BackgroundThe 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.MethodsUsing 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.ResultsAt 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.ConclusionsChanges 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-806) contains supplementary material, which is available to authorized users.

Food reformulation: Reformulation of foods is considered one of the key options to achieve population nutrient goals. The compositions of many foods are modified to assist the consumer bring his or her daily diet more in line with dietary recommendations. Initiatives on food reformulation: Over the past few years the number of reformulated foods introduced on the European market has increased enormously and it is expected that this trend will continue for the coming years. Limits to food reformulation: Limitations to food reformulation in terms of choice of foods appropriate for reformulation and level of feasible reformulation relate mainly to consumer acceptance, safety aspects, technological challenges and food legislation. Impact on key nutrient intake and health: The potential impact of reformulated foods on key nutrient intake and health is obvious. Evaluation of the actual impact requires not only regular food consumption surveys, but also regular updates of the food composition table including the compositions of newly launched reformulated foods. Keywords Food reformulation Key nutrients Health impactIn 2003 a Joint WHO/FAO Expert Consultation (1) provided population goals for nutrients consistent with the prevention of major public health problems in Europe. These goals include a reduction of total dietary fat, in particular of saturated fat, a reduction in trans fatty acids, an increase in PUFA, a reduction in sugar consumption and a reduction in salt intake. Reformulation of commonly eaten foods was considered one of the key options to achieve these goals (2) . Leading companies report to have recently reformulated at least 50 % of their products and claim to have put more than 4000 new or reformulated products on the market over the past 3 years (3) . There are also impressive ongoing national campaigns on food reformulation such as the campaigns on salt reduction by governmental agencies in England, Ireland, France and Finland.Whether the consumer will indeed choose for reformulated foods and a lower salt consumption remains to be seen. Only when actual consumption figures are known can the relevance of reformulated foods with respect to dietary goals and health impact be indicated.The present paper starts with a description of developments in dietary recommendations and the concept and definition of food reformulation. Subsequently, important current initiatives on food reformulation are presented, main limitations in terms of choice of appropriate foods for reformulation and level of feasible reformulation are clarified, and the potential impact of reformulated foods on key nutrient intake and health is discussed. Developments in dietary recommendationsIn the second half of the 20th century, political and socioeconomic developments in Europe resulted in a more secure and abundant food supply than ever before and life expectancy increased steadily. However, at the same time a huge increase in several chronic diseases was observed, and it was recognized that these chronic diseases could be ...

BackgroundThe 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/m2 (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.ConclusionsThe school-based integrated obesity intervention program was cost-effectiveness for children in urban China.Trial RegistrationChinese Clinical Trial Registry ChiCTR-PRC-09000402 URL:http://www.chictr.org/cn/

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%−95% of schools) and school nutrition environment scores (range: 0.30−0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20−1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the “unhealthy” school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

The study aimed to: (a) determine perceptions regarding fruits and vegetables (b) identify selected practices on fruit and vegetables consumption (c) assess consumption of fruit and vegetables in terms of serving and grams per day and (d) identify factors affecting fruit and vegetable consumption. The study was conducted in seven randomly selected public schools and three public colleges in the City of Manila. Two hundred randomly selected students aged 12-16 years and 17-20 years were personally interviewed using a structured questionnaire. A food frequency questionnaire was used to determine the past month's fruit and vegetable consumption. Data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics, like frequencies, means and percentages, ANOVA, T-test and simple correlation were used. Results showed that inadequate consumption of vegetables was prevalent among the study populations but fruit intake was higher than the Philippine recommendation. Fruit and vegetable intakes varied with age and sex. Male adolescents consumed more vegetables compared to their female counterparts. Female adolescents consumed more fruits than their male counterparts. Generally, the adolescents had a good perception of fruits and vegetables. The study concluded that Filipino adolescents are consuming substantially fewer servings of vegetables than the recommended daily allowances but fruit intake was higher than the recommended. The study advanced recommendations useful for promoting fruit and vegetable consumption among adolescents and for future studies focused on nutritional behaviour change related to fruit and vegetable consumption among adolescent.