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

The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China.

BACKGROUND:The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA) is more cost-effective than the same intensity of single intervention. METHODS:And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its' control group were located in other 5 cities. In nutrition education group, 'nutrition and health classes' were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m(2) (SE 0.09) and 0.01 (SE 0.11) in the combined intervention, respectively, significantly lower than that in its' control group (0.82 ± 0.09 for BMI, 0.10 ± 0.11 for BAZ). No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its' control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and$249.3 for BAZ in combined intervention, respectively. CONCLUSIONS:The school-based integrated obesity intervention program was cost-effectiveness for children in urban China. TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR-PRC-09000402 URL:http://www.chictr.org/cn

Cost-effectiveness ratio (CER) by city in the nutrition & PA combined intervention group.

<p>^a For BMI, BAZ and overweight & obesity prevalence, the ‘effect’ means BMI, BAZ and overweight & obesity prevalence reduction (post intervention vs before intervention) in intervention group compared with that of in the control group, respectively. ^b ALL CER was presented in US dollars. ^c O & B means overweight & obesity. ^d Total’ means the average effect of four intervention centers (Jinan, Guangzhou, Harbin, Shanghai), Chongqing was excluded here because the intervention in this city was not effective (p>0.05). </p

Characteristics of the subjects at baseline by group.

<p>^a^b: Percentage shared the different letter means significant difference at baseline among groups in Beijing, p<0.05. ^* Significant difference (p<0.05) between control and Nutrition & PA intervention group. ^c statistical analysis and compare between intervention group with it’s control group. No superscript means no significant difference among groups.</p

The costs of development and evaluation of the program (RMB (US dollars)^<b>*</b>).

*<p>US dollars was calculated by Jan, 2010 exchange rate (6.8).</p

Anthropometric characteristics and obesity prevalence at baseline, after intervention and changes in different groups<b>^</b>.

<p>^{^} Continuous variables were expressed as mean±standard error.</p><p>^{a, b}: Means shared the different letter means significant difference at baseline among groups in Beijing, p<0.05. </p><p>^{c, d} : Means shared the different letter means significant difference of changes (post-intervention vs. baseline) among groups in Beijing, p<0.05.</p><p>^* Comparison the mean between post-intervention and baseline in each group, p< 0.05.</p><p>^# Comparison means between combined intervention group and control group at baseline as well as for changes (post-intervention vs. baseline), ^# p<0.05; ^## p<0.01.</p><p>^† OR and 95% CI for overweight & obesity prevalence using generalized linear mixed model, no significantly difference of OR between nutrition or PA individual intervention group with their control group, but a borderline difference between combined intervention group with its’ control group (p=0.06). </p