Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

INTRODUCTION: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions. METHODS: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. RESULTS: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries. DISCUSSION/CONCLUSION: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.

Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017.

In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

BACKGROUND: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. OBJECTIVES: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). METHOD: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. RESULTS: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. CONCLUSIONS: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.

Effects of a practice-focused nutrition intervention in Hungarian adolescents.

INTRODUCTION: This work evaluated the impact of a nutrition intervention in school children of 6th and 7th grade and assessed whether changes persisted after the summer break. MATERIALS AND METHODS: Eight classes of Hungarian adolescents (45% boys; 12.6 ± 0.1 years) were randomized into intervention (n = 117) and control (n = 112) groups. The 9-month long intervention included: 1) weekly classroom-based education with strong focus on practical elements such as tasting and meal preparation; 2) five sessions of after-school cooking classes (open to children, parents and grandparents); and 3) online education materials. Anthropometric parameters (weight, height, waist circumference and body fat), aerobic fitness (Cooper test, 20-meter shuttle run test), nutrition knowledge and behaviors (questionnaires) were measured three times at baseline, post-intervention and after the summer holiday. RESULTS: Slight improvement in dietary knowledge and habits from baseline to post-intervention which did not persist after summer. Aerobic fitness increased in the intervention group, while did not change among controls. Anthropometric parameters remained unchanged in the intervention group, but waist circumference increased in controls, particularly in summer. CONCLUSIONS: Findings suggest a positive impact of this intervention. Measures to mitigate unhealthy changes during the summer break are needed.

Prevalence of Severe Obesity among Primary School Children in 21 European Countries.

BACKGROUND: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published. OBJECTIVES: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI. METHOD: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries. RESULTS: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower. CONCLUSIONS: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.

Substantial variation across geographic regions in the obesity prevalence among 6-8 years old Hungarian children (COSI Hungary 2016).

BACKGROUND: There have been previous representative nutritional status surveys conducted in Hungary, but this is the first one that examines overweight and obesity prevalence according to the level of urbanization and in different geographic regions among 6-8-year-old children. We also assessed whether these variations were different by sex. METHODS: This survey was part of the fourth data collection round of World Health Organization (WHO) Childhood Obesity Surveillance Initiative which took place during the academic year 2016/2017. The representative sample was determined by two-stage cluster sampling. A total of 5332 children (48.4% boys; age 7.54 ± 0.64 years) were measured from all seven geographic regions including urban (at least 500 inhabitants per square kilometer; n = 1598), semi-urban (100 to 500 inhabitants per square kilometer; n = 1932) and rural (less than 100 inhabitants per square kilometer; n = 1802) areas. RESULTS: Using the WHO reference, prevalence of overweight and obesity within the whole sample were 14.2, and 12.7%, respectively. According to the International Obesity Task Force (IOTF) reference, rates were 12.6 and 8.6%. Northern Hungary and Southern Transdanubia were the regions with the highest obesity prevalence of 11.0 and 12.0%, while Central Hungary was the one with the lowest obesity rate (6.1%). The prevalence of overweight and obesity tended to be higher in rural areas (13.0 and 9.8%) than in urban areas (11.9 and 7.0%). Concerning differences in sex, girls had higher obesity risk in rural areas (OR = 2.0) but boys did not. Odds ratios were 2.0-3.4 in different regions for obesity compared to Central Hungary, but only among boys. CONCLUSIONS: Overweight and obesity are emerging problems in Hungary. Remarkable differences were observed in the prevalence of obesity by geographic regions. These variations can only be partly explained by geographic characteristics. TRIAL REGISTRATION: Study protocol was approved by the Scientific and Research Ethics Committee of the Medical Research Council ( 61158-2/2016/EKU ).

Weight Status of 7-Year-Old Hungarian Children between 2010 and 2016 Using Different Classifications (COSI Hungary).

AIMS: To describe the prevalence of thinness, overweight, and obesity in Hungarian children (age 7.0-7.9 years) according to different classifications, to assess the progress between 2010 and 2016, and to investigate whether tendencies differ according to gender. METHODS: A national representative sample was generated by two-stage cluster sampling, and a total of 2,651 children (50.9% boys; age 7.49 ± 0.3 years) were measured (weight and height) in October 2016. Population estimates were calculated using the WHO, IOTF, and national cut-offs. RESULTS: Prevalence of thinness (including grade 1 and 2) was 12.6% based on the IOTF criteria and 15.6% based on the WHO definition. 22.5% of children were identified as overweight or obese according to the IOTF classification, compared with 28.4% according to the WHO definition. Between 2010 and 2016, each classification indicated possible stability in overweight and obesity prevalence. In contrast, the prevalence of thinness grade 2 almost doubled in 6 years according to all definitions (p < 0.05). No significant gender difference was observed in the progress. CONCLUSION: Overweight and obesity appeared to be stable over 6 years, but we detected growing thinness rates. Routine collection of high-quality data that are based on standardized and comparable methods is essential to monitor the childhood obesity problem.

[Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat 2014. I. A magyar felnott lakosság tápláltsági állapota.

INTRODUCTION AND AIM: The Hungarian Diet and Nutritional Status Survey examines the obesity prevalence, dietary habits and, since 2014, physical activity in Hungarian adults in every 5 years. METHOD: The survey provides national data representative by age and gender, based on anthropometric measurements and international standards. RESULTS: In 2014, nearly two-thirds of adults were overweight or obese. 28.2% of men and 31.5% of women were obese. Prevalence of morbid obesity were 2.6% and 3.3% in men and women, respectively. Abdominal obesity was more prevalent among women than men (55% vs. 38%), and the rate was increasing with age in both genders. In elderly, 55% of men and almost 80% of women were abdominally obese. CONCLUSION: In conclusion, the prevalence of overweight, obesity, and abdominal obesity is high in Hungarian adults. In order to tackle obesity, we need to obtain representative and measured data, which form the basis of targeted interventions and the assessment of their impact. Orv. Hetil., 2017, 158(14), 533-540.

[Hungarian Diet and Nutritional Status Survey -- the OTAP2009 study. III. Vitamin intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat - OTÁP2009. III. A magyar lakosság vitaminbevitele.

UNLABELLED: For the healthy status the adequate intake of vitamins is essential. AIM AND METHOD: The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. This work presents the vitamins intake. RESULTS: The intake of all water soluble vitamins, vitamin E and D were significantly higher in men than in women. Favourable phenomena were the increased ß-carotene and vitamin C intakes in men and women compared to the earlier data. Intakes of vitamin C, B1-, B2-, B6- and B12, and niacin meet the recommendations. Crucially low intakes of vitamin D and folate were calculated in both genders, particularly in the elders, mainly in case of vitamin D. Imperfect intakes of panthotenic acid and biotin were also observed. CONCLUSIONS: For maintaining the adequate vitamin supply and for prevention of vitamin deficiency, diversified nutrition, information of the population on the basic principles of healthy nutrition and availability of healthy food are essential.

[Hungarian diet and nutritional status survey -- the OTAP2009 study. I. Nutritional status of the Hungarian population]. / Országos Táplálkozás- és Tápláltsági Állapot Vizsgálat - OTÁP2009. I. A magyar lakosság tápláltsági állapota.

UNLABELLED: Obesity is a leading public health problem, but representative data on measured prevalence among Hungarian adults has been missing since the late eighties. AIM AND METHOD: Joining in European Health Interview Survey the aim of the OTAP2009 study was to provide data representative by age and gender on the prevalence of obesity and abdominal obesity among Hungarian adults based on their measured anthropometric data. RESULTS: Participation rate was 35% (n = 1165). Data shows that nearly two-thirds of adults are overweight or obese. 26.2% of men and 30.4% of women are obese. Prevalence of morbid obesity is 3.1% and 2.6% in men and women, respectively. Abdominal obesity is more prevalent among women than men (51.0% vs. 33.2%), and rate is increasing parallel with age in both gender. In elderly, 55% of men and almost 80% of women are abdominally obese. CONCLUSIONS: Besides interventions of population level for tackling obesity, individual preventive measures are indispensable.

[Sport habits and sedentary lifestyle among elementary school children in Obuda, Hungary]. / Sportolási szokások és inaktív életmód óbudai általános iskolások körében.

UNLABELLED: Childhood obesity has become a worldwide epidemic. Declining physical activity is one of the major contributors. AIM: To obtain data on Hungarian primary school students' weight status, sport club participation and sedentary behaviors. METHODS: A cross-sectional survey was distributed to all primary schools (n=18) in Obuda, Budapest. Children (1648 boys, 1654 girls; 11.3+/-2.3 years) completed questionnaires about sedentary behaviors and sport participation. Height, weight and waist circumference were measured. RESULTS: According to the IOTF criteria, 14.5% of the children were overweight and 4.6% were obese. The rate of those children who did not attend any extracurricular sport increased parallel with age in both gender. At the lower end of the range, 15.3% of the 9-year-old boys and 21% of the 10-year old girls did not sport. These numbers increased up to 31.0% in boys and 53.8% in girls by the age of 15 years. Screening time on weekdays and on weekends was 2.2+/-1.9 and 3.6+/-2.6 hours/day, respectively. One third of participants (32.2%) spent >2 h/day in front of a screen on weekdays, whereas 61.8% did on weekends. CONCLUSIONS: The frequency of sedentary behaviors was high among urban Hungarian school children. Health promotion strategies should start in early ages.

Role of waist circumference in predicting the risk of high blood pressure in children.

OBJECTIVE: This paper was designed to evaluate the role of waist circumference (WC) in identification of children with high blood pressure. METHODS: Cross-sectional data on body mass index (BMI), WC and blood pressure (BP) were analyzed in 3 678 children (1 849 boys; 11.3 +/- 2.3 years) who participated in the LEARN study. RESULTS: Prevalence of abdominal obesity (WC >or=90th percentile) in normal weight (n = 2 982), overweight (n = 528) and obese (n = 168) children were 3.7%, 51.7% and 89.9%, respectively. Systolic BP (SBP) was higher in children with abdominal obesity compared with those with normal WC (p < 0.01) both in normal and in overweight BMI categories. Similar results were found for diastolic BP (DBP) in normal weight girls (p = 0.032) and overweight boys (p = 0.04). WC was significantly correlated with SBP and DPB in all BMI categories, even after adjustment for age and BMI. Despite these findings, no significant odds ratio (OR) of prehypertension or hypertension for abdominal obesity was found in the normal weight category. On the contrary, in overweight children, prevalence of prehypertension (OR 1.42 [1.1; 1.8]) and hypertension (OR 1.35 [1.1; 1.7]) was higher among abdominal obese children. Similarly, the prevalence of prehypertension was almost two-times higher among obese children with abdominal obesity (11.8% vs. 22.5%); however, no significant OR was found. CONCLUSIONS: The ability of WC to detect high-risk normal weight children is controversial. The additional measure of WC among overweight children seems to be relevant in identifying those at increased risk of high BP. Further research with a larger sample size is required in the obese group.

School-based exercise program improves fitness, body composition and cardiovascular risk profile in overweight/obese children.

We determined the effect of a school-based exercise training (ET) without dietary intervention, on body composition, fitness and cardiovascular risk in overweight/obese children. Subjects were 51 overweight/obese 6.5- to 12.5-year-old children (23 boys, 28 girls; BMI 25.6+/-4.3 kg/m 2 ), of whom 48 completed the program. Participants were enrolled in a 15-week aerobic training (three 60-minute sessions/week). Working heart rate was between 120-185 beats/minute. Participation rate was 87%. BMI, waist circumference, body composition (bioimpedance), aerobic capacity (treadmill), blood pressure, lipids and insulin sensitivity (HOMA) were assessed. Waist circumference (85.9+/-12.4 vs. 80.9+/-10.2 cm), muscle mass (32.4+/-6.2 vs. 33.7+/-6.1 kg), maximal oxygen consumption (37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute), systolic blood pressure (113.3+/-11.2 vs. 106.7+/-11.6 mmHg) and LDL cholesterol (2.4+/-0.6 vs. 1.9+/-0.6 mM/l) improved significantly. Number of children with abdominal obesity (29 vs. 20), hypertension (10 vs. 5) and elevated triglyceride (18 vs. 14) also declined significantly over time. We concluded that as a result of high attendance and appropriate training program, cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile.