Overweight and obesity in 7- to 9-year-old children from 26 countries: preliminary results of the World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2021-2023

Abstract

Introduction: In 2021–2023, the sixth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 37 countries. Since 2007/08, COSI has provided country-level estimates of overweight and obesity for primary school children aged 6–9 years using measured height and weight, collected by countries using a standard methodology1. Data presented here are the first COSI estimates of overweight and obesity following the COVID-19 pandemic. Methods: Out of 37 COSI countries that participated in the sixth round, 26 have finished the process of data validation and have been included in the analysis: Albania, Austria, Azerbaijan, Bulgaria, Croatia, Cyprus, Denmark, Estonia, Finland, Georgia, Hungary, Israel, Kazakhstan (Almaty city only), Latvia, Lithuania, Luxembourg, Malta, Montenegro, North Macedonia, Portugal, Republic of Moldova, San Marino, Slovakia, Slovenia, Sweden and Uzbekistan. Data from the other 11 countries are undergoing validation and will be available for the conference (Czechia, Germany - Bremen city only, Greece, Ireland, Italy, Kyrgyzstan, Poland, Romania, Spain, Türkiye and Ukraine). For the first time COSI was implemented in the humanitarian setting (Ukraine). Data collectors measured children using the COSI protocol and weight status was calculated using the 2007 WHO-recommended growth reference 1,2,3. Sampling weights were applied.1 Only one targeted age group per country was included in the analysis (i.e. 7-year-olds if they were targeted, otherwise the nearest targeted age group). Results: We included 127651 children (7-9 years old) in the analysis. Preliminary results suggests a high heterogeneity in the region, with values for overweight (incl obesity) ranging from 9.5% in Uzbekistan to 41.9% in Cyprus among children and from 2.8% to 19.7% in the same countries for obesity. Results according to sex showed a similar picture for boys with overweight prevalence ranging from 10.7% in Uzbekistan to 47.9% in Cyprus and from 4.0% to 24.8% in the same countries for obesity. Among girls, values ranged from 8.0% in Uzbekistan to 36.2% in Cyprus for overweight and from 1.8% in Uzbekistan to 15.1% in Malta for obesity. Preliminary results suggests overweight and obesity have increased in some countries since the fifth round. Future analyses will include all countries who collected data. Conclusion: These preliminary results provide the latest information on the burden of childhood overweight and obesity in the WHO European Region. COSI is an important source of information for public health and future work is needed to use the data to inform policy action in countries.