Is socioeconomic status a risk factor for children´s overweight and obesity? - Mun-SI Portugal, A Community Based Program

MUN-Si (www.mun-si.com) is an on-going Portuguese community-based program at local level which aims to promote lifestyles changes in the long-term particularly to children and families that do not have adequate resources. The objective of this study was to address the association between socioeconomic (SE) indicators and children´s nutritional status (NS) of the two rounds of the MUN-SI NS surveys (2009 and 2011). A total of 2726 children (round 1 (R1) = 1126; round 2 (R2)= 1600) aged between 6-12 years old were evaluated from 5 municipalities. Childhood overweight and obesity prevalence was assessed according to WHO criteria. Low SE status was defined according to 3 criteria: family income, parents occupation and education level. These SE characteristics were obtained by a self response questionnaire. In R1 (2009), the prevalence of overweight was 39.4% (n = 444), of which 15.8% (n = 178) were obese. In the second round (2011) similar prevalence were obtained (40.8% of overweight, in which 16.9% obese). In both rounds, 69% of the families had a low income (45%) unqualified or semi-qualified. In R1, a family income of 0-1500 € was associated with higher obesity prevalence (OR = 2,37; IC95%: 1,11-5,02). In R2, no significant association between obesity prevalence and low family income (p=0.494) was observed. Families where the parents had a non-qualified or semi-qualified occupation had a higher probability (mother - OR ≥ 3.4; father - OR ≥ 2.7) to have children with obesity. Low education level of the parents was also proved to be associated with higher childhood obesity prevalence. This study observed that low SE status is an important risk factor to development of childhood obesity in Portuguese population. These results support that further intervention is needed on low socioeconomic families

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.

BACKGROUND: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. METHODS: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. RESULTS: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. CONCLUSIONS: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation

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

Background: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Methods: Using cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. Results: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. Conclusions: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation

WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren

Objective: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. Design: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children’s behavioural data were reported by their parents and children’s weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed. Setting: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic. Subjects: Nationally representative samples of 6–9-year-olds (n 15 643). Results: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating ‘foods like pizza, French fries, hamburgers, sausages or meat pies’ >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity. Conclusions: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity

Социоекономските разлики помеѓу семејствата на деца со зголемена телесна тежина и дебелина во Северна Македонија

Globally, the prevalence of overweight and obesity is increasing among children and adolescents. Halting the rise in obesity is a significant challenge because of the complex interplay of factors and influences. We aimed to explore the role of family socioeconomic status (SES) indicators in relation to overweight and obesity prevalence rates among primary school children in North Macedonia. Materials and methods: Data were collected on a nationally representative sample of children and their parent(s)/caregiver(s) participating in the 6th round of World Health Organization (WHO)-European Childhood Obesity Surveillance Initiative (COSI) in North Macedonia. Every child had their height and weight objectively measured and their family sociodemographic and SES data were obtained through a self-reported record form by their parent(s)/caregiver(s). According to COSI reporting, responses on three SES indicators (parental educational attainment, parental employment status and family-perceived wealth) were categorized in levels for data analysis. Overweight and obesity rates were estimated based on 2007 WHO growth references. Pearson’s χ2-tests, corrected with the Rao-Scott method, were used to test differences in overweight and obesity across various subgroups. Results: The sample consisted of primarily native-born children (97.3%) and parents (mothers - 96.2%; fathers - 97.6%), living in urban areas (66.9%), in two-parent families (84.9%) and spoke Macedonian at home (59.8%). The majority of children lived in families with low to medium SES level. Prevalence of overweight was 30.5% [95% CI: 28.5-32.7], whilst of obesity 14.1% [95% CI: 12.3-16.0]. There were no significant differences observed across family SES indicators in overweight or obesity rates.  Conclusion: Our findings contribute towards reporting on family SES among children living with overweight and obesity to better understand and address potential obesity risk factors. Future research should focus on exploring family SES within the long-term context of children’s health-related behaviours.На глобално ниво, стапката на преваленција од зголемена телесна тежина и дебелина кај деца и адолесценти се зголемува. Запирањето на порастот на дебелината е значаен предизвик поради комплексната интеракција на многу фактори и влијанија. Цел на студијата беше да се истражи улогата на социоекономскиот статус (СЕС) на семејството во однос на преваленцијата на зголемена телесна тежина и дебелина кај децата, ученици во основните училишта во Северна Македонија.  Материјали и методи: Податоците беа собрани на национално репрезентативен примерок на деца и нивните родител(и)/старател(и), учесници во 6-от круг на СЗО - Европската иницијатива за следење на дебелината (COSI) во Северна Македонија. Телесната висина и тежина на секое дете беше објективно измерена, а социодемографските и СЕС податоци беа добиени од прашалникот за семејство пополнет од страна на нивните родител(и)/старател(и). Според претходни COSI публикации, одговорите за трите СЕС индикатори (степен на образование, работен статус и перцепции за економската благосостојба) беа категоризирани во нивоа за анализа на податоците. Стапките на зголемена телесна тежина и дебелина беа пресметани врз основа на СЗО референците за раст од 2007 година. Pearson-ов χ2-тест, коригиран со Rao-Scott методот, беа употребени за тестирање на разликите во стапките на зголемена телесна тежина и дебелина помеѓу различните подгрупи. Резултати: Примерокот за анализа се состоеше примарно од деца (97,3%) и родители мајка - 96,2%; татко - 97,6%) кои се родени во Македонија, живеат во урбани средини (66,9%), како двородителски семејства (84,9%), и зборуваат дома на македонски јазик (59,8%). Поголемиот број деца живееја во семејства со низок до среден социоекономски статус. Преваленцијата на зголемена телесна телесна тежина беше 30,5% [95% CI: 28.5-32.7], додека на дебелина 14,1% [95% CI: 12.3-16.0]. Не беа забележани значајни разлики помеѓу индикаторите на семејниот СЕС и превалентноста на зголемена телесна тежина и дебелина.  Заклучок: Нашите резултати придонесуваат кон евидентирање на социоекономскиот статус на семејството кај децата кои живеат со зголемена телесна тежина и дебелина со подобро разбирање и адресирање на потенцијалните ризик-фактори на дебелина. Идните истражувања треба да се фокусираат кон анализирање на семејниот СЕС во долгорочен контекст на поврзаноста со однесувањата поврзани со здравјето кај децата

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

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, andaccurate data on children's weight status—through standardized measurement ofbodyweight and height—in the WHO European Region. Additional data on dietaryintake, physical activity, sedentary behavior, family background, and schoolenvironments are collected in several countries. In total, 45 countries in the EuropeanRegion have participated in COSI. The first five data collection rounds, between 2007and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI,data are collected according to a common protocol, using standardized instrumentsand procedures. The systematic collection and analysis of these data enables inter-country 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 poten-tial risk or protective factors and improves the understanding of the development ofoverweight and obesity in European primary-school children in order to supportappropriate and effective policy responses.The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in countries was made possible through funding from the following: Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health. Austria: Federal Ministry of Labor, Social Affairs, Health and Consumer Protection of Austria. Bulgaria: Ministry of Health, National Center of Public Health and Analyses, and WHO Regional Office for Europe. Bosnia and Herzegovina: WHO country office support for training and data management. Croatia: Ministry of Health, Croatian Institute of Public Health, and WHO Regional Office for Europe. Czechia: Ministry of Health of the Czech Republic, grant number 17-31670A and MZCR—RVO EU 00023761. Denmark: Danish Ministry of Health. Estonia: Ministry of Social Affairs, Ministry of Education and Research (IUT 42-2), WHO Country Office, and National Institute for Health Development. Finland: Finnish Institute for Health and Welfare. France: Santé publique France (the French Agency for Public Health). Georgia: WHO. Greece: International Hellenic University and Hellenic Medical Association for Obesity. Hungary: WHO Country Office for Hungary. Ireland: Health Service Executive. Italy: Ministry of Health. Kazakhstan: Ministry of Health of the Republic of Kazakhstan, WHO, and UNICEF. Kyrgyzstan: World Health Organization. Latvia: Ministry of Health and Centre for Disease Prevention and Control. Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. Malta: Ministry of Health. Montenegro: WHO and Institute of Public Health of Montenegro. North Macedonia: Government of North Macedonia through National Annual Program of Public Health and implemented by the Institute of Public Health and Centers of Public Health; WHO country office provides support for training and data management. Norway: the Norwegian Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Institute of Public Health. Poland: National Health Programme, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates, and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). Romania: Ministry of Health. Russian Federation: WHO. San Marino: Health Ministry, Educational Ministry, and Social Security Institute and Health Authority. Serbia: WHO and the WHO Country Office (2015-540940 and 2018/873491-0). Slovakia: Biennial Collaborative Agreement between WHO Regional Office for Europe and Ministry of Health SR. Slovenia: Ministry of Education, Science and Sport of the Republic of Slovenia within the SLOfit surveillance system. Spain: Spanish Agency for Food Safety and Nutrition. Sweden: Public Health Agency of Sweden. Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection. Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry of Health and World Bank.info:eu-repo/semantics/publishedVersio

Dietary Habits and Nutritional Status of Youths Living in Rural and Semi-Urban Albania in the Ongoing Nutrition Transition: Preliminary Results

Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study was conducted on a convenience sample of students (10–18 years) attending secondary schools in rural and semi-urban areas (October–November 2024). Information collected included sociodemographic data, anthropometric measurements (weight, height), and adherence to the Mediterranean Diet (MD) (KIDMED). Factors influencing dietary patterns were investigated, with a multivariate logistic regression performed to identify key drivers for poor MD adherence (AOR 95% CI). Results: In total, 426 children (47.2% females) were interviewed. Over 20% of the sample was overweight or obese, with the prevalence of these diseases decreasing with age regardless of gender. The KIDMED score highlighted suboptimal MD adherence (4.6 ± 2.5 SD), with significant differences between females and males (4.1 ± 2.4 SD vs. 5.1 ± 2.4 SD, p &lt; 0.001), especially in rural areas (3.9 ± 2.4 SD vs. 4.9 ± 2.5 SD, p = 0.003). Dietary quality tended to decline with age. Female gender was the strongest predictor of poor MD adherence (AOR 2.08 CI: 1.34–3.22; p = 0.001). Conclusions: The MD is a cornerstone for ensuring the Albanian population’s long-term health and well-being. This study holds significant public health relevance in a country with high mortality rates due to cardiovascular diseases. Future nutrition interventions focused on the poor MD adherence of new generations should take into consideration geographic, cultural, and social dimensions, including gender equality