEO
IREITA
KAZLTULVA
MATMNEPOLPOR
ROMRUSSMRSPATJK
TKM
6-year-olds 7-year-olds 8-year-olds 9-year-olds
Children age by country
75 78 77 79 95 64 93 49 55 73 57 92 84 96 64 93 93 75 90
ALB
BUL
CRO
CZH
DEN
GEO IR
E
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
Every day
Most days (4-6 days)
Some days (1-3 days)
Never
Over a typical or usual week, how often does your child have breakfast?
* Parents’ participation in the survey was high in most of the countries, except in Albania, Denmark and Ireland where it was below 40%. In Lithuania and Montenegro parents of around 2 out of 3 children enrolled in selected classes filled in the family form. In all other countries, the participation rate was higher than 70%, with the highest values recorded in Italy, San Marino and Turkmenistan (above 90%).
Eating habitsEating habits are an important factor in children becoming overweight and obese. COSI collects some information on health-related behaviours to provide the information necessary for policy-makers to design, implement and evaluate the effectiveness of policies and strategies aimed at improving diets. Greater availability and affordability of energy-dense, nutrient-poor foods and drinks has
contributed to an environment that encourages weight gain and in which many children now grow up. Regularly eating breakfast, daily consumption of fruits and vegetables and limited consumption of foods such as savoury snacks, fast foods, processed meat products and sugary soft drinks reduce the risk of becoming overweight or obese.
Lifestyle behaviours
In addition to the physical measurements that are used to calculate levels of overweight and obesity, information on the obesity-related behaviours of study participants is collected through a questionnaire for the parents of study participants.
© WHO 2016
COSI CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
Lifestyle behavioursChildren's Eating Habits
108 8
4
17
8
129
17
9
5
117
13
5 6
15 15
1
27 27
17
52
14
46
54
30
1418
30
23
38
27
35
74
9
43
68
ALB
BUL
CRO
DEN
GEO IR
E
ITA
KA
Z
LTU
LVA
MN
E
POL
POR
ROM
RUS
SMR
SPA
TJK
TKM
Every day
Never or less than once
a week
VEGETABLES
4 5 53
10
6 69 9
6
25
36
2 3
8
21
2
58
35 34
60
24
61
73
33
1923
46
37
63
42
51
81
29
33
70
ALB
BUL
CRO
DEN
GEO IR
E
ITA
KA
Z
LTU
LVA
MN
E
POL
POR
ROM
RUS
SMR
SPA
TJK
TKM
Every day
Never or less than once
a week
FRUITS
Over a typical or usual week, how often does your child consume the following kinds of foods or beverages?
© WHO 2016
COSI CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
Lifestyle behavioursChildren's Eating Habits contd
69
65
39
54
46
88
50
72
62
36
43
60
64
69
84
34 34
1418
29
8
25
1
22
912
3229
15 14 14
4
4442
ALB
BUL
CRO
DEN
GEO IR
E
KA
Z
LTU
LVA
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
More than three days a week
Never or less than once
a week
SOFT DRINKS CONTAINING SUGAR
41
45
50
75
57
49
63
8380
41
77
85
49
91
70
46
54
34
26
12
0.5
17
8
14
3 3
23
42
22
13
2420
ALB
BUL
CRO
DEN
GEO IR
E
KA
Z
LTU
LVA
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
More than three days a week
Never or less than once
a week
SAVOURY SNACKS
Over a typical or usual week, how often does your child consume the following kinds of foods or beverages?
© WHO 2016
COSI CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
Lifestyle behavioursChildren's Physical ActivityPhysical activity patterns are closely linked to the energy imbalances that result in children becoming overweight and obese. The benefits of physical activity, which includes active play, walking, cycling and participation in sports, are important for children’s physical and mental health and habitual physical activity is associated with lower levels of overweight in children. WHO recommends that children carry
out at least 60 minutes of moderate-to-vigorous physical activity a day, but only a small proportion of children currently meet this recommendation. Active transportation, such as walking or cycling, is associated with higher levels of physical activity and cardiovascular fitness but in many countries the proportion of children walking or cycling to or from school has been declining.
ALB
BUL
CRO
CZH
DEN FR
A
GEO
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
61 45 42 44 36 40 48 71 37 34 19 39 39 18 50 66 52 94 80
6 21 25 17 22 9 12 9 21 20 10 24 16 6 18 16 3 3 6
32
34 3238
42
51 40
20
42 46 72 37 4576
3218 44
14
Combination of walking /cycling and motorised
vehicles (%) Motorised vehicles (%) Walking/cycling (%)
Going to and from school on foot or bike
ALB
BUL
CRO
CZH
DEN
GEO IR
E
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
86 90 90 98 74 87 86 68 90 80 66 95 82 81 94 90 73 62 81
98 98 99 99
8796 96 94 98 98
88
9993 97 98 97
82 8492
At least 1 h/day on week days
At least 1 h/day on weekend days
Time spent playing actively/vigorously (e.g. running, jumping outside or moving and fitness games inside)
ALB
BUL
CRO
DEN
GEO
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
60 59 32 17 51 56 39 20 34 52 33 48 64 32 31 84 73
3338
6458
47
38
53
75
5546
5748
31
6661
10
22
At least2 hours a week
Not being a memberof any sport clubs
or dancing courses/ No time spent
Time spent on practicing sports and physical activities with sport clubs or dancing courses
COSI
© WHO 2016
CHILDHOOD OBESITY SURVEILLANCE INITIATIVE
Lifestyle behavioursChildren's Sedentary BehavioursConcerns have been raised that the time children spent watching television or using electronic media (screen time) is displacing unstructured play and resulting in more sedentary time and less physical activity. This has promoted some national authorities to issue guidance for parents
about limiting their children’s screen or sedentary time. Short sleep duration is another energy-related behaviour that is independently associated with weight gain and adiposity in childhood
ALB
BUL
CRO
DEN FR
A
GEO
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SPA
TJK
TKM
39 48 51 49 30 41 25 43 47 43 52 41 22 52 25 33 6022
7983
8691
8077
52
71
85
77 75
8579 80
62 64
85
53
At least2 h/day on week days
At least2 h/day on
weekend days
Outside school lessons, how much time does your child usually spend watching TV or using electronicdevices such as computer, tablet, smartphone or other electronic device, either at home or outside home?
ALB
BUL
CRO
CZH
DEN
GEO IR
E
ITA
KA
Z
LTU
LVA
MAT
MN
E
POL
POR
ROM
RUS
SMR
SPA
TJK
TKM
21 4 9 14 39 17 73 1 20 1 1 8 24 6 10 1 0111114
58
32
47
77
96
58
99
24
45
26 26
54
68
48
72
2629
4242
72
21
9185
9599 100 98 100
8783
9087
94 9693
99
90 9184
9894
86
At least 11 hours/night
At least 10 hours/night
At least 9 hours/night
At what time does your child usually go to bed on school days (weekdays)?& At what time does your child usually wake up on school days (weekdays)?
© World Health Organization 2018
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