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WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools
Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark .
Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands .
Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland; National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland .
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2014 (English)In: International Journal of Environment and Bioenergy, ISSN 1832-2077, E-ISSN 1660-4601, Vol. 11, no 11, 11261-11285 p.Article in journal (Refereed) Published
Abstract [en]

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention.

Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries.

Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated.

Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed.

Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

Place, publisher, year, edition, pages
2014. Vol. 11, no 11, 11261-11285 p.
Keyword [en]
school policy; monitoring; healthy school environment; nutrition; physical activity; overweight; primary schools; Europe
National Category
Medical and Health Sciences Environmental Sciences
Research subject
Pediatrics; Public health; Culinary Arts and Meal Science
URN: urn:nbn:se:uu:diva-304952DOI: 10.3390/ijerph111111261ISI: 000345532000015PubMedID: 25361044ScopusID: 2-s2.0-84908349931OAI: oai:DiVA.org:uu-304952DiVA: diva2:1034304
WHO Childhood Obesity Surveillance Initiative COSI
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council

Funding Agencies:

Bulgaria: Ministry of Health

Bulgaria: National Center of Public Health and Analyses

Bulgaria: Regional Health Inspectorates

Czech Republic: Internal Grant Agency of the Ministry of Health IGA NS/9832-4

Greece: Hellenic Medical Association for Obesity

Greece: Alexander Technological Educational Institute of Thessaloniki

Hungary: National Institute for Food and Nutrition Science

Hungary: Chamber of Hungarian Health Care Professionals

Ireland: Health Service Executive

Ireland: Department of Health

Latvia: Centre for Disease Prevention and Control

Lithuania: Lithuanian State Science and Studies Foundation

Lithuania: Lithuanian University of Health Sciences

Lithuania: Research Council of Lithuania SIN-17/2012

Malta: Primary Health Care Department

Norway: Norwegian Institute of Public Health

Norway: Directorate of Health

Portugal: Ministry of Health

Portugal: Regional Health Directorates

Slovenia: Ministry of Education, Science and Sport

General Health Directorate of Portugal

National Health Institute Doutor Ricardo Jorge in Lisbon, Portugal

National Institute of Health in Rome, Italy

Norwegian Institute of Public Health in Oslo, Norway

Hellenic Medical Association for Obesity in Athens, Greece

Directorate-General for Health of France

Karolinska Institute in Huddinge, Sweden

Available from: 2014-11-02 Created: 2016-10-11 Last updated: 2016-10-11

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