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Figure 1.
PRISMA Flow Diagram
PRISMA Flow Diagram

IOTF indicates International Obesity Task Force

Figure 2.
Pooled Estimate for the Prevalence of Overweight and Obesity in Children Aged 2-13 Years Across European Regions According to International Obesity Task Force Definition Criteria
Pooled Estimate for the Prevalence of Overweight and Obesity in Children Aged 2-13 Years Across European Regions According to International Obesity Task Force Definition Criteria

Pooled estimate and trends are presented for the combined prevalence of overweight and obesity in children aged 2 to 6 years (A) and prevalence of obesity in children aged 2 to 6 years (B). Pooled estimate and trends are presented for the prevalence of overweight and obesity combined in children aged 7 to 13 years (C) and prevalence of obesity in children aged 7 to 13 years (D). NA indicates not available.

Figure 3.
Meta-regression Plot of Prevalence
Meta-regression Plot of Prevalence

Plot shows the prevalence of the combined overweight and obesity of different countries in Europe during 2011 to 2016 according to their gross national income (GNI) per capita based on purchasing power parity (PPP). Dotted lines indicate the confidence interval and solid lines, regression.

Figure 4.
Meta-regression Plot of Trends
Meta-regression Plot of Trends

Plot shows the trends of combined overweight and obesity in different countries of Europe during 1999 to 2016 according to their gross national income (GNI) per capita based on purchasing power parity (PPP). Dotted lines indicate the confidence interval and solid lines, regression.

Table.  
Trends in the Prevalence of Childhood Overweight and Obesity Combined and Obesity Alone for 28 European Countries Using IOTF Definition Criteria
Trends in the Prevalence of Childhood Overweight and Obesity Combined and Obesity Alone for 28 European Countries Using IOTF Definition Criteria4,15,32-132
1.
Ng  M, Fleming  T, Robinson  M,  et al.  Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2014;384(9945):766-781. doi:10.1016/S0140-6736(14)60460-8PubMedGoogle ScholarCrossref
2.
Wang  Y, Lobstein  T.  Worldwide trends in childhood overweight and obesity.  Int J Pediatr Obes. 2006;1(1):11-25. doi:10.1080/17477160600586747PubMedGoogle ScholarCrossref
3.
Abarca-Gómez  L, Abdeen  ZA, Hamid  ZA,  et al; NCD Risk Factor Collaboration (NCD-RisC).  Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.  Lancet. 2017;390(10113):2627-2642. doi:10.1016/S0140-6736(17)32129-3PubMedGoogle ScholarCrossref
4.
Wijnhoven  TM, van Raaij  JM, Spinelli  A,  et al.  WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children.  Pediatr Obes. 2013;8(2):79-97. doi:10.1111/j.2047-6310.2012.00090.xPubMedGoogle ScholarCrossref
5.
Prentice  AM.  The emerging epidemic of obesity in developing countries.  Int J Epidemiol. 2006;35(1):93-99. doi:10.1093/ije/dyi272PubMedGoogle ScholarCrossref
6.
Rokholm  B, Baker  JL, Sørensen  TI.  The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives.  Obes Rev. 2010;11(12):835-846. doi:10.1111/j.1467-789X.2010.00810.xPubMedGoogle ScholarCrossref
7.
Tsiros  MD, Olds  T, Buckley  JD,  et al.  Health-related quality of life in obese children and adolescents.  Int J Obes (Lond). 2009;33(4):387-400. doi:10.1038/ijo.2009.42PubMedGoogle ScholarCrossref
8.
Orsi  CM, Hale  DE, Lynch  JL.  Pediatric obesity epidemiology.  Curr Opin Endocrinol Diabetes Obes. 2011;18(1):14-22. doi:10.1097/MED.0b013e3283423de1PubMedGoogle ScholarCrossref
9.
Simmonds  M, Llewellyn  A, Owen  CG, Woolacott  N.  Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.  Obes Rev. 2016;17(2):95-107. doi:10.1111/obr.12334PubMedGoogle ScholarCrossref
10.
Baker  JL, Olsen  LW, Sørensen  TI.  Childhood body-mass index and the risk of coronary heart disease in adulthood.  N Engl J Med. 2007;357(23):2329-2337. doi:10.1056/NEJMoa072515PubMedGoogle ScholarCrossref
11.
Twig  G, Yaniv  G, Levine  H,  et al.  Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood.  N Engl J Med. 2016;374(25):2430-2440. doi:10.1056/NEJMoa1503840PubMedGoogle ScholarCrossref
12.
WHO.  Consideration of the Evidence on Childhood Obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. Geneva, Switzerland: World Health Organization; 2016.
13.
Park  MH, Falconer  C, Viner  RM, Kinra  S.  The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review.  Obes Rev. 2012;13(11):985-1000. doi:10.1111/j.1467-789X.2012.01015.xPubMedGoogle ScholarCrossref
14.
Quek  YH, Tam  WWS, Zhang  MWB, Ho  RCM.  Exploring the association between childhood and adolescent obesity and depression: a meta-analysis.  Obes Rev. 2017;18(7):742-754. doi:10.1111/obr.12535PubMedGoogle ScholarCrossref
15.
Brug  J, van Stralen  MM, Te Velde  SJ,  et al.  Differences in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-project.  PLoS One. 2012;7(4):e34742. doi:10.1371/journal.pone.0034742PubMedGoogle ScholarCrossref
16.
Yngve  A, De Bourdeaudhuij  I, Wolf  A,  et al.  Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study.  Eur J Public Health. 2008;18(2):126-130. doi:10.1093/eurpub/ckm099PubMedGoogle ScholarCrossref
17.
Martínez  JA, Kearney  JM, Kafatos  A, Paquet  S, Martínez-González  MA.  Variables independently associated with self-reported obesity in the European Union.  Public Health Nutr. 1999;2(1a):125-133. doi:10.1017/S1368980099000178PubMedGoogle ScholarCrossref
18.
Gallus  S, Lugo  A, Murisic  B, Bosetti  C, Boffetta  P, La Vecchia  C.  Overweight and obesity in 16 European countries.  Eur J Nutr. 2015;54(5):679-689. doi:10.1007/s00394-014-0746-4PubMedGoogle ScholarCrossref
19.
Stroup  DF, Berlin  JA, Morton  SC,  et al.  Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.  JAMA. 2000;283(15):2008-2012. doi:10.1001/jama.283.15.2008PubMedGoogle ScholarCrossref
20.
Moher  D, Liberati  A, Tetzlaff  J, Altman  DG; PRISMA Group.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.  J Clin Epidemiol. 2009;62(10):1006-1012. doi:10.1016/j.jclinepi.2009.06.005PubMedGoogle ScholarCrossref
21.
Garrido-Miguel  M, Cavero-Redondo  I, Álvarez-Bueno  C,  et al.  Prevalence and trends of thinness, overweight and obesity among children and adolescents aged 3-18 years across Europe: a protocol for a systematic review and meta-analysis.  BMJ Open. 2017;7(12):e018241. doi:10.1136/bmjopen-2017-018241PubMedGoogle ScholarCrossref
22.
Cole  TJ, Bellizzi  MC, Flegal  KM, Dietz  WH.  Establishing a standard definition for child overweight and obesity worldwide: international survey.  BMJ. 2000;320(7244):1240-1243. doi:10.1136/bmj.320.7244.1240PubMedGoogle ScholarCrossref
23.
Cole  TJ, Lobstein  T.  Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity.  Pediatr Obes. 2012;7(4):284-294. doi:10.1111/j.2047-6310.2012.00064.xPubMedGoogle ScholarCrossref
24.
de Blij  HJ, Muller  PO, Nijman  J.  Geography: Realms, Regions, and Concepts. 16th ed. Hoboken, New Jersey: Wiley; 2013.
25.
Munn  Z, Moola  S, Riitano  D, Lisy  K.  The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence.  Int J Health Policy Manag. 2014;3(3):123-128. doi:10.15171/ijhpm.2014.71PubMedGoogle ScholarCrossref
26.
Armijo-Olivo  S, Stiles  CR, Hagen  NA, Biondo  PD, Cummings  GG.  Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research.  J Eval Clin Pract. 2012;18(1):12-18. doi:10.1111/j.1365-2753.2010.01516.xPubMedGoogle ScholarCrossref
27.
Barendregt  JJ, Doi  SA, Lee  YY, Norman  RE, Vos  T.  Meta-analysis of prevalence.  J Epidemiol Community Health. 2013;67(11):974-978. doi:10.1136/jech-2013-203104PubMedGoogle ScholarCrossref
28.
Leonard  T, Duffy  JC.  A Bayesian fixed effects analysis of the Mantel-Haenszel model applied to meta-analysis.  Stat Med. 2002;21(16):2295-2312. doi:10.1002/sim.1048PubMedGoogle ScholarCrossref
29.
DerSimonian  R, Kacker  R.  Random-effects model for meta-analysis of clinical trials: an update.  Contemp Clin Trials. 2007;28(2):105-114. doi:10.1016/j.cct.2006.04.004PubMedGoogle ScholarCrossref
30.
Higgins  JP, Thompson  SG.  Quantifying heterogeneity in a meta-analysis.  Stat Med. 2002;21(11):1539-1558. doi:10.1002/sim.1186PubMedGoogle ScholarCrossref
31.
Higgins  JP, Altman  DG, Gøtzsche  PC,  et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.  BMJ. 2011;343:d5928. doi:10.1136/bmj.d5928PubMedGoogle ScholarCrossref
32.
Júlíusson  PB, Brannsether  B, Kristiansen  H, Hoppenbrouwers  K, Bjerknes  R, Roelants  M.  Should children with overweight or obesity be excluded from height references?  Arch Dis Child. 2015;100(11):1044-1048. doi:10.1136/archdischild-2015-308537PubMedGoogle ScholarCrossref
33.
Ahrens  W, Pigeot  I, Pohlabeln  H,  et al; IDEFICS consortium.  Prevalence of overweight and obesity in European children below the age of 10.  Int J Obes (Lond). 2014;38(suppl 2):S99-S107. doi:10.1038/ijo.2014.140PubMedGoogle ScholarCrossref
34.
Wijnhoven  TM, van Raaij  JM, Spinelli  A,  et al.  WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.  BMC Public Health. 2014;14:806. doi:10.1186/1471-2458-14-806PubMedGoogle ScholarCrossref
35.
Mladenova  S, Andreenko  E.  Prevalence of underweight, overweight, general and central obesity among 8-15-years old Bulgarian children and adolescents (Smolyan region, 2012-2014).  Nutr Hosp. 2015;31(6):2419-2427. doi:10.3305/nh.2015.31.6.8805PubMedGoogle Scholar
36.
Savva  SC, Kourides  YA, Hadjigeorgiou  C, Tornaritis  MJ.  Overweight and obesity prevalence and trends in children and adolescents in Cyprus 2000-2010.  Obes Res Clin Pract. 2014;8(5):e426-e434. doi:10.1016/j.orcp.2013.11.005PubMedGoogle ScholarCrossref
37.
Savva  SC, Tornaritis  MJ, Chadjigeorgiou  C, Kourides  YA, Siamounki  M, Kafatos  A.  Prevalence of overweight and obesity among 11-year-old children in Cyprus, 1997-2003.  Int J Pediatr Obes. 2008;3(3):186-192. doi:10.1080/17477160701705451PubMedGoogle ScholarCrossref
38.
Savva  SC, Tornaritis  M, Chadjigeorgiou  C,  et al.  Prevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cyprus.  Eur J Clin Nutr. 2005;59(11):1259-1265. doi:10.1038/sj.ejcn.1602237PubMedGoogle ScholarCrossref
39.
Ahrens  W, Siani  A, Adan  R,  et al; I.Family consortium.  Cohort profile: the transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort.  Int J Epidemiol. 2017;46(5):1394-1395j. doi:10.1093/ije/dyw317PubMedGoogle Scholar
40.
Eloranta  AM, Lindi  V, Schwab  U,  et al.  Dietary factors associated with overweight and body adiposity in Finnish children aged 6-8 years: the PANIC Study.  Int J Obes (Lond). 2012;36(7):950-955. doi:10.1038/ijo.2012.89PubMedGoogle ScholarCrossref
41.
Heude  B, Lafay  L, Borys  JM,  et al.  Time trend in height, weight, and obesity prevalence in school children from Northern France, 1992-2000.  Diabetes Metab. 2003;29(3):235-240. doi:10.1016/S1262-3636(07)70032-0PubMedGoogle ScholarCrossref
42.
Salanave  B, Peneau  S, Rolland-Cachera  MF, Hercberg  S, Castetbon  K.  Stabilization of overweight prevalence in French children between 2000 and 2007.  Int J Pediatr Obes. 2009;4(2):66-72. doi:10.1080/17477160902811207PubMedGoogle ScholarCrossref
43.
Carriere  C, Langevin  C, Déti  EK, Barberger-Gateau  P, Maurice  S, Thibault  H.  Stabilization of overweight prevalence and improvement of dietary habits in French children between 2004 and 2008.  Public Health Nutr. 2015;18(10):1883-1889. doi:10.1017/S1368980014002195PubMedGoogle ScholarCrossref
44.
Thibault  H, Contrand  B, Saubusse  E, Baine  M, Maurice-Tison  S.  Risk factors for overweight and obesity in French adolescents: physical activity, sedentary behavior and parental characteristics.  Nutrition. 2010;26(2):192-200. doi:10.1016/j.nut.2009.03.015PubMedGoogle ScholarCrossref
45.
Thibault  H, Carriere  C, Langevin  C, Kossi Déti  E, Barberger-Gateau  P, Maurice  S.  Prevalence and factors associated with overweight and obesity in French primary-school children.  Public Health Nutr. 2013;16(2):193-201. doi:10.1017/S136898001200359XPubMedGoogle ScholarCrossref
46.
Beyerlein  A, Toschke  AM, von Kries  R.  Risk factors for childhood overweight: shift of the mean body mass index and shift of the upper percentiles: results from a cross-sectional study.  Int J Obes (Lond). 2010;34(4):642-648. doi:10.1038/ijo.2009.301PubMedGoogle ScholarCrossref
47.
Blüher  S, Meigen  C, Gausche  R,  et al.  Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008.  Int J Pediatr Obes. 2011;6(2-2):e199-e206. doi:10.3109/17477166.2010.526305PubMedGoogle ScholarCrossref
48.
Landsberg  B, Plachta-Danielzik  S, Lange  D, Johannsen  M, Seiberl  J, Müller  MJ.  Clustering of lifestyle factors and association with overweight in adolescents of the Kiel Obesity Prevention Study.  Public Health Nutr. 2010;13(10a):1708-1715. doi:10.1017/S1368980010002260PubMedGoogle ScholarCrossref
49.
Kromeyer-Hauschild  K, Zellner  K.  Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany.  Eur J Clin Nutr. 2007;61(3):404-411. doi:10.1038/sj.ejcn.1602533PubMedGoogle ScholarCrossref
50.
Boneberger  A, von Kries  R, Milde-Busch  A, Bolte  G, Rochat  MK, Rückinger  S; GME Study Group.  Association between peer relationship problems and childhood overweight/obesity.  Acta Paediatr. 2009;98(12):1950-1955. doi:10.1111/j.1651-2227.2009.01484.xPubMedGoogle ScholarCrossref
51.
Nagel  G, Wabitsch  M, Galm  C,  et al.  Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE).  Eur J Pediatr. 2009;168(10):1259-1267. doi:10.1007/s00431-009-1016-yPubMedGoogle ScholarCrossref
52.
Tokmakidis  SP, Kasambalis  A, Christodoulos  AD.  Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity.  Eur J Pediatr. 2006;165(12):867-874. doi:10.1007/s00431-006-0176-2PubMedGoogle ScholarCrossref
53.
Manios  Y, Angelopoulos  PD, Kourlaba  G,  et al.  Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children.  Int J Pediatr Obes. 2011;6(2):135-141. doi:10.3109/17477161003792572PubMedGoogle ScholarCrossref
54.
Manios  Y, Moschonis  G, Chrousos  GP,  et al.  The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study.  J Hum Nutr Diet. 2013;26(5):470-478. doi:10.1111/jhn.12025PubMedGoogle ScholarCrossref
55.
Farajian  P, Panagiotakos  DB, Risvas  G, Malisova  O, Zampelas  A.  Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study.  Eur J Clin Nutr. 2014;68(10):1107-1112. doi:10.1038/ejcn.2014.89PubMedGoogle ScholarCrossref
56.
Kleanthous  K, Dermitzaki  E, Papadimitriou  DT, Papaevangelou  V, Papadimitriou  A.  Overweight and obesity decreased in Greek schoolchildren from 2009 to 2012 during the early phase of the economic crisis.  Acta Paediatr. 2016;105(2):200-205. doi:10.1111/apa.13143PubMedGoogle ScholarCrossref
57.
Grigorakis  DA, Georgoulis  M, Psarra  G, Tambalis  KD, Panagiotakos  DB, Sidossis  LS.  Prevalence and lifestyle determinants of central obesity in children.  Eur J Nutr. 2016;55(5):1923-1931. doi:10.1007/s00394-015-1008-9PubMedGoogle ScholarCrossref
58.
Pikramenou  V, Dimitraki  D, Zoumpoulakis  M, Verykouki  E, Kotsanos  N.  Association between dental caries and body mass in preschool children.  Eur Arch Paediatr Dent. 2016;17(3):171-175. doi:10.1007/s40368-016-0222-3PubMedGoogle ScholarCrossref
59.
Whelton  H, Harrington  J, Crowley  E, Kelleher  V, Cronin  M, Perry  IJ.  Prevalence of overweight and obesity on the island of Ireland: results from the North South Survey of Children’s Height, Weight and Body Mass Index, 2002.  BMC Public Health. 2007;7:187. doi:10.1186/1471-2458-7-187PubMedGoogle ScholarCrossref
60.
Evans  DS, Glacken  M, Goggin  D.  Childhood obesity: the extent of the problem among 6-year-old Irish national school children.  Child Care Health Dev. 2011;37(3):352-359. doi:10.1111/j.1365-2214.2010.01169.xPubMedGoogle ScholarCrossref
61.
Dowd  KP, Kirwan  RP, Hannigan  A, Purtill  H, O’Gorman  CS.  The association between maternal perceptions of own weight status and weight status of her child: results from a national cohort study.  Arch Dis Child. 2016;101(1):28-32. doi:10.1136/archdischild-2015-308721PubMedGoogle ScholarCrossref
62.
Barron  C, Comiskey  C, Saris  J.  Prevalence rates and comparisons of obesity levels in Ireland.  Br J Nurs. 2009;18(13):799-803. doi:10.12968/bjon.2009.18.13.43208PubMedGoogle ScholarCrossref
63.
Reulbach  U, Ladewig  EL, Nixon  E, O’Moore  M, Williams  J, O’Dowd  T.  Weight, body image and bullying in 9-year-old children.  J Paediatr Child Health. 2013;49(4):E288-E293. doi:10.1111/jpc.12159PubMedGoogle ScholarCrossref
64.
Heinen  M, Murrin  C, Daly  L,  et al.  The Childhood Obesity Surveillance Initiative (COSI) in the Republic of Ireland: Findings from 2008, 2010 and 2012. Dublin, Ireland: Health Service Executive; 2014. https://www.hse.ie/eng/services/publications/topics/cosi2012.pdf. Accessed June 21, 2019.
65.
Parrino  C, Rossetti  P, Baratta  R,  et al.  Secular trends in the prevalence of overweight and obesity in Sicilian schoolchildren aged 11-13 years during the last decade.  PLoS One. 2012;7(4):e34551. doi:10.1371/journal.pone.0034551PubMedGoogle ScholarCrossref
66.
Maffeis  C, Consolaro  A, Cavarzere  P,  et al.  Prevalence of overweight and obesity in 2- to 6-year-old Italian children.  Obesity (Silver Spring). 2006;14(5):765-769. doi:10.1038/oby.2006.87PubMedGoogle ScholarCrossref
67.
Albertini  A, Tripodi  A, Fabbri  A,  et al.  Prevalence of obesity in 6- and 9-year-old children living in Central-North Italy: analysis of determinants and indicators of risk of overweight.  Obes Rev. 2008;9(1):4-10.PubMedGoogle Scholar
68.
Bertoncello  C, Cazzaro  R, Ferraresso  A, Mazzer  R, Moretti  G.  Prevalence of overweight and obesity among school-aged children in urban, rural and mountain areas of the Veneto Region, Italy.  Public Health Nutr. 2008;11(9):887-890. doi:10.1017/S1368980007001152PubMedGoogle ScholarCrossref
69.
Genovesi  S, Antolini  L, Giussani  M,  et al.  Hypertension, prehypertension, and transient elevated blood pressure in children: association with weight excess and waist circumference.  Am J Hypertens. 2010;23(7):756-761. doi:10.1038/ajh.2010.50PubMedGoogle ScholarCrossref
70.
Caserta  CA, Pendino  GM, Alicante  S,  et al; MAREA Study Group.  Body mass index, cardiovascular risk factors, and carotid intima-media thickness in a pediatric population in southern Italy.  J Pediatr Gastroenterol Nutr. 2010;51(2):216-220. doi:10.1097/MPG.0b013e3181d4c21dPubMedGoogle ScholarCrossref
71.
Toselli  S, Brasili  P, Spiga  F.  Body image, body dissatisfaction and weight status in children from Emilia-Romagna (Italy): comparison between immigrant and native-born.  Ann Hum Biol. 2014;41(1):23-28. doi:10.3109/03014460.2013.822557PubMedGoogle ScholarCrossref
72.
Ceschia  A, Giacomini  S, Santarossa  S,  et al.  Deleterious effects of obesity on physical fitness in pre-pubertal children.  Eur J Sport Sci. 2016;16(2):271-278. doi:10.1080/17461391.2015.1030454PubMedGoogle ScholarCrossref
73.
OKkio alla SALUTE 2012: sintesi dei risultati. Il Portale dell'Epidemiologia per la Sanità Pubblica. https://www.epicentro.iss.it/okkioallasalute/IndagineNazionale2012. Accessed July 2, 2019.
74.
Nardone  P, Spinelli  A, Buoncristiano  M,  et al.  Il Sistema di Sorveglianza OKkio alla SALUTE: Risultati 2014. Rome, Italy: Istituto Superiore di Sanità; 2016.
75.
Smetanina  N, Albaviciute  E, Babinska  V,  et al.  Prevalence of overweight/obesity in relation to dietary habits and lifestyle among 7-17 years old children and adolescents in Lithuania.  BMC Public Health. 2015;15:1001. doi:10.1186/s12889-015-2340-yPubMedGoogle ScholarCrossref
76.
Decelis  A, Jago  R, Fox  KR.  Physical activity, screen time and obesity status in a nationally representative sample of Maltese youth with international comparisons.  BMC Public Health. 2014;14:664. doi:10.1186/1471-2458-14-664PubMedGoogle ScholarCrossref
77.
de Wilde  JA, van Dommelen  P, Middelkoop  BJ, Verkerk  PH.  Trends in overweight and obesity prevalence in Dutch, Turkish, Moroccan and Surinamese South Asian children in the Netherlands.  Arch Dis Child. 2009;94(10):795-800. doi:10.1136/adc.2009.163709PubMedGoogle ScholarCrossref
78.
Jansen  PW, Roza  SJ, Jaddoe  VW,  et al.  Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study.  Int J Behav Nutr Phys Act. 2012;9:130. doi:10.1186/1479-5868-9-130PubMedGoogle ScholarCrossref
79.
Drukker  M, Wojciechowski  F, Feron  FJ, Mengelers  R, Van Os  J.  A community study of psychosocial functioning and weight in young children and adolescents.  Int J Pediatr Obes. 2009;4(2):91-97. doi:10.1080/17477160802395442PubMedGoogle ScholarCrossref
80.
Kolle  E, Steene-Johannessen  J, Holme  I, Andersen  LB, Anderssen  SA.  Secular trends in adiposity in Norwegian 9-year-olds from 1999-2000 to 2005.  BMC Public Health. 2009;9:389. doi:10.1186/1471-2458-9-389PubMedGoogle ScholarCrossref
81.
Júlíusson  PB, Eide  GE, Roelants  M, Waaler  PE, Hauspie  R, Bjerknes  R.  Overweight and obesity in Norwegian children: prevalence and socio-demographic risk factors.  Acta Paediatr. 2010;99(6):900-905. doi:10.1111/j.1651-2227.2010.01730.xPubMedGoogle ScholarCrossref
82.
Oellingrath  IM, Svendsen  MV, Brantsaeter  AL.  Eating patterns and overweight in 9- to 10-year-old children in Telemark County, Norway: a cross-sectional study.  Eur J Clin Nutr. 2010;64(11):1272-1279. doi:10.1038/ejcn.2010.152PubMedGoogle ScholarCrossref
83.
Chrzanowska  M, Koziel  S, Ulijaszek  SJ.  Changes in BMI and the prevalence of overweight and obesity in children and adolescents in Cracow, Poland, 1971-2000.  Econ Hum Biol. 2007;5(3):370-378. doi:10.1016/j.ehb.2007.08.004PubMedGoogle ScholarCrossref
84.
Kowal  M, Kryst  Ł, Woronkowicz  A, Sobiecki  J.  Long-term changes in body composition and prevalence of overweight and obesity in girls (aged 3-18 years) from Kraków (Poland) from 1983, 2000 and 2010.  Ann Hum Biol. 2014;41(5):415-427. doi:10.3109/03014460.2013.878394PubMedGoogle ScholarCrossref
85.
Popławska  H, Dmitruk  A, Wilczewski  A.  Changes in body adiposity in girls and boys from the rural areas of East Poland over a time span of 20 years.  Ann Hum Biol. 2006;33(1):78-88. doi:10.1080/03014460500446244PubMedGoogle ScholarCrossref
86.
Malecka-Tendera  E, Klimek  K, Matusik  P, Olszanecka-Glinianowicz  M, Lehingue  Y; Polish Childhood Obesity Study Group.  Obesity and overweight prevalence in Polish 7- to 9-year-old children.  Obes Res. 2005;13(6):964-968. doi:10.1038/oby.2005.112PubMedGoogle ScholarCrossref
87.
Kułaga  Z, Litwin  M, Tkaczyk  M,  et al.  Polish 2010 growth references for school-aged children and adolescents.  Eur J Pediatr. 2011;170(5):599-609. doi:10.1007/s00431-010-1329-xPubMedGoogle ScholarCrossref
88.
Mazur  A, Klimek  K, Telega  G, Filip  R, Małecka-Tendera  E.  Ten-year secular trend of overweight and obesity in school children in south-eastern Poland.  Ann Agric Environ Med. 2014;21(3):634-638. doi:10.5604/12321966.1120616PubMedGoogle ScholarCrossref
89.
Kułaga  Z, Gurzkowska  B, Grajda  A, Wojtyło  M, Góźdź  M, Litwin  M.  The prevalence of overweight and obesity among Polish pre-school-aged children.  Dev Period Med. 2016;20(2):143-149.PubMedGoogle Scholar
90.
Marques-Vidal  P, Ferreira  R, Oliveira  JM, Paccaud  F.  Is thinness more prevalent than obesity in Portuguese adolescents?  Clin Nutr. 2008;27(4):531-536. doi:10.1016/j.clnu.2008.04.002PubMedGoogle ScholarCrossref
91.
Padez  C, Mourão  I, Moreira  P, Rosado  V.  Prevalence and risk factors for overweight and obesity in Portuguese children.  Acta Paediatr. 2005;94(11):1550-1557. doi:10.1080/08035250510042924PubMedGoogle ScholarCrossref
92.
Ferreira  RJ, Marques-Vidal  PM.  Prevalence and determinants of obesity in children in public schools of Sintra, Portugal.  Obesity (Silver Spring). 2008;16(2):497-500. doi:10.1038/oby.2007.74PubMedGoogle ScholarCrossref
93.
Antunes  AM, Maia  JA, Stasinopoulos  MD,  et al.  Gross motor coordination and weight status of Portuguese children aged 6-14 years.  Am J Hum Biol. 2015;27(5):681-689. doi:10.1002/ajhb.22715PubMedGoogle ScholarCrossref
94.
Rito  A, Wijnhoven  TM, Rutter  H,  et al.  Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008.  Pediatr Obes. 2012;7(6):413-422. doi:10.1111/j.2047-6310.2012.00068.xPubMedGoogle ScholarCrossref
95.
Seabra  A, Mendonça  D, Maia  J,  et al.  Gender, weight status and socioeconomic differences in psychosocial correlates of physical activity in schoolchildren.  J Sci Med Sport. 2013;16(4):320-326. doi:10.1016/j.jsams.2012.07.008PubMedGoogle ScholarCrossref
96.
Sardinha  LB, Santos  R, Vale  S,  et al.  Prevalence of overweight and obesity among Portuguese youth: a study in a representative sample of 10-18-year-old children and adolescents.  Int J Pediatr Obes. 2011;6(2-2):e124-e128. doi:10.3109/17477166.2010.490263PubMedGoogle ScholarCrossref
97.
Bingham  DD, Varela-Silva  MI, Ferrão  MM,  et al.  Socio-demographic and behavioral risk factors associated with the high prevalence of overweight and obesity in Portuguese children.  Am J Hum Biol. 2013;25(6):733-742. doi:10.1002/ajhb.22440PubMedGoogle ScholarCrossref
98.
Vale  S, Trost  S, Ruiz  JJ, Rêgo  C, Moreira  P, Mota  J.  Physical activity guidelines and preschooler’s obesity status.  Int J Obes (Lond). 2013;37(10):1352-1355. doi:10.1038/ijo.2013.109PubMedGoogle ScholarCrossref
99.
Minghelli  B, Oliveira  R, Nunes  C.  Association of obesity with chronic disease and musculoskeletal factors.  [in Portuguese].  Rev Assoc Med Bras (1992). 2015;61(4):347-354. doi:10.1590/1806-9282.61.04.347PubMedGoogle ScholarCrossref
100.
Rito  AI, Graça  P.  Childhood Obesity Initiative Surveillance. Lisbon, Portugal: Instituto Nacional de Saúde Doutor Ricardo Jorge; 2013. https://www.dgs.pt/documentos-e-publicacoes/childhood-obesity-surveillance-initiative-cosi-portugal-2013-pdf.aspx. Accessed June 27, 2019.
101.
Silva-Santos  S, Santos  A, Vale  S, Mota  J.  Motor fitness and preschooler children obesity status.  J Sports Sci. 2017;35(17):1704-1708. doi:10.1080/02640414.2016.1232486PubMedGoogle ScholarCrossref
102.
Barbu  CG, Teleman  MD, Albu  AI,  et al.  Obesity and eating behaviors in school children and adolescents -data from a cross sectional study from Bucharest, Romania.  BMC Public Health. 2015;15:206. doi:10.1186/s12889-015-1569-9PubMedGoogle ScholarCrossref
103.
Rakić  R, Pavlica  T, Jovičić  D.  Overweight and obesity in children and adolescents from Serbia in the period 2001-2004 and 2011-2014.  Anthropol Anz. 2016;73(2). doi:10.1127/anthranz/2016/0507PubMedGoogle Scholar
104.
Djordjic  V, Radisavljevic  S, Milanovic  I,  et al.  WHO European Childhood Obesity Surveillance Initiative in Serbia: a prevalence of overweight and obesity among 6-9-year-old school children.  J Pediatr Endocrinol Metab. 2016;29(9):1025-1030. doi:10.1515/jpem-2016-0138PubMedGoogle ScholarCrossref
105.
Serra-Majem  L, Aranceta Bartrina  J, Pérez-Rodrigo  C, Ribas-Barba  L, Delgado-Rubio  A.  Prevalence and determinants of obesity in Spanish children and young people.  Br J Nutr. 2006;96(suppl 1):S67-S72. doi:10.1079/BJN20061703PubMedGoogle ScholarCrossref
106.
Martínez-Vizcaíno  V, Sánchez López  M, Moya Martínez  P,  et al.  Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study.  Public Health Nutr. 2009;12(7):1015-1018. doi:10.1017/S1368980008003571PubMedGoogle ScholarCrossref
107.
Martín  JJ, Hernández  LS, Gonzalez  MG, Mendez  CP, Rey Galán  C, Guerrero  SM.  Trends in childhood and adolescent obesity prevalence in Oviedo (Asturias, Spain) 1992-2006.  Acta Paediatr. 2008;97(7):955-958. doi:10.1111/j.1651-2227.2008.00828.xPubMedGoogle ScholarCrossref
108.
Ara  I, Moreno  LA, Leiva  MT, Gutin  B, Casajús  JA.  Adiposity, physical activity, and physical fitness among children from Aragón, Spain.  Obesity (Silver Spring). 2007;15(8):1918-1924. doi:10.1038/oby.2007.228PubMedGoogle ScholarCrossref
109.
García  E, Vázquez López  MÁ, Galera Martínez  R,  et al.  Prevalence of overweight and obesity in children and adolescents aged 2-16 years.  Endocrinol Nutr. 2013;60(3):121-126. doi:10.1016/j.endonu.2012.09.014PubMedGoogle ScholarCrossref
110.
Aguilar Cordero  MJ, González Jiménez  E, García  CJ,  et al.  Obesity in a school children population from Granada: assessment of the efficacy of an educational intervention  [in Spanish].  Nutr Hosp. 2011;26(3):636-641. doi:10.1590/S0212-16112011000300029PubMedGoogle Scholar
111.
Alvarez Caro  F, Díaz Martín  JJ, Riaño Galán  I, Pérez Solís  D, Venta Obaya  R, Málaga Guerrero  S.  Classic and emergent cardiovascular risk factors in schoolchildren in Asturias  [in Spanish].  An Pediatr (Barc). 2011;74(6):388-395. doi:10.1016/j.anpedi.2011.01.007PubMedGoogle ScholarCrossref
112.
Gulías-González  R, Martínez-Vizcaíno  V, García-Prieto  JC, Díez-Fernández  A, Olivas-Bravo  A, Sánchez-López  M.  Excess of weight, but not underweight, is associated with poor physical fitness in children and adolescents from Castilla-La Mancha, Spain.  Eur J Pediatr. 2014;173(6):727-735. doi:10.1007/s00431-013-2233-yPubMedGoogle ScholarCrossref
113.
Sánchez-Cruz  JJ, Jiménez-Moleón  JJ, Fernández-Quesada  F, Sánchez  MJ.  Prevalence of child and youth obesity in Spain in 2012.  Rev Esp Cardiol (Engl Ed). 2013;66(5):371-376. doi:10.1016/j.rec.2012.10.012PubMedGoogle ScholarCrossref
114.
González García  A, Álvarez Bueno  C, Lucas de la Cruz  L,  et al.  Prevalence of thinness, overweight and obesity among 4-to-6-year-old Spanish schoolchildren in 2013; situation in the European context  [in Spanish].  Nutr Hosp. 2015;32(4):1476-1482. doi:10.3305/nh.2015.32.4.9508PubMedGoogle Scholar
115.
Gómez Santos  SF, Estévez Santiago  R, Palacios Gil-Antuñano  N,  et al.  THAO-CHILD health programme: community based intervention for healthy lifestyles promotion to children and families: results of a cohort study.  Nutr Hosp. 2015;32(6):2584-2587. doi:10.3305/nh.2015.32.6.9736PubMedGoogle Scholar
116.
Ortega Anta  RM, López-Sobaler  AM, Aparicio Vizuete  A,  et al.  Estudio ALADINO 2015: Estudio de Vigilancia del Crecimiento, Alimentación, Actividad Física, Desarrollo Infantil y Obesidad en España 2015. Madrid, Spain: Agencia Española de Consumo, Seguridad Alimentaria y Nutrición, Ministerio de Sanidad, Servicios Sociales e Igualdad; 2016.
117.
Mårild  S, Bondestam  M, Bergström  R, Ehnberg  S, Hollsing  A, Albertsson-Wikland  K.  Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index.  Acta Paediatr. 2004;93(12):1588-1595. doi:10.1111/j.1651-2227.2004.tb00848.xPubMedGoogle ScholarCrossref
118.
Sjöberg  A, Lissner  L, Albertsson-Wikland  K, Mårild  S.  Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls.  Acta Paediatr. 2008;97(1):118-123. doi:10.1111/j.1651-2227.2007.00613.xPubMedGoogle ScholarCrossref
119.
Petersen  S, Brulin  C, Bergström  E.  Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001.  Acta Paediatr. 2003;92(7):848-853. doi:10.1111/j.1651-2227.2003.tb02545.xPubMedGoogle ScholarCrossref
120.
Garmy  P, Clausson  EK, Nyberg  P, Jakobsson  U.  Overweight and television and computer habits in Swedish school-age children and adolescents: a cross-sectional study.  Nurs Health Sci. 2014;16(2):143-148. doi:10.1111/nhs.12076PubMedGoogle ScholarCrossref
121.
Moraeus  L, Lissner  L, Sjöberg  A.  Stable prevalence of obesity in Swedish schoolchildren from 2008 to 2013 but widening socio-economic gap in girls.  Acta Paediatr. 2014;103(12):1277-1284. doi:10.1111/apa.12785PubMedGoogle ScholarCrossref
122.
Lasserre  AM, Chiolero  A, Cachat  F, Paccaud  F, Bovet  P.  Overweight in Swiss children and associations with children’s and parents’ characteristics.  Obesity (Silver Spring). 2007;15(12):2912-2919. doi:10.1038/oby.2007.347PubMedGoogle ScholarCrossref
123.
Jeannot  E, Mahler  P, Elia  N, Cerruti  B, Chastonnay  P.  Sociodemographic and economic determinants of overweight and obesity for public-school children in Geneva State, Switzerland: a cross-sectional study.  Int J Prev Med. 2015;6:39. doi:10.4103/2008-7802.156836PubMedGoogle ScholarCrossref
124.
Manios  Y, Kolotourou  M, Moschonis  G,  et al.  Macronutrient intake, physical activity, serum lipids and increased body weight in primary schoolchildren in Istanbul.  Pediatr Int. 2005;47(2):159-166. doi:10.1111/j.1442-200x.2005.02047.xPubMedGoogle ScholarCrossref
125.
Sur  H, Kolotourou  M, Dimitriou  M,  et al.  Biochemical and behavioral indices related to BMI in schoolchildren in urban Turkey.  Prev Med. 2005;41(2):614-621. doi:10.1016/j.ypmed.2004.11.029PubMedGoogle ScholarCrossref
126.
Pirinçci  E, Durmuş  B, Gündoğdu  C, Açik  Y.  Prevalence and risk factors of overweight and obesity among urban school children in Elazig city, Eastern Turkey, 2007.  Ann Hum Biol. 2010;37(1):44-56. doi:10.3109/03014460903218984PubMedGoogle ScholarCrossref
127.
Agirbasli  M, Adabag  S, Ciliv  G.  Secular trends of blood pressure, body mass index, lipids and fasting glucose among children and adolescents in Turkey.  Clin Obes. 2011;1(4-6):161-167. doi:10.1111/j.1758-8111.2012.00033.xPubMedGoogle ScholarCrossref
128.
Senol  V, Unalan  D, Bayat  M, Mazicioglu  MM, Ozturk  A, Kurtoglu  S.  Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents.  J Pediatr Endocrinol Metab. 2014;27(11-12):1121-1129. doi:10.1515/jpem-2013-0467PubMedGoogle Scholar
129.
Dummer  TJ, Gibbon  MA, Hackett  AF, Stratton  G, Taylor  SR.  Is overweight and obesity in 9-10-year-old children in Liverpool related to deprivation and/or electoral ward when based on school attended?  Public Health Nutr. 2005;8(6):636-641. doi:10.1079/PHN2005719PubMedGoogle ScholarCrossref
130.
Bartle  NC, Hill  C, Webber  L, van Jaarsveld  CH, Wardle  J.  Emergence and persistence of overweight and obesity in 7- to 11-year-old children.  Obes Facts. 2013;6(5):415-423. doi:10.1159/000355677PubMedGoogle ScholarCrossref
131.
Basterfield  L, Jones  AR, Parkinson  KN,  et al; Gateshead Millennium Study Core Team.  Physical activity, diet and BMI in children aged 6-8 years: a cross-sectional analysis.  BMJ Open. 2014;4(6):e005001. doi:10.1136/bmjopen-2014-005001PubMedGoogle ScholarCrossref
132.
Steele  RM, van Sluijs  EM, Cassidy  A, Griffin  SJ, Ekelund  U.  Targeting sedentary time or moderate- and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children.  Am J Clin Nutr. 2009;90(5):1185-1192. doi:10.3945/ajcn.2009.28153PubMedGoogle ScholarCrossref
133.
Lobstein  T, Baur  L, Uauy  R; IASO International Obesity TaskForce.  Obesity in children and young people: a crisis in public health.  Obes Rev. 2004;5(suppl 1):4-104. doi:10.1111/j.1467-789X.2004.00133.xPubMedGoogle ScholarCrossref
134.
Olds  T, Maher  C, Zumin  S,  et al.  Evidence that the prevalence of childhood overweight is plateauing: data from nine countries.  Int J Pediatr Obes. 2011;6(5-6):342-360. doi:10.3109/17477166.2011.605895PubMedGoogle ScholarCrossref
135.
Bonaccio  M, Iacoviello  L, de Gaetano  G; Moli-Sani Investigators.  The Mediterranean diet: the reasons for a success.  Thromb Res. 2012;129(3):401-404. doi:10.1016/j.thromres.2011.10.018PubMedGoogle ScholarCrossref
136.
Roccaldo  R, Censi  L, D’Addezio  L,  et al; ZOOM8 Study group.  Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study).  Int J Food Sci Nutr. 2014;65(5):621-628. doi:10.3109/09637486.2013.873887PubMedGoogle ScholarCrossref
137.
Kalman  M, Inchley  J, Sigmundova  D,  et al.  Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective.  Eur J Public Health. 2015;25(suppl 2):37-40. doi:10.1093/eurpub/ckv024PubMedGoogle ScholarCrossref
138.
Van Hecke  L, Loyen  A, Verloigne  M,  et al; DEDIPAC consortium.  Variation in population levels of physical activity in European children and adolescents according to cross-European studies: a systematic literature review within DEDIPAC.  Int J Behav Nutr Phys Act. 2016;13:70. doi:10.1186/s12966-016-0396-4PubMedGoogle ScholarCrossref
139.
Shrewsbury  V, Wardle  J.  Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005.  Obesity (Silver Spring). 2008;16(2):275-284. doi:10.1038/oby.2007.35PubMedGoogle ScholarCrossref
140.
Karanikolos  M, Mladovsky  P, Cylus  J,  et al.  Financial crisis, austerity, and health in Europe.  Lancet. 2013;381(9874):1323-1331. doi:10.1016/S0140-6736(13)60102-6PubMedGoogle ScholarCrossref
141.
Ludwig  DS, Pollack  HA.  Obesity and the economy: from crisis to opportunity.  JAMA. 2009;301(5):533-535. doi:10.1001/jama.2009.52PubMedGoogle ScholarCrossref
142.
Wisniewski  AB, Chernausek  SD.  Gender in childhood obesity: family environment, hormones, and genes.  Gend Med. 2009;6(suppl 1):76-85. doi:10.1016/j.genm.2008.12.001PubMedGoogle ScholarCrossref
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Original Investigation
August 5, 2019

Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
  • 2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz, Madrid, Spain
  • 3CIBERESP and IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
  • 4Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
  • 5Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
  • 6Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain;
  • 7Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
  • 8Promoting Fitness And Health through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
  • 9Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
  • 10Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
JAMA Pediatr. Published online August 5, 2019. doi:10.1001/jamapediatrics.2019.2430
Key Points

Question  What are the prevalence and trends of overweight and obesity in European children?

Findings  In this meta-analysis of 103 studies that included 477 620 children aged 2 to 13 years in 28 European countries, the combined prevalence of overweight and obesity in children increased from 1999 to 2006 to 2011 to 2016. Additionally, the weighted prevalence of obesity increased during the same period.

Meaning  Despite a recent stabilization of the trends in childhood excess weight in most European countries, current interventions to address the excess weight epidemic should be maintained or strengthened because the prevalence of excess weight is still very high.

Abstract

Importance  Studies of trends in excess weight among European children throughout the last few decades have rendered mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, or included only a few European countries.

Objective  To assess prevalence trends in measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology.

Data Sources  MEDLINE, Embase, CINAHL, and Web of Science were searched from their inception until May 2018. Moreover, searches were conducted on health institutions’ websites to identify studies not published in scientific journals.

Study Selection  The inclusion criteria were: (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity according to body mass index cutoffs proposed by the International Obesity Task Force; (2) cross-sectional or follow-up studies; and (3) studies including populations aged 2 to 13 years.

Data Extraction and Synthesis  Literature review and data extraction followed established guidelines. The Mantel-Haenszel method was used to compute the pooled prevalence estimates and their 95% CI whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by study year, country, or European region (Atlantic, Iberian, Central, and Mediterranean) were conducted. Prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals in each study.

Results  A total of 103 studies (477 620 children aged 2 to 13 years) with data from 28 countries were included. The combined prevalence of overweight and obesity in the Iberian region tended to decrease from 30.3% (95% CI, 28.3%-32.3%) to 25.6% (95% CI, 19.7%-31.4%) but tended to increase in the Mediterranean region from 22.9% (95% CI, 17.9%-27.9%) to 25.0% (95% CI, 14.5%-35.5%). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18.3% (95% CI, 14.0%-23.9%) to 19.3% (95% CI, 17.7%-20.9%) and from 15.8% (95% CI, 13.4%-18.5%) to 15.3% (95% CI, 11.6%-20.3%), respectively.

Conclusions and Relevance  The prevalence of childhood overweight and obesity is very high, but trends have stabilized in most European countries. There are substantial between-country differences in the current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome.

Trial Registration  PROSPERO identifier: CRD42017056924

Introduction

The prevalence of obesity and overweight has markedly risen in the last 2 decades in Europe, even though noticeable variations in the estimations across countries have been reported.1-3 According to estimates from the World Health Organization’s Childhood Obesity Surveillance Initiative, using the International Obesity Task Force (IOTF) criteria, approximately one-quarter of European children aged 6 to 9 years had overweight or obesity in 2010, with estimates ranging from 10.8% (Belgium) to 39.9% (Greece).4 The prevalence of overweight and obesity among children and adolescents is growing in low- and middle-income countries,5 although some country-specific analyses have suggested a recent plateau, or even a decrease, in the frequency of excess weight, especially in high-income countries.3,6

Although obesity is a multidimensional health problem, unhealthy dietary habits and sedentary lifestyles are the main immediate drivers.5 The adverse consequences of childhood obesity go far beyond some unfavorable health and psychosocial conditions in infancy and adolescence because children with overweight or obesity are at greater risk of obesity in adulthood7-9 than their peers with normal weight, with the ensuing burden of chronic diseases, including type 2 diabetes, cardiovascular diseases, cancer, and mental health disorders.10-14

In Europe, several studies on excess-weight trends among children in recent decades yielded somewhat mixed results.1,3,15 Additionally, some studies were outdated,16 covered narrow age groups,4 relied on self-reported weight and height,16-18 or included only a few countries.4 Thus, this study was aimed at assessing the trends in prevalence of measured overweight and obesity among children aged 2 to 13 years in Europe from 1999 to 2016 using a systematic methodology. This information is important to assess the progress achieved in the control of the childhood obesity epidemic and to identify specific regions where additional measures must be implemented to address unfavorable excess-weight trends.

Methods

The systematic review and meta-analysis were conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline19 and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline20 (Figure 1). We have registered and published this review on PROSPERO, and its protocol has been published elsewhere.21

Search Strategy

We systematically searched the MEDLINE (via PubMed), Embase, CINAHL, and Web of Science databases from their inception until May 2018. The following terms were combined to design the search strategy: (1) population (children, childhood, schooler, schoolchildren, preadolescent, adolescent, school aged, school-aged); (2) outcome (obesity, overweight, body composition, body constitution, weight status, anthropometry); (3) study design (prevalence, trend, epidemiology, observational, cross-sectional, longitudinal); and (4) location (includes terms for different European countries) (eTable 1 in the Supplement). Additionally, we scanned the reference lists of the included studies. Finally, we conducted an open search on national and international institutional public health and health ministry websites to identify weight status estimates not reported in scientific journals. The literature search, the data extraction, and the quality assessment were performed independently by 2 investigators (M.G.-M. and C.Á.-B.), and disagreements were resolved by consensus or involving a third researcher (V.M.-V.).

Study Selection

The inclusion criteria were (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity, according to body mass index (calculated as weight in kilograms divided by height in meters squared) cutoffs proposed by the IOTF22,23; (2) cross-sectional or follow-up studies and panel surveys with weight and height measured by trained personnel; and (3) studies including populations aged 2 to 13 years.

Studies were excluded from the analyses when (1) they were published in languages other than English, Spanish, Italian, or Portuguese; (2) the sample was less than 250 children (on the rationale that smaller samples may lead to a lack of precision in the prevalence estimates); (3) the target population was a specific subgroup, such as aboriginal groups, immigrants, or those with a single socioeconomic status; and (4) they were duplicate reports of the same study. When more than one article provided data on the same sample, the one reporting the most detailed results and/or with the largest sample size was retained in data synthesis.

Search and Data Extraction

The main characteristics of the selected studies are summarized in eTable 2 in the Supplement, including information regarding (1) country; (2) European region24; (3) period of the study; (4) study design; (5) level of representativeness (regional or national); (6) population characteristics (age distribution and sample size); and (7) prevalence of overweight and obesity combined and obesity alone based on the IOTF definition.22,23

When some important data were not reported in the articles, we asked the authors to provide these data if possible. Inconsistencies in data reporting across studies underlie the differences in data presentation in eTable 2 in the Supplement.

Quality Assessment

We used the Joanna Briggs Institute tool25 to evaluate the risk of bias in the prevalence studies. This tool consists of a rating list with 10 criteria, which can be assessed as yes (coded as 1), no (coded as 0), not applicable (coded as NA), or unclear (coded as ?); thus, the score for each study ranged from 0 to 10. Depending on its score, we rated each study as low risk (7-10), moderate risk (4-6), or high risk of bias (1-3).

For longitudinal studies, we used the Effective Public Health Practice Project tool.26 This instrument evaluates the risk of bias according to 7 domains: selection bias, study design, confounders, blinding, data collection method, withdrawals, and dropouts. Each domain can be considered strong (with no weak domains), moderate (with 1 weak domain), or weak (with 2 or more weak domains).

Statistical Analysis

Data used to estimate the pooled prevalence means were obtained from cross-sectional studies as well as from baseline or final measurements of longitudinal studies. When studies reported estimates of morbid obesity (body mass index, ≥35 at age 18 years), these were included in the obesity category to estimate a single value for obesity (body mass index, ≥30 at age 18 years). We used the weighted pooling to study size method in each analysis.27 Therefore, the prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals with excess weight of each study. Thus, we calculated the general point estimate and performed subgroup analyses according to sex, age group (2 to 6 years and 7 to 13 years), period, country, and European region. The Mantel-Haenszel fixed-effects method28 was used to compute the pooled prevalence estimate and its 95% CI whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method29 was used. The heterogeneity of results across studies was evaluated with the I2 statistic,30 which was interpreted as not important (0%-40%), moderate heterogeneity (30%-60%), substantial heterogeneity (50%-90%), or large heterogeneity (75%-100%).31 Considering the overlapping between these heterogeneity categories, we decided to use the Mantel-Haenszel fixed-effects method when I2 was less than 50%.

In the subgroup analyses, we distinguished 3 periods: the wealthy period (1999-2006), the peak of the economic crisis (2007-2010), and the years that followed the crisis (2011-2016), hereafter precrisis, crisis, and postcrisis periods, respectively. We also distinguished 4 European regions24: Atlantic (France, Ireland, United Kingdom, Belgium, the Netherlands, Finland, Norway, and Sweden), Iberian (Portugal and Spain), Central (Germany, Czech Republic, Switzerland, Poland, Romania, Lithuania, Estonia, Hungary, and Latvia), and Mediterranean (Cyprus, Greece, Italy, Malta, Slovenia, Republic of North Macedonia, Serbia, Bulgaria, and Turkey). Additionally, random-effects meta-regression analyses were used to evaluate whether the prevalence estimate differed according to the gross national income per capita based on the purchasing power parity of each European country.

The significance value of the pooled effect size was estimated based on the 95% CI. Two-sided P values of .05 or less were significant. Statistical analyses were performed using Stata SE software, version 15 (StataCorp).

Results
Study Selection and Characteristics

The PRISMA diagram with the flow of studies through the review is presented in Figure 1. From the 4310 articles identified, 103 studies (2.4%) met the inclusion criteria (eTable 2 in the Supplement).4,15,32-132 Of these, 5 studies displayed data for several European countries.4,15,33,34,39 Studies were conducted in 28 European countries: Belgium (3 reports), Bulgaria (2), Cyprus (5), Czech Republic (1), Estonia (2), Finland (1), France (5), Germany (8), Greece (9), Hungary (4), Ireland (8), Italy (13), Latvia (2), Lithuania (3), Malta (2), the Netherlands (4), Norway (6), Poland (7), Portugal (13), Romania (1), Serbia (2), Slovenia (3), Spain (14), Sweden (8), Switzerland (2), Turkey (5), United Kingdom (4), and Republic of North Macedonia (1).

A total of 477 620 children aged 2 to 13 years were included in this review, with sample sizes of analyzed studies ranging from 259 to 124 113. The reports were published between 1999 and 2016, including 97 cross-sectional prevalence studies and 6 longitudinal studies. Furthermore, 27 studies were based on national samples, and 76 were based on samples from regions of a country.

Study Quality

As evaluated by the Joanna Briggs Institute tool,25 8 prevalence studies (8.8%) showed a high risk of bias, 25 (25.2%) showed a moderate risk, and 64 (66.0%) showed a low risk. In 66 studies (68.2%), the measurement of weight and height was described in detail. Only 63 studies (64.9%) met the criteria for sample representativeness (eTable 3 in the Supplement).

From 6 longitudinal studies in which quality was assessed using the Effective Public Health Practice Project tool,26 5 scored as moderate and 1 as weak. Where studies were analyzed by individual domains, all studies included information regarding data collection, but 4 studies (66.7%) had limitations in the control of confounders and in blinding (eTable 4 in the Supplement).

Prevalence and Trends of Overweight and Obesity

Overall, the prevalence of overweight and obesity combined in European children aged 2 to 13 years changed from 20.6% (95% CI, 18.8%-22.4%) during 1999 to 2006 to 21.3% (95% CI, 19.2%-23.6%) during 2011 to 2016. Additionally, the prevalence of obesity in this age group changed from 4.4% (95% CI, 3.8%-5.1%) during 1999 to 2006 to 5.7% (95% CI, 5.0%-6.6%) during 2011 to 2016. When we used only studies with representative samples and assessed as moderate or high quality, the trends estimates were similar, in such a way that the prevalence estimates for overweight and obesity combined changed from 20.0% (95% CI, 17.6%-22.6%) during 1999 to 2006 to 22.9% (95% CI, 20.1%-25.9%) during 2011 to 2016; similarly, the prevalence of obesity changed from 4.2% (95% CI, 3.3%-5.3%) to 6.3% (95% CI, 5.4%-7.4%) (eTable 5 in the Supplement).

Time Trends by Country

The Table shows the prevalence of overweight and obesity combined and obesity alone in children (aged 2-6 and 7-13 years) for 28 European countries from 1999 to 2016, using IOTF definition criteria.22,23 From 1999 to 2006, the lowest prevalences of overweight and obesity were observed in Belgium (9.0%; 95% CI, 8.0%-10.0%) and the Netherlands (10.2%; 95% CI, 8.4%-12.3%), and the highest prevalences were in Greece (40.8%; 95% CI, 38.0%-43.6%) and Spain (31.9%; 95% CI, 29.2%-34.7%). However, during 2011 to 2016, the lowest figures were seen in Poland (12.3%; 95% CI, 11.4%-13.3%) and Switzerland (14.4%; 95% CI, 13.1%-15.8%), and the highest were in Greece (36.8%; 95% CI, 24.4%-51.3%) and Italy (35.2%; 95% CI, 32.4%-38.1%).

In regards to the prevalence of obesity, during 1999 to 2006, the lowest estimates were reported in Belgium (1.6%; 95% CI, 1.2%-2.1%) and Switzerland (1.7%; 95% CI, 1.4%-2.1%), and the highest were in Greece (14.1%; 95% CI, 12.3%-16.2%) and Spain (10.4%; 95% CI, 7.7%-13.9%). Nevertheless, during 2011 to 2016, the lowest prevalences were observed in Switzerland (2.4%; 95% CI, 1.9%-3.1%) and Sweden (2.9%; 95% CI, 2.2%-3.9%), and the highest prevalences were in Italy (16.8%; 95% CI, 11.3%-24.2%) and Malta (14.2%; 95% CI, 11.9%-16.8%). eFigure 1 in Supplement shows the trends of overweight and obesity in children (aged 2-13 years) from 1999 to 2016. Girls presented a higher prevalence of overweight and obesity than boys in most European countries, although sex differences in the levels and trends of overweight and obesity were small (eTable 6 in Supplement provides sex-specific prevalence in each age group and country).

Time Trends by Regions

Figure 2 displays trends in the pooled prevalence estimates of overweight and obesity in children (aged 2-6 and 7-13 years) from the 4 regions of Europe from 1999 to 2016. During 1999 to 2006, the Atlantic region showed the lowest prevalence (12.8%; 95% CI, 9.5%-16.2%), whereas the highest was observed in the Iberian region (31.0%; 95% CI, 28.8%-33.3%). However, during 2011 to 2016, the Central region presented the lowest prevalence (13.2%; 95% CI, 11.3%-15.4%), and the Mediterranean region had the highest prevalence (30.4%; 95% CI, 25.8%-35.9%).

For obesity prevalence, during 1999 to 2006, the Central region presented the lowest estimate (2.7%; 95% CI, 1.3%-4.1%), and the Iberian region had the highest (10.4%; 95% CI, 7.7%-13.9%). From 2011 to 2016, the Central region showed the lowest prevalence (3.2%; 95% CI, 2.3%-4.6%), and the Mediterranean region had the highest prevalence (10.1%; 95% CI, 6.1%-14.1%) (Figure 3).

Meta-regression

Random-effects meta-regression models showed a negatively significant association between the combined prevalence of overweight and obesity and gross national income per capita in European countries during 3 periods, 1999 to 2006 (95% CI, −0.23 to −0.16), 2007 to 2010 (95% CI, −0.15 to −0.08), and 2011 to 2016 (95% CI, −0.20 to −0.12) (P < .001) (eFigures 2 and 3 in the Supplement and Figure 3). However, no significant differences were found in the 2- to 6-year subgroup during 2011 to 2016 (95% CI, −0.04 to 0.03) (Figure 3A). Otherwise, the trends in the combined prevalence of overweight and obesity from 1999 to 2016 was also negatively associated with gross national income per capita in different countries in Europe for the age range of 7 to 13 years (P < .001; 95% CI, −0.15 to −0.08) (Figure 4). Nevertheless, no significant differences were found for the age range of 2 to 6 years (95% CI, −0.03 to 0.12) (Figure 4A).

Discussion

This systematic review and meta-analysis provides a comprehensive picture of the trends from 1999 to 2016 in the prevalence of overweight and obesity in children aged 2 to 13 years across the European region. Overall, our results indicate a stabilization of the obesity epidemic in Europe, although substantial differences between countries in both current levels and trends should be noted. For example, while a downward trend in excess weight is occurring in the Iberian region, the prevalence is increasing in most Mediterranean countries. Otherwise, data from Atlantic and Central Europe indicate a stabilization or even a decrease in both regions.

There is evidence of a worldwide increase in the overweight and obesity prevalence in children that started in approximately 1980.133 However, during the first decade of the 21st century, in some European countries as well as Australia, China, and the United States, this growing trend has reached a plateau or shown a slight decline.1,3,6,134 Since this phenomenon has been reported in countries with different prevalence rates, it is plausible that the increased population awareness of this public health problem, as well as interventions promoting daily physical activity and healthy diets, have contributed to the stabilization of childhood obesity rates.134 Nevertheless, given that prevalence rates are still increasing in some European countries, other cultural or socioeconomic factors could underlie the marked differences in obesity prevalence. Specifically, in Europe, there are distinct cultural differences by geographical region. In our study, as has been noted in previous studies,4,15 children residing in countries across the Mediterranean basin showed the highest prevalence rates of overweight/obesity (24% to 37%), while those in Atlantic and Central Europe showed substantially lower prevalence (14% to 21%). The high prevalence of childhood obesity in Cyprus, Greece, Malta, Italy, Spain, and Portugal could be partially attributed to the gradual shift from the healthy Mediterranean diet to a more Westernized diet,135 indicated a recent study in which only 5% of Italian children aged 8 to 9 years adhered to the Mediterranean diet.136 Additionally, physical activity levels in children living in the Mediterranean countries are lower than in those living in Atlantic and Central Europe.137,138

Socioeconomic status is usually inversely associated with childhood obesity139; thus, the abrupt socioeconomic changes resulting from the financial crisis of 2007, which mostly affected some southern European countries, may have contributed to the observed trends in excess weight. In these southern countries, between 2005 and 2010, the proportion of children at risk of poverty increased from 20.6% to 23.7%, and the proportion of those living in unemployed families rose from 3.7% to 11.2%.140 Some studies have also observed the highest rates of overweight and obesity in the most disadvantaged population groups, in part, due to their lower diet quality.139,141 Our results showed that during the crisis the prevalence rates of overweight and obesity were highest, especially in some southern European countries, such as Greece, Spain, Malta, Italy, or Portugal, where the effect of this crisis was more serious. However, during the postcrisis period, the prevalence rates of overweight and obesity stabilized, dropping lower than the precrisis period in many European countries.

Girls showed a higher prevalence of overweight/obesity than boys in most countries in Europe; however, sex differences were small, which is consistent with the results of other studies.3,6 Boys and girls differ in patterns of body weight gain and hormone biology, but it seems that the shared obesogenic environment minimizes sex differences in excess weight trends.142

Limitations

There were some limitations of this meta-analysis that should be acknowledged. Some of these are common to meta-analyses (eg, selection bias and limited availability of complete information from study reports), but others are particularly important in our study. First, only studies that defined overweight and obesity with the IOTF criteria were included,22,23 which limited the comparability with other relevant studies. Second, studies using the 2 versions of these IOTF criteria were included,22,23 and although differences in the cutoffs were small, they may have affected prevalence estimates. Third, not all studies ensured representative samples of the population, which posed a threat to the validity of their estimates. Fourth, there were limited data for children aged 2 to 6 years during 2011 to 2016; thus, our findings for this age group should be taken with caution. Fifth, the selection of unbalanced periods can be responsible for a sampling bias, but we considered that establishing socioeconomic-related periods could provide more valuable information because the potential influence that the socioeconomic circumstances could have on the excess weight prevalence. Sixth, for our analyses, because of the scarcity of follow-up studies involving the same people over time, the analysis of time series was discarded. Seventh, differences in sample characteristics, number of studies by country, limited number of national based samples, especially in the postcrisis period, geographic location, and the quality of the included data may have increased heterogeneity between studies, which may have reduced the quality of evidence on excess weight trends.

Conclusions

Despite a recent stabilization of the trends in childhood excess weight in most European countries, current interventions to address the excess weight epidemic should be maintained or strengthened because the prevalence of excess weight is still very high. The Mediterranean countries show a worrying upward trend in childhood excess weight, which requires urgent appropriate public health measures.

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Article Information

Corresponding Author: Iván Cavero-Redondo, PhD, Universidad de Castilla-La Mancha, Health and Social Research Center, C/ Santa Teresa Jornet, s/n, cp: 16071, Cuenca, Spain (ivan.cavero@uclm.es).

Accepted for Publication: May 21, 2019.

Published Online: August 5, 2019. doi:10.1001/jamapediatrics.2019.2430

Author Contributions: Ms Garrido-Miguel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Garrido-Miguel, Cavero-Redondo, Rodríguez-Artalejo, Moreno, Ruiz, Martínez-Vizcaíno.

Acquisition, analysis, or interpretation of data: Garrido-Miguel, Cavero-Redondo, Álvarez-Bueno, Ruiz, Ahrens, Martínez-Vizcaíno.

Drafting of the manuscript: Garrido-Miguel, Cavero-Redondo, Álvarez-Bueno, Martínez-Vizcaíno.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Garrido-Miguel, Cavero-Redondo, Álvarez-Bueno, Ahrens, Martínez-Vizcaíno.

Administrative, technical, or material support: Ruiz.

Supervision: Cavero-Redondo, Rodríguez-Artalejo, Moreno, Ruiz, Martínez-Vizcaíno.

Conflict of Interest Disclosures: Dr Garrido-Miguel reported receiving grants from the Ministerio de Educación and Cultura y Deporte during the conduct of this study. Dr Cavero-Redondo reported receiving a grant from the Universidad de Castilla-La Mancha during the conduct of the study. Dr Ruiz reported receiving support from the University of Granada Plan Propio de Investigación Unit of Excellence on Exercise and Health and Plan Propio de Investigación 2018, Programa Contratos-Puente, and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades. No other disclosures were reported.

Additional Contributions: We thank Hermann Pohlabeln, PhD, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany, for providing additional information relating to his studies. No compensation was received.

References
1.
Ng  M, Fleming  T, Robinson  M,  et al.  Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2014;384(9945):766-781. doi:10.1016/S0140-6736(14)60460-8PubMedGoogle ScholarCrossref
2.
Wang  Y, Lobstein  T.  Worldwide trends in childhood overweight and obesity.  Int J Pediatr Obes. 2006;1(1):11-25. doi:10.1080/17477160600586747PubMedGoogle ScholarCrossref
3.
Abarca-Gómez  L, Abdeen  ZA, Hamid  ZA,  et al; NCD Risk Factor Collaboration (NCD-RisC).  Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.  Lancet. 2017;390(10113):2627-2642. doi:10.1016/S0140-6736(17)32129-3PubMedGoogle ScholarCrossref
4.
Wijnhoven  TM, van Raaij  JM, Spinelli  A,  et al.  WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children.  Pediatr Obes. 2013;8(2):79-97. doi:10.1111/j.2047-6310.2012.00090.xPubMedGoogle ScholarCrossref
5.
Prentice  AM.  The emerging epidemic of obesity in developing countries.  Int J Epidemiol. 2006;35(1):93-99. doi:10.1093/ije/dyi272PubMedGoogle ScholarCrossref
6.
Rokholm  B, Baker  JL, Sørensen  TI.  The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives.  Obes Rev. 2010;11(12):835-846. doi:10.1111/j.1467-789X.2010.00810.xPubMedGoogle ScholarCrossref
7.
Tsiros  MD, Olds  T, Buckley  JD,  et al.  Health-related quality of life in obese children and adolescents.  Int J Obes (Lond). 2009;33(4):387-400. doi:10.1038/ijo.2009.42PubMedGoogle ScholarCrossref
8.
Orsi  CM, Hale  DE, Lynch  JL.  Pediatric obesity epidemiology.  Curr Opin Endocrinol Diabetes Obes. 2011;18(1):14-22. doi:10.1097/MED.0b013e3283423de1PubMedGoogle ScholarCrossref
9.
Simmonds  M, Llewellyn  A, Owen  CG, Woolacott  N.  Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.  Obes Rev. 2016;17(2):95-107. doi:10.1111/obr.12334PubMedGoogle ScholarCrossref
10.
Baker  JL, Olsen  LW, Sørensen  TI.  Childhood body-mass index and the risk of coronary heart disease in adulthood.  N Engl J Med. 2007;357(23):2329-2337. doi:10.1056/NEJMoa072515PubMedGoogle ScholarCrossref
11.
Twig  G, Yaniv  G, Levine  H,  et al.  Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood.  N Engl J Med. 2016;374(25):2430-2440. doi:10.1056/NEJMoa1503840PubMedGoogle ScholarCrossref
12.
WHO.  Consideration of the Evidence on Childhood Obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. Geneva, Switzerland: World Health Organization; 2016.
13.
Park  MH, Falconer  C, Viner  RM, Kinra  S.  The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review.  Obes Rev. 2012;13(11):985-1000. doi:10.1111/j.1467-789X.2012.01015.xPubMedGoogle ScholarCrossref
14.
Quek  YH, Tam  WWS, Zhang  MWB, Ho  RCM.  Exploring the association between childhood and adolescent obesity and depression: a meta-analysis.  Obes Rev. 2017;18(7):742-754. doi:10.1111/obr.12535PubMedGoogle ScholarCrossref
15.
Brug  J, van Stralen  MM, Te Velde  SJ,  et al.  Differences in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-project.  PLoS One. 2012;7(4):e34742. doi:10.1371/journal.pone.0034742PubMedGoogle ScholarCrossref
16.
Yngve  A, De Bourdeaudhuij  I, Wolf  A,  et al.  Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study.  Eur J Public Health. 2008;18(2):126-130. doi:10.1093/eurpub/ckm099PubMedGoogle ScholarCrossref
17.
Martínez  JA, Kearney  JM, Kafatos  A, Paquet  S, Martínez-González  MA.  Variables independently associated with self-reported obesity in the European Union.  Public Health Nutr. 1999;2(1a):125-133. doi:10.1017/S1368980099000178PubMedGoogle ScholarCrossref
18.
Gallus  S, Lugo  A, Murisic  B, Bosetti  C, Boffetta  P, La Vecchia  C.  Overweight and obesity in 16 European countries.  Eur J Nutr. 2015;54(5):679-689. doi:10.1007/s00394-014-0746-4PubMedGoogle ScholarCrossref
19.
Stroup  DF, Berlin  JA, Morton  SC,  et al.  Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.  JAMA. 2000;283(15):2008-2012. doi:10.1001/jama.283.15.2008PubMedGoogle ScholarCrossref
20.
Moher  D, Liberati  A, Tetzlaff  J, Altman  DG; PRISMA Group.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.  J Clin Epidemiol. 2009;62(10):1006-1012. doi:10.1016/j.jclinepi.2009.06.005PubMedGoogle ScholarCrossref
21.
Garrido-Miguel  M, Cavero-Redondo  I, Álvarez-Bueno  C,  et al.  Prevalence and trends of thinness, overweight and obesity among children and adolescents aged 3-18 years across Europe: a protocol for a systematic review and meta-analysis.  BMJ Open. 2017;7(12):e018241. doi:10.1136/bmjopen-2017-018241PubMedGoogle ScholarCrossref
22.
Cole  TJ, Bellizzi  MC, Flegal  KM, Dietz  WH.  Establishing a standard definition for child overweight and obesity worldwide: international survey.  BMJ. 2000;320(7244):1240-1243. doi:10.1136/bmj.320.7244.1240PubMedGoogle ScholarCrossref
23.
Cole  TJ, Lobstein  T.  Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity.  Pediatr Obes. 2012;7(4):284-294. doi:10.1111/j.2047-6310.2012.00064.xPubMedGoogle ScholarCrossref
24.
de Blij  HJ, Muller  PO, Nijman  J.  Geography: Realms, Regions, and Concepts. 16th ed. Hoboken, New Jersey: Wiley; 2013.
25.
Munn  Z, Moola  S, Riitano  D, Lisy  K.  The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence.  Int J Health Policy Manag. 2014;3(3):123-128. doi:10.15171/ijhpm.2014.71PubMedGoogle ScholarCrossref
26.
Armijo-Olivo  S, Stiles  CR, Hagen  NA, Biondo  PD, Cummings  GG.  Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research.  J Eval Clin Pract. 2012;18(1):12-18. doi:10.1111/j.1365-2753.2010.01516.xPubMedGoogle ScholarCrossref
27.
Barendregt  JJ, Doi  SA, Lee  YY, Norman  RE, Vos  T.  Meta-analysis of prevalence.  J Epidemiol Community Health. 2013;67(11):974-978. doi:10.1136/jech-2013-203104PubMedGoogle ScholarCrossref
28.
Leonard  T, Duffy  JC.  A Bayesian fixed effects analysis of the Mantel-Haenszel model applied to meta-analysis.  Stat Med. 2002;21(16):2295-2312. doi:10.1002/sim.1048PubMedGoogle ScholarCrossref
29.
DerSimonian  R, Kacker  R.  Random-effects model for meta-analysis of clinical trials: an update.  Contemp Clin Trials. 2007;28(2):105-114. doi:10.1016/j.cct.2006.04.004PubMedGoogle ScholarCrossref
30.
Higgins  JP, Thompson  SG.  Quantifying heterogeneity in a meta-analysis.  Stat Med. 2002;21(11):1539-1558. doi:10.1002/sim.1186PubMedGoogle ScholarCrossref
31.
Higgins  JP, Altman  DG, Gøtzsche  PC,  et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.  BMJ. 2011;343:d5928. doi:10.1136/bmj.d5928PubMedGoogle ScholarCrossref
32.
Júlíusson  PB, Brannsether  B, Kristiansen  H, Hoppenbrouwers  K, Bjerknes  R, Roelants  M.  Should children with overweight or obesity be excluded from height references?  Arch Dis Child. 2015;100(11):1044-1048. doi:10.1136/archdischild-2015-308537PubMedGoogle ScholarCrossref
33.
Ahrens  W, Pigeot  I, Pohlabeln  H,  et al; IDEFICS consortium.  Prevalence of overweight and obesity in European children below the age of 10.  Int J Obes (Lond). 2014;38(suppl 2):S99-S107. doi:10.1038/ijo.2014.140PubMedGoogle ScholarCrossref
34.
Wijnhoven  TM, van Raaij  JM, Spinelli  A,  et al.  WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.  BMC Public Health. 2014;14:806. doi:10.1186/1471-2458-14-806PubMedGoogle ScholarCrossref
35.
Mladenova  S, Andreenko  E.  Prevalence of underweight, overweight, general and central obesity among 8-15-years old Bulgarian children and adolescents (Smolyan region, 2012-2014).  Nutr Hosp. 2015;31(6):2419-2427. doi:10.3305/nh.2015.31.6.8805PubMedGoogle Scholar
36.
Savva  SC, Kourides  YA, Hadjigeorgiou  C, Tornaritis  MJ.  Overweight and obesity prevalence and trends in children and adolescents in Cyprus 2000-2010.  Obes Res Clin Pract. 2014;8(5):e426-e434. doi:10.1016/j.orcp.2013.11.005PubMedGoogle ScholarCrossref
37.
Savva  SC, Tornaritis  MJ, Chadjigeorgiou  C, Kourides  YA, Siamounki  M, Kafatos  A.  Prevalence of overweight and obesity among 11-year-old children in Cyprus, 1997-2003.  Int J Pediatr Obes. 2008;3(3):186-192. doi:10.1080/17477160701705451PubMedGoogle ScholarCrossref
38.
Savva  SC, Tornaritis  M, Chadjigeorgiou  C,  et al.  Prevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cyprus.  Eur J Clin Nutr. 2005;59(11):1259-1265. doi:10.1038/sj.ejcn.1602237PubMedGoogle ScholarCrossref
39.
Ahrens  W, Siani  A, Adan  R,  et al; I.Family consortium.  Cohort profile: the transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort.  Int J Epidemiol. 2017;46(5):1394-1395j. doi:10.1093/ije/dyw317PubMedGoogle Scholar
40.
Eloranta  AM, Lindi  V, Schwab  U,  et al.  Dietary factors associated with overweight and body adiposity in Finnish children aged 6-8 years: the PANIC Study.  Int J Obes (Lond). 2012;36(7):950-955. doi:10.1038/ijo.2012.89PubMedGoogle ScholarCrossref
41.
Heude  B, Lafay  L, Borys  JM,  et al.  Time trend in height, weight, and obesity prevalence in school children from Northern France, 1992-2000.  Diabetes Metab. 2003;29(3):235-240. doi:10.1016/S1262-3636(07)70032-0PubMedGoogle ScholarCrossref
42.
Salanave  B, Peneau  S, Rolland-Cachera  MF, Hercberg  S, Castetbon  K.  Stabilization of overweight prevalence in French children between 2000 and 2007.  Int J Pediatr Obes. 2009;4(2):66-72. doi:10.1080/17477160902811207PubMedGoogle ScholarCrossref
43.
Carriere  C, Langevin  C, Déti  EK, Barberger-Gateau  P, Maurice  S, Thibault  H.  Stabilization of overweight prevalence and improvement of dietary habits in French children between 2004 and 2008.  Public Health Nutr. 2015;18(10):1883-1889. doi:10.1017/S1368980014002195PubMedGoogle ScholarCrossref
44.
Thibault  H, Contrand  B, Saubusse  E, Baine  M, Maurice-Tison  S.  Risk factors for overweight and obesity in French adolescents: physical activity, sedentary behavior and parental characteristics.  Nutrition. 2010;26(2):192-200. doi:10.1016/j.nut.2009.03.015PubMedGoogle ScholarCrossref
45.
Thibault  H, Carriere  C, Langevin  C, Kossi Déti  E, Barberger-Gateau  P, Maurice  S.  Prevalence and factors associated with overweight and obesity in French primary-school children.  Public Health Nutr. 2013;16(2):193-201. doi:10.1017/S136898001200359XPubMedGoogle ScholarCrossref
46.
Beyerlein  A, Toschke  AM, von Kries  R.  Risk factors for childhood overweight: shift of the mean body mass index and shift of the upper percentiles: results from a cross-sectional study.  Int J Obes (Lond). 2010;34(4):642-648. doi:10.1038/ijo.2009.301PubMedGoogle ScholarCrossref
47.
Blüher  S, Meigen  C, Gausche  R,  et al.  Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008.  Int J Pediatr Obes. 2011;6(2-2):e199-e206. doi:10.3109/17477166.2010.526305PubMedGoogle ScholarCrossref
48.
Landsberg  B, Plachta-Danielzik  S, Lange  D, Johannsen  M, Seiberl  J, Müller  MJ.  Clustering of lifestyle factors and association with overweight in adolescents of the Kiel Obesity Prevention Study.  Public Health Nutr. 2010;13(10a):1708-1715. doi:10.1017/S1368980010002260PubMedGoogle ScholarCrossref
49.
Kromeyer-Hauschild  K, Zellner  K.  Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany.  Eur J Clin Nutr. 2007;61(3):404-411. doi:10.1038/sj.ejcn.1602533PubMedGoogle ScholarCrossref
50.
Boneberger  A, von Kries  R, Milde-Busch  A, Bolte  G, Rochat  MK, Rückinger  S; GME Study Group.  Association between peer relationship problems and childhood overweight/obesity.  Acta Paediatr. 2009;98(12):1950-1955. doi:10.1111/j.1651-2227.2009.01484.xPubMedGoogle ScholarCrossref
51.
Nagel  G, Wabitsch  M, Galm  C,  et al.  Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE).  Eur J Pediatr. 2009;168(10):1259-1267. doi:10.1007/s00431-009-1016-yPubMedGoogle ScholarCrossref
52.
Tokmakidis  SP, Kasambalis  A, Christodoulos  AD.  Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity.  Eur J Pediatr. 2006;165(12):867-874. doi:10.1007/s00431-006-0176-2PubMedGoogle ScholarCrossref
53.
Manios  Y, Angelopoulos  PD, Kourlaba  G,  et al.  Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children.  Int J Pediatr Obes. 2011;6(2):135-141. doi:10.3109/17477161003792572PubMedGoogle ScholarCrossref
54.
Manios  Y, Moschonis  G, Chrousos  GP,  et al.  The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study.  J Hum Nutr Diet. 2013;26(5):470-478. doi:10.1111/jhn.12025PubMedGoogle ScholarCrossref
55.
Farajian  P, Panagiotakos  DB, Risvas  G, Malisova  O, Zampelas  A.  Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study.  Eur J Clin Nutr. 2014;68(10):1107-1112. doi:10.1038/ejcn.2014.89PubMedGoogle ScholarCrossref
56.
Kleanthous  K, Dermitzaki  E, Papadimitriou  DT, Papaevangelou  V, Papadimitriou  A.  Overweight and obesity decreased in Greek schoolchildren from 2009 to 2012 during the early phase of the economic crisis.  Acta Paediatr. 2016;105(2):200-205. doi:10.1111/apa.13143PubMedGoogle ScholarCrossref
57.
Grigorakis  DA, Georgoulis  M, Psarra  G, Tambalis  KD, Panagiotakos  DB, Sidossis  LS.  Prevalence and lifestyle determinants of central obesity in children.  Eur J Nutr. 2016;55(5):1923-1931. doi:10.1007/s00394-015-1008-9PubMedGoogle ScholarCrossref
58.
Pikramenou  V, Dimitraki  D, Zoumpoulakis  M, Verykouki  E, Kotsanos  N.  Association between dental caries and body mass in preschool children.  Eur Arch Paediatr Dent. 2016;17(3):171-175. doi:10.1007/s40368-016-0222-3PubMedGoogle ScholarCrossref
59.
Whelton  H, Harrington  J, Crowley  E, Kelleher  V, Cronin  M, Perry  IJ.  Prevalence of overweight and obesity on the island of Ireland: results from the North South Survey of Children’s Height, Weight and Body Mass Index, 2002.  BMC Public Health. 2007;7:187. doi:10.1186/1471-2458-7-187PubMedGoogle ScholarCrossref
60.
Evans  DS, Glacken  M, Goggin  D.  Childhood obesity: the extent of the problem among 6-year-old Irish national school children.  Child Care Health Dev. 2011;37(3):352-359. doi:10.1111/j.1365-2214.2010.01169.xPubMedGoogle ScholarCrossref
61.
Dowd  KP, Kirwan  RP, Hannigan  A, Purtill  H, O’Gorman  CS.  The association between maternal perceptions of own weight status and weight status of her child: results from a national cohort study.  Arch Dis Child. 2016;101(1):28-32. doi:10.1136/archdischild-2015-308721PubMedGoogle ScholarCrossref
62.
Barron  C, Comiskey  C, Saris  J.  Prevalence rates and comparisons of obesity levels in Ireland.  Br J Nurs. 2009;18(13):799-803. doi:10.12968/bjon.2009.18.13.43208PubMedGoogle ScholarCrossref
63.
Reulbach  U, Ladewig  EL, Nixon  E, O’Moore  M, Williams  J, O’Dowd  T.  Weight, body image and bullying in 9-year-old children.  J Paediatr Child Health. 2013;49(4):E288-E293. doi:10.1111/jpc.12159PubMedGoogle ScholarCrossref
64.
Heinen  M, Murrin  C, Daly  L,  et al.  The Childhood Obesity Surveillance Initiative (COSI) in the Republic of Ireland: Findings from 2008, 2010 and 2012. Dublin, Ireland: Health Service Executive; 2014. https://www.hse.ie/eng/services/publications/topics/cosi2012.pdf. Accessed June 21, 2019.
65.
Parrino  C, Rossetti  P, Baratta  R,  et al.  Secular trends in the prevalence of overweight and obesity in Sicilian schoolchildren aged 11-13 years during the last decade.  PLoS One. 2012;7(4):e34551. doi:10.1371/journal.pone.0034551PubMedGoogle ScholarCrossref
66.
Maffeis  C, Consolaro  A, Cavarzere  P,  et al.  Prevalence of overweight and obesity in 2- to 6-year-old Italian children.  Obesity (Silver Spring). 2006;14(5):765-769. doi:10.1038/oby.2006.87PubMedGoogle ScholarCrossref
67.
Albertini  A, Tripodi  A, Fabbri  A,  et al.  Prevalence of obesity in 6- and 9-year-old children living in Central-North Italy: analysis of determinants and indicators of risk of overweight.  Obes Rev. 2008;9(1):4-10.PubMedGoogle Scholar
68.
Bertoncello  C, Cazzaro  R, Ferraresso  A, Mazzer  R, Moretti  G.  Prevalence of overweight and obesity among school-aged children in urban, rural and mountain areas of the Veneto Region, Italy.  Public Health Nutr. 2008;11(9):887-890. doi:10.1017/S1368980007001152PubMedGoogle ScholarCrossref
69.
Genovesi  S, Antolini  L, Giussani  M,  et al.  Hypertension, prehypertension, and transient elevated blood pressure in children: association with weight excess and waist circumference.  Am J Hypertens. 2010;23(7):756-761. doi:10.1038/ajh.2010.50PubMedGoogle ScholarCrossref
70.
Caserta  CA, Pendino  GM, Alicante  S,  et al; MAREA Study Group.  Body mass index, cardiovascular risk factors, and carotid intima-media thickness in a pediatric population in southern Italy.  J Pediatr Gastroenterol Nutr. 2010;51(2):216-220. doi:10.1097/MPG.0b013e3181d4c21dPubMedGoogle ScholarCrossref
71.
Toselli  S, Brasili  P, Spiga  F.  Body image, body dissatisfaction and weight status in children from Emilia-Romagna (Italy): comparison between immigrant and native-born.  Ann Hum Biol. 2014;41(1):23-28. doi:10.3109/03014460.2013.822557PubMedGoogle ScholarCrossref
72.
Ceschia  A, Giacomini  S, Santarossa  S,  et al.  Deleterious effects of obesity on physical fitness in pre-pubertal children.  Eur J Sport Sci. 2016;16(2):271-278. doi:10.1080/17461391.2015.1030454PubMedGoogle ScholarCrossref
73.
OKkio alla SALUTE 2012: sintesi dei risultati. Il Portale dell'Epidemiologia per la Sanità Pubblica. https://www.epicentro.iss.it/okkioallasalute/IndagineNazionale2012. Accessed July 2, 2019.
74.
Nardone  P, Spinelli  A, Buoncristiano  M,  et al.  Il Sistema di Sorveglianza OKkio alla SALUTE: Risultati 2014. Rome, Italy: Istituto Superiore di Sanità; 2016.
75.
Smetanina  N, Albaviciute  E, Babinska  V,  et al.  Prevalence of overweight/obesity in relation to dietary habits and lifestyle among 7-17 years old children and adolescents in Lithuania.  BMC Public Health. 2015;15:1001. doi:10.1186/s12889-015-2340-yPubMedGoogle ScholarCrossref
76.
Decelis  A, Jago  R, Fox  KR.  Physical activity, screen time and obesity status in a nationally representative sample of Maltese youth with international comparisons.  BMC Public Health. 2014;14:664. doi:10.1186/1471-2458-14-664PubMedGoogle ScholarCrossref
77.
de Wilde  JA, van Dommelen  P, Middelkoop  BJ, Verkerk  PH.  Trends in overweight and obesity prevalence in Dutch, Turkish, Moroccan and Surinamese South Asian children in the Netherlands.  Arch Dis Child. 2009;94(10):795-800. doi:10.1136/adc.2009.163709PubMedGoogle ScholarCrossref
78.
Jansen  PW, Roza  SJ, Jaddoe  VW,  et al.  Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study.  Int J Behav Nutr Phys Act. 2012;9:130. doi:10.1186/1479-5868-9-130PubMedGoogle ScholarCrossref
79.
Drukker  M, Wojciechowski  F, Feron  FJ, Mengelers  R, Van Os  J.  A community study of psychosocial functioning and weight in young children and adolescents.  Int J Pediatr Obes. 2009;4(2):91-97. doi:10.1080/17477160802395442PubMedGoogle ScholarCrossref
80.
Kolle  E, Steene-Johannessen  J, Holme  I, Andersen  LB, Anderssen  SA.  Secular trends in adiposity in Norwegian 9-year-olds from 1999-2000 to 2005.  BMC Public Health. 2009;9:389. doi:10.1186/1471-2458-9-389PubMedGoogle ScholarCrossref
81.
Júlíusson  PB, Eide  GE, Roelants  M, Waaler  PE, Hauspie  R, Bjerknes  R.  Overweight and obesity in Norwegian children: prevalence and socio-demographic risk factors.  Acta Paediatr. 2010;99(6):900-905. doi:10.1111/j.1651-2227.2010.01730.xPubMedGoogle ScholarCrossref
82.
Oellingrath  IM, Svendsen  MV, Brantsaeter  AL.  Eating patterns and overweight in 9- to 10-year-old children in Telemark County, Norway: a cross-sectional study.  Eur J Clin Nutr. 2010;64(11):1272-1279. doi:10.1038/ejcn.2010.152PubMedGoogle ScholarCrossref
83.
Chrzanowska  M, Koziel  S, Ulijaszek  SJ.  Changes in BMI and the prevalence of overweight and obesity in children and adolescents in Cracow, Poland, 1971-2000.  Econ Hum Biol. 2007;5(3):370-378. doi:10.1016/j.ehb.2007.08.004PubMedGoogle ScholarCrossref
84.
Kowal  M, Kryst  Ł, Woronkowicz  A, Sobiecki  J.  Long-term changes in body composition and prevalence of overweight and obesity in girls (aged 3-18 years) from Kraków (Poland) from 1983, 2000 and 2010.  Ann Hum Biol. 2014;41(5):415-427. doi:10.3109/03014460.2013.878394PubMedGoogle ScholarCrossref
85.
Popławska  H, Dmitruk  A, Wilczewski  A.  Changes in body adiposity in girls and boys from the rural areas of East Poland over a time span of 20 years.  Ann Hum Biol. 2006;33(1):78-88. doi:10.1080/03014460500446244PubMedGoogle ScholarCrossref
86.
Malecka-Tendera  E, Klimek  K, Matusik  P, Olszanecka-Glinianowicz  M, Lehingue  Y; Polish Childhood Obesity Study Group.  Obesity and overweight prevalence in Polish 7- to 9-year-old children.  Obes Res. 2005;13(6):964-968. doi:10.1038/oby.2005.112PubMedGoogle ScholarCrossref
87.
Kułaga  Z, Litwin  M, Tkaczyk  M,  et al.  Polish 2010 growth references for school-aged children and adolescents.  Eur J Pediatr. 2011;170(5):599-609. doi:10.1007/s00431-010-1329-xPubMedGoogle ScholarCrossref
88.
Mazur  A, Klimek  K, Telega  G, Filip  R, Małecka-Tendera  E.  Ten-year secular trend of overweight and obesity in school children in south-eastern Poland.  Ann Agric Environ Med. 2014;21(3):634-638. doi:10.5604/12321966.1120616PubMedGoogle ScholarCrossref
89.
Kułaga  Z, Gurzkowska  B, Grajda  A, Wojtyło  M, Góźdź  M, Litwin  M.  The prevalence of overweight and obesity among Polish pre-school-aged children.  Dev Period Med. 2016;20(2):143-149.PubMedGoogle Scholar
90.
Marques-Vidal  P, Ferreira  R, Oliveira  JM, Paccaud  F.  Is thinness more prevalent than obesity in Portuguese adolescents?  Clin Nutr. 2008;27(4):531-536. doi:10.1016/j.clnu.2008.04.002PubMedGoogle ScholarCrossref
91.
Padez  C, Mourão  I, Moreira  P, Rosado  V.  Prevalence and risk factors for overweight and obesity in Portuguese children.  Acta Paediatr. 2005;94(11):1550-1557. doi:10.1080/08035250510042924PubMedGoogle ScholarCrossref
92.
Ferreira  RJ, Marques-Vidal  PM.  Prevalence and determinants of obesity in children in public schools of Sintra, Portugal.  Obesity (Silver Spring). 2008;16(2):497-500. doi:10.1038/oby.2007.74PubMedGoogle ScholarCrossref
93.
Antunes  AM, Maia  JA, Stasinopoulos  MD,  et al.  Gross motor coordination and weight status of Portuguese children aged 6-14 years.  Am J Hum Biol. 2015;27(5):681-689. doi:10.1002/ajhb.22715PubMedGoogle ScholarCrossref
94.
Rito  A, Wijnhoven  TM, Rutter  H,  et al.  Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008.  Pediatr Obes. 2012;7(6):413-422. doi:10.1111/j.2047-6310.2012.00068.xPubMedGoogle ScholarCrossref
95.
Seabra  A, Mendonça  D, Maia  J,  et al.  Gender, weight status and socioeconomic differences in psychosocial correlates of physical activity in schoolchildren.  J Sci Med Sport. 2013;16(4):320-326. doi:10.1016/j.jsams.2012.07.008PubMedGoogle ScholarCrossref
96.
Sardinha  LB, Santos  R, Vale  S,  et al.  Prevalence of overweight and obesity among Portuguese youth: a study in a representative sample of 10-18-year-old children and adolescents.  Int J Pediatr Obes. 2011;6(2-2):e124-e128. doi:10.3109/17477166.2010.490263PubMedGoogle ScholarCrossref
97.
Bingham  DD, Varela-Silva  MI, Ferrão  MM,  et al.  Socio-demographic and behavioral risk factors associated with the high prevalence of overweight and obesity in Portuguese children.  Am J Hum Biol. 2013;25(6):733-742. doi:10.1002/ajhb.22440PubMedGoogle ScholarCrossref
98.
Vale  S, Trost  S, Ruiz  JJ, Rêgo  C, Moreira  P, Mota  J.  Physical activity guidelines and preschooler’s obesity status.  Int J Obes (Lond). 2013;37(10):1352-1355. doi:10.1038/ijo.2013.109PubMedGoogle ScholarCrossref
99.
Minghelli  B, Oliveira  R, Nunes  C.  Association of obesity with chronic disease and musculoskeletal factors.  [in Portuguese].  Rev Assoc Med Bras (1992). 2015;61(4):347-354. doi:10.1590/1806-9282.61.04.347PubMedGoogle ScholarCrossref
100.
Rito  AI, Graça  P.  Childhood Obesity Initiative Surveillance. Lisbon, Portugal: Instituto Nacional de Saúde Doutor Ricardo Jorge; 2013. https://www.dgs.pt/documentos-e-publicacoes/childhood-obesity-surveillance-initiative-cosi-portugal-2013-pdf.aspx. Accessed June 27, 2019.
101.
Silva-Santos  S, Santos  A, Vale  S, Mota  J.  Motor fitness and preschooler children obesity status.  J Sports Sci. 2017;35(17):1704-1708. doi:10.1080/02640414.2016.1232486PubMedGoogle ScholarCrossref
102.
Barbu  CG, Teleman  MD, Albu  AI,  et al.  Obesity and eating behaviors in school children and adolescents -data from a cross sectional study from Bucharest, Romania.  BMC Public Health. 2015;15:206. doi:10.1186/s12889-015-1569-9PubMedGoogle ScholarCrossref
103.
Rakić  R, Pavlica  T, Jovičić  D.  Overweight and obesity in children and adolescents from Serbia in the period 2001-2004 and 2011-2014.  Anthropol Anz. 2016;73(2). doi:10.1127/anthranz/2016/0507PubMedGoogle Scholar
104.
Djordjic  V, Radisavljevic  S, Milanovic  I,  et al.  WHO European Childhood Obesity Surveillance Initiative in Serbia: a prevalence of overweight and obesity among 6-9-year-old school children.  J Pediatr Endocrinol Metab. 2016;29(9):1025-1030. doi:10.1515/jpem-2016-0138PubMedGoogle ScholarCrossref
105.
Serra-Majem  L, Aranceta Bartrina  J, Pérez-Rodrigo  C, Ribas-Barba  L, Delgado-Rubio  A.  Prevalence and determinants of obesity in Spanish children and young people.  Br J Nutr. 2006;96(suppl 1):S67-S72. doi:10.1079/BJN20061703PubMedGoogle ScholarCrossref
106.
Martínez-Vizcaíno  V, Sánchez López  M, Moya Martínez  P,  et al.  Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study.  Public Health Nutr. 2009;12(7):1015-1018. doi:10.1017/S1368980008003571PubMedGoogle ScholarCrossref
107.
Martín  JJ, Hernández  LS, Gonzalez  MG, Mendez  CP, Rey Galán  C, Guerrero  SM.  Trends in childhood and adolescent obesity prevalence in Oviedo (Asturias, Spain) 1992-2006.  Acta Paediatr. 2008;97(7):955-958. doi:10.1111/j.1651-2227.2008.00828.xPubMedGoogle ScholarCrossref
108.
Ara  I, Moreno  LA, Leiva  MT, Gutin  B, Casajús  JA.  Adiposity, physical activity, and physical fitness among children from Aragón, Spain.  Obesity (Silver Spring). 2007;15(8):1918-1924. doi:10.1038/oby.2007.228PubMedGoogle ScholarCrossref
109.
García  E, Vázquez López  MÁ, Galera Martínez  R,  et al.  Prevalence of overweight and obesity in children and adolescents aged 2-16 years.  Endocrinol Nutr. 2013;60(3):121-126. doi:10.1016/j.endonu.2012.09.014PubMedGoogle ScholarCrossref
110.
Aguilar Cordero  MJ, González Jiménez  E, García  CJ,  et al.  Obesity in a school children population from Granada: assessment of the efficacy of an educational intervention  [in Spanish].  Nutr Hosp. 2011;26(3):636-641. doi:10.1590/S0212-16112011000300029PubMedGoogle Scholar
111.
Alvarez Caro  F, Díaz Martín  JJ, Riaño Galán  I, Pérez Solís  D, Venta Obaya  R, Málaga Guerrero  S.  Classic and emergent cardiovascular risk factors in schoolchildren in Asturias  [in Spanish].  An Pediatr (Barc). 2011;74(6):388-395. doi:10.1016/j.anpedi.2011.01.007PubMedGoogle ScholarCrossref
112.
Gulías-González  R, Martínez-Vizcaíno  V, García-Prieto  JC, Díez-Fernández  A, Olivas-Bravo  A, Sánchez-López  M.  Excess of weight, but not underweight, is associated with poor physical fitness in children and adolescents from Castilla-La Mancha, Spain.  Eur J Pediatr. 2014;173(6):727-735. doi:10.1007/s00431-013-2233-yPubMedGoogle ScholarCrossref
113.
Sánchez-Cruz  JJ, Jiménez-Moleón  JJ, Fernández-Quesada  F, Sánchez  MJ.  Prevalence of child and youth obesity in Spain in 2012.  Rev Esp Cardiol (Engl Ed). 2013;66(5):371-376. doi:10.1016/j.rec.2012.10.012PubMedGoogle ScholarCrossref
114.
González García  A, Álvarez Bueno  C, Lucas de la Cruz  L,  et al.  Prevalence of thinness, overweight and obesity among 4-to-6-year-old Spanish schoolchildren in 2013; situation in the European context  [in Spanish].  Nutr Hosp. 2015;32(4):1476-1482. doi:10.3305/nh.2015.32.4.9508PubMedGoogle Scholar
115.
Gómez Santos  SF, Estévez Santiago  R, Palacios Gil-Antuñano  N,  et al.  THAO-CHILD health programme: community based intervention for healthy lifestyles promotion to children and families: results of a cohort study.  Nutr Hosp. 2015;32(6):2584-2587. doi:10.3305/nh.2015.32.6.9736PubMedGoogle Scholar
116.
Ortega Anta  RM, López-Sobaler  AM, Aparicio Vizuete  A,  et al.  Estudio ALADINO 2015: Estudio de Vigilancia del Crecimiento, Alimentación, Actividad Física, Desarrollo Infantil y Obesidad en España 2015. Madrid, Spain: Agencia Española de Consumo, Seguridad Alimentaria y Nutrición, Ministerio de Sanidad, Servicios Sociales e Igualdad; 2016.
117.
Mårild  S, Bondestam  M, Bergström  R, Ehnberg  S, Hollsing  A, Albertsson-Wikland  K.  Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index.  Acta Paediatr. 2004;93(12):1588-1595. doi:10.1111/j.1651-2227.2004.tb00848.xPubMedGoogle ScholarCrossref
118.
Sjöberg  A, Lissner  L, Albertsson-Wikland  K, Mårild  S.  Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls.  Acta Paediatr. 2008;97(1):118-123. doi:10.1111/j.1651-2227.2007.00613.xPubMedGoogle ScholarCrossref
119.
Petersen  S, Brulin  C, Bergström  E.  Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001.  Acta Paediatr. 2003;92(7):848-853. doi:10.1111/j.1651-2227.2003.tb02545.xPubMedGoogle ScholarCrossref
120.
Garmy  P, Clausson  EK, Nyberg  P, Jakobsson  U.  Overweight and television and computer habits in Swedish school-age children and adolescents: a cross-sectional study.  Nurs Health Sci. 2014;16(2):143-148. doi:10.1111/nhs.12076PubMedGoogle ScholarCrossref
121.
Moraeus  L, Lissner  L, Sjöberg  A.  Stable prevalence of obesity in Swedish schoolchildren from 2008 to 2013 but widening socio-economic gap in girls.  Acta Paediatr. 2014;103(12):1277-1284. doi:10.1111/apa.12785PubMedGoogle ScholarCrossref
122.
Lasserre  AM, Chiolero  A, Cachat  F, Paccaud  F, Bovet  P.  Overweight in Swiss children and associations with children’s and parents’ characteristics.  Obesity (Silver Spring). 2007;15(12):2912-2919. doi:10.1038/oby.2007.347PubMedGoogle ScholarCrossref
123.
Jeannot  E, Mahler  P, Elia  N, Cerruti  B, Chastonnay  P.  Sociodemographic and economic determinants of overweight and obesity for public-school children in Geneva State, Switzerland: a cross-sectional study.  Int J Prev Med. 2015;6:39. doi:10.4103/2008-7802.156836PubMedGoogle ScholarCrossref
124.
Manios  Y, Kolotourou  M, Moschonis  G,  et al.  Macronutrient intake, physical activity, serum lipids and increased body weight in primary schoolchildren in Istanbul.  Pediatr Int. 2005;47(2):159-166. doi:10.1111/j.1442-200x.2005.02047.xPubMedGoogle ScholarCrossref
125.
Sur  H, Kolotourou  M, Dimitriou  M,  et al.  Biochemical and behavioral indices related to BMI in schoolchildren in urban Turkey.  Prev Med. 2005;41(2):614-621. doi:10.1016/j.ypmed.2004.11.029PubMedGoogle ScholarCrossref
126.
Pirinçci  E, Durmuş  B, Gündoğdu  C, Açik  Y.  Prevalence and risk factors of overweight and obesity among urban school children in Elazig city, Eastern Turkey, 2007.  Ann Hum Biol. 2010;37(1):44-56. doi:10.3109/03014460903218984PubMedGoogle ScholarCrossref
127.
Agirbasli  M, Adabag  S, Ciliv  G.  Secular trends of blood pressure, body mass index, lipids and fasting glucose among children and adolescents in Turkey.  Clin Obes. 2011;1(4-6):161-167. doi:10.1111/j.1758-8111.2012.00033.xPubMedGoogle ScholarCrossref
128.
Senol  V, Unalan  D, Bayat  M, Mazicioglu  MM, Ozturk  A, Kurtoglu  S.  Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents.  J Pediatr Endocrinol Metab. 2014;27(11-12):1121-1129. doi:10.1515/jpem-2013-0467PubMedGoogle Scholar
129.
Dummer  TJ, Gibbon  MA, Hackett  AF, Stratton  G, Taylor  SR.  Is overweight and obesity in 9-10-year-old children in Liverpool related to deprivation and/or electoral ward when based on school attended?  Public Health Nutr. 2005;8(6):636-641. doi:10.1079/PHN2005719PubMedGoogle ScholarCrossref
130.
Bartle  NC, Hill  C, Webber  L, van Jaarsveld  CH, Wardle  J.  Emergence and persistence of overweight and obesity in 7- to 11-year-old children.  Obes Facts. 2013;6(5):415-423. doi:10.1159/000355677PubMedGoogle ScholarCrossref
131.
Basterfield  L, Jones  AR, Parkinson  KN,  et al; Gateshead Millennium Study Core Team.  Physical activity, diet and BMI in children aged 6-8 years: a cross-sectional analysis.  BMJ Open. 2014;4(6):e005001. doi:10.1136/bmjopen-2014-005001PubMedGoogle ScholarCrossref
132.
Steele  RM, van Sluijs  EM, Cassidy  A, Griffin  SJ, Ekelund  U.  Targeting sedentary time or moderate- and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children.  Am J Clin Nutr. 2009;90(5):1185-1192. doi:10.3945/ajcn.2009.28153PubMedGoogle ScholarCrossref
133.
Lobstein  T, Baur  L, Uauy  R; IASO International Obesity TaskForce.  Obesity in children and young people: a crisis in public health.  Obes Rev. 2004;5(suppl 1):4-104. doi:10.1111/j.1467-789X.2004.00133.xPubMedGoogle ScholarCrossref
134.
Olds  T, Maher  C, Zumin  S,  et al.  Evidence that the prevalence of childhood overweight is plateauing: data from nine countries.  Int J Pediatr Obes. 2011;6(5-6):342-360. doi:10.3109/17477166.2011.605895PubMedGoogle ScholarCrossref
135.
Bonaccio  M, Iacoviello  L, de Gaetano  G; Moli-Sani Investigators.  The Mediterranean diet: the reasons for a success.  Thromb Res. 2012;129(3):401-404. doi:10.1016/j.thromres.2011.10.018PubMedGoogle ScholarCrossref
136.
Roccaldo  R, Censi  L, D’Addezio  L,  et al; ZOOM8 Study group.  Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study).  Int J Food Sci Nutr. 2014;65(5):621-628. doi:10.3109/09637486.2013.873887PubMedGoogle ScholarCrossref
137.
Kalman  M, Inchley  J, Sigmundova  D,  et al.  Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective.  Eur J Public Health. 2015;25(suppl 2):37-40. doi:10.1093/eurpub/ckv024PubMedGoogle ScholarCrossref
138.
Van Hecke  L, Loyen  A, Verloigne  M,  et al; DEDIPAC consortium.  Variation in population levels of physical activity in European children and adolescents according to cross-European studies: a systematic literature review within DEDIPAC.  Int J Behav Nutr Phys Act. 2016;13:70. doi:10.1186/s12966-016-0396-4PubMedGoogle ScholarCrossref
139.
Shrewsbury  V, Wardle  J.  Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005.  Obesity (Silver Spring). 2008;16(2):275-284. doi:10.1038/oby.2007.35PubMedGoogle ScholarCrossref
140.
Karanikolos  M, Mladovsky  P, Cylus  J,  et al.  Financial crisis, austerity, and health in Europe.  Lancet. 2013;381(9874):1323-1331. doi:10.1016/S0140-6736(13)60102-6PubMedGoogle ScholarCrossref
141.
Ludwig  DS, Pollack  HA.  Obesity and the economy: from crisis to opportunity.  JAMA. 2009;301(5):533-535. doi:10.1001/jama.2009.52PubMedGoogle ScholarCrossref
142.
Wisniewski  AB, Chernausek  SD.  Gender in childhood obesity: family environment, hormones, and genes.  Gend Med. 2009;6(suppl 1):76-85. doi:10.1016/j.genm.2008.12.001PubMedGoogle ScholarCrossref
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