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

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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?

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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