Table of Contents
Epidemiology Research International
Volume 2016, Article ID 5130317, 16 pages
Research Article

WHO European Childhood Obesity Surveillance Initiative: Impact of Type of Clothing Worn during Anthropometric Measurements and Timing of the Survey on Weight and Body Mass Index Outcome Measures in 6–9-Year-Old Children

1Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
2Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, Netherlands
3Division of Human Nutrition, Wageningen University, P.O. Box 17, 6700 AA Wageningen, Netherlands
4National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
5School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, 712 02 Grythyttan, Sweden
6Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 300, 405 30 Gothenburg, Sweden
7Department of Physiology and Monitoring of Nutrition, Institute of Public Health, 50. Divizija 6, 1000 Skopje, Macedonia
8Primary Child Health, Floriana Health Centre, Triq Francesco Saverio Fenech, Floriana, Malta
9Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Alcala 56, 28071 Madrid, Spain
10National Institute of Pharmacy and Nutrition, Albert Flórián Street 3/a., Budapest 1097, Hungary
11National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin 4, Ireland
12Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694 Prague 1, Czech Republic
13Instituto Nacional de Saúde Dr. Ricardo Jorge, IP, Avenida Padre Cruz, 1649-016 Lisbon, Portugal
14Department of Health Statistics, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway
15Faculty of Sport, University of Ljubljana, Gortanova 22, SI-1000 Ljubljana, Slovenia
16Department of Food and Nutrition, National Center of Public Health and Analyses, 15 Akademik Ivan Evstatiev Geshov Boulevard, 1431 Sofia, Bulgaria
17Centre for Disease Prevention and Control, 22 Duntes Street, LV-1005 Riga, Latvia
18Department of Preventive Medicine, Lithuanian University of Health Sciences, Eiveniu Street 4, LT-50009 Kaunas, Lithuania
19Flemish Agency for Care and Health, Flemish Ministry of Welfare, Public Health and Family, Koning Albert II-Laan 35, P.O. Box 33, 1030 Brussels, Belgium
20Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, P.O. Box 14561, 54101 Thessaloniki, Greece

Received 14 August 2015; Accepted 24 December 2015

Academic Editor: How-Ran Guo

Copyright © 2016 World Health Organization. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should be no suggestion that WHO endorses any specific organization or products. The use of the WHO logo is not permitted.


Background. The World Health Organization European Childhood Obesity Surveillance Initiative (COSI) conducted examinations in 6–9-year-old children from 16 countries in the first two rounds of data collection. Allowing participating countries to adhere to their local legal requirements or adapt to other circumstances required developing a flexible protocol for anthropometric procedures. Objectives. (1) Review intercountry variation in types of clothing worn by children during weight and height measurements, clothes weight adjustments applied, timing of the survey, and duration of data collection; (2) assess the impact of the observed variation in these practices on the children’s weight or body mass index (BMI) outcome measures. Results. The relative difference between countries’ unadjusted and clothes-adjusted prevalence estimates for overweight was 0.3–11.5%; this figure was 1.4–33.3% for BMI-for-age Z-score values. Monthly fluctuations in mean BMI-for-age Z-score values did not show a systematic seasonal effect. The majority of the monthly BMI-for-age Z-score values did not differ statistically within a country; only 1–3 monthly values were statistically different within some countries. Conclusions. The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and thus do not necessitate a revision of the COSI protocol.