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Ramos Salas X, Buoncristiano M, Williams J, Kebbe M, Spinelli A, Nardone P, Rito A, Duleva V, Musić Milanović S, Kunesova M, Braunerová RT, Hejgaard T, Rasmussen M, Shengelia L, Abdrakhmanova S, Abildina A, Usuopva Z, Hyska J, Burazeri G, Petrauskiene A, Pudule I, Sant'Angelo VF, Kujundzic E, Fijałkowska A, Cucu A, Brinduse LA, Peterkova V, Bogova E, Gualtieri A, Solano MG, Gutiérrez-González E, Rakhmatullaeva S, Tanrygulyyeva M, Yardim N, Weghuber D, Mäki P, Russell Jonsson K, Starc G, Juliusson PB, Heinen MM, Kelleher C, Ostojic S, Popovic S, Kovacs VA, Akhmedova D, Farpour-Lambert NJ, Rutter H, Li B, Boymatova K, Rakovac I, Wickramasinghe K, Breda J. Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017. Obes Facts 2021; 14:658-674. [PMID: 34818257 PMCID: PMC8739931 DOI: 10.1159/000517586] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Ximena Ramos Salas
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | - Julianne Williams
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | | | - Ana Rito
- National Institute of Health Dr. Ricardo Jorge I.P., Lisbon, Portugal
| | - Vesselka Duleva
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sanja Musić Milanović
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Marie Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | | | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lela Shengelia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Shynar Abdrakhmanova
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Akbota Abildina
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | | | | | | | - Aušra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Iveta Pudule
- Centre for Disease Prevention and Control, Riga, Latvia
| | | | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Alexandra Cucu
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Lacramioara Aurelia Brinduse
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Valentina Peterkova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | - Elena Bogova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | | | - Marta García Solano
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Enrique Gutiérrez-González
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Sanavbar Rakhmatullaeva
- Department for Organization of Health Services to Children, Mothers, Adolescents and Family Planning, Ministry of Health and Social Protection of the Population, Dushanbe, Tajikistan
| | - Maya Tanrygulyyeva
- Internal Diseases Department of the Scientific Clinical Centre of Mother and Child Health, Ashgabat, Turkmenistan
| | - Nazan Yardim
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Daniel Weghuber
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Päivi Mäki
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | | | | | - Mirjam M. Heinen
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Cecily Kelleher
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sergej Ostojic
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Stevo Popovic
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | - Dilorom Akhmedova
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Harry Rutter
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Bai Li
- Centre for Health Promotion, Bishkek, Kyrgyzstan
| | | | - Ivo Rakovac
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Kremlin Wickramasinghe
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joao Breda
- European Association for the Study of Obesity, Teddington, United Kingdom
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Breda J, McColl K, Buoncristiano M, Williams J, Abdrakhmanova S, Abdurrahmonova Z, Ahrens W, Akhmedova D, Bakacs M, Boer JMA, Boymatova K, Brinduse LA, Cucu A, Duleva V, Endevelt R, Sant'Angelo VF, Fijałkowska A, Hadžiomeragić AF, García-Solano M, Grøholt EK, Gualtieri A, Hassapidou M, Hejgaard T, Hyska J, Kelleher CC, Kujundžić E, Mäki P, Markidou Ioannidou E, Melkumova M, Moyersoen I, Milanović SM, Nurk E, Ostojic SM, Peterkova V, Petrauskienė A, Pudule I, Rito AI, Russell Jonsson K, Rutter H, Salanave B, Seyidov N, Shengelia L, Silitrari N, Spinelli A, Spiroski I, Starc G, Stojisavljević D, Tanrygulyyeva M, Tichá Ľ, Usupova Z, Weghuber D, Yardim N, Zamrazilová H, Zbanatskyi V, Branca F, Weber M, Rakovac I. Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI). Obes Rev 2021; 22 Suppl 6:e13215. [PMID: 34738283 DOI: 10.1111/obr.13215] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Karen McColl
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Shynar Abdrakhmanova
- Department of Science and Professional Development, National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan.,Kazakhstan School of Public Health, Kazakhstan's Medical University, Almaty, Kazakhstan
| | - Zulfiya Abdurrahmonova
- Republican Centre for Nutrition, Ministry of Health and Social Protection of Population, Dushanbe, Tajikistan
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Dilorom Akhmedova
- Republic Specialized Scientific Practical Medical Centre for Pediatrics, Tashkent, Uzbekistan
| | - Márta Bakacs
- Department of Nutrition and Epidemiology, National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - Jolanda M A Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Khadichamo Boymatova
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Country Office, Dushanbe, Tajikistan
| | - Lacramioara Aurelia Brinduse
- National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania.,Faculty of Medicine, Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Alexandra Cucu
- National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania.,Faculty of Midwifery and Nursing, Discipline of Public health and Health management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Vesselka Duleva
- Department Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | - Ronit Endevelt
- University of Haifa School of Public Health, Israel.,Ministry of Health, Israel
| | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Aida Filipović Hadžiomeragić
- Department of Hygiene, Health Ecology Service, Institute of Public Health of Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Marta García-Solano
- Spanish Agency for Food Safety and Nutrition, Ministry of Consumer Affairs, Madrid, Spain
| | - Else Karin Grøholt
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Tatjana Hejgaard
- Health Promotion and Inequality, Danish Health Authority, Copenhagen, Denmark
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Cecily C Kelleher
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Enisa Kujundžić
- Center for Health Ecology, Institute of Public Health of Montenegro, Podgorica, Montenegro
| | - Päivi Mäki
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Marina Melkumova
- Institute of Child and Adolescent Health, Arabkir Medical Centre, Yerevan, Armenia
| | - Isabelle Moyersoen
- Department of Epidemiology and Public Health Sciensano, Brussels, Belgium
| | - Sanja Musić Milanović
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eha Nurk
- Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
| | - Sergej M Ostojic
- Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Valentina Peterkova
- Institute of Paediatric Endocrinology, National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Aušra Petrauskienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Ana Isabel Rito
- WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Kenisha Russell Jonsson
- Department of Living Conditions and Lifestyle, Public Health Agency of Sweden, Solna, Sweden
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Benoît Salanave
- Department of Non-Communicable Diseases and Traumatisms, Santé publique France, the French Public Health Agency, Saint Maurice, France.,Nutritional Surveillance and Epidemiology Team (ESEN), University Sorbonne Paris Nord, Bobigny, France
| | - Nabil Seyidov
- Department of Healthy Policy and Planning, Public Health and Reforms Center of Ministry of Health, Baku, Azerbaijan
| | - Lela Shengelia
- Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, SS. Cyril and Methodius University, Skopje, North Macedonia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Dragana Stojisavljević
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.,Public Health Institute of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Maya Tanrygulyyeva
- Internal Diseases Department, Scientific Clinical Centre of Mother and Child Health, Ashgabat, Turkmenistan
| | - Ľubica Tichá
- Children's Hospital National Institute of Children's Diseases, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Zhamilya Usupova
- Republican Center for Health Promotion and Mass Communication, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nazan Yardim
- Public Health General Directorate, Ministry of Health of Turkey, Ankara, Turkey
| | - Hana Zamrazilová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | - Francesco Branca
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Martin Weber
- World Health Organization (WHO) Child and Adolescent Health and Development, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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