In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.

Biomedical Sciences Department Faculty of Sport and Physical Education University of Novi Sad Novi Sad Serbia

Center for Health Ecology Institute of Public Health Podgorica Montenegro

Children's Hospital National Institute of Children's Diseases Medical Faculty Comenius University Bratislava Slovakia

Croatian Institute of Public Health Zagreb Croatia

Departement of Non Communicable Diseases and Traumatisms Santé publique France the French Public Health Agency Saint Maurice France

Department Food and Nutrition National Center of Public Health and Analyses Sofia Bulgaria

Department of Cardiology Institute of Mother and Child Warsaw Poland

Department of Clinical Science University of Bergen Bergen Norway

Department of Health Promotion and Centre for Evaluation of Public Health Measures Norwegian Institute of Public Health Bergen Norway

Department of Health Registry Research and Development Norwegian Institute of Public Health Bergen Norway

Department of Hygiene Health Ecology Service Institute of Public Health of Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina

Department of Living Conditions and Lifestyle Public Health Agency of Sweden Solna Sweden

Department of Medical and Public Health Services Ministry of Health Nicosia Cyprus

Department of Nutrition Research National Institute for Health Development Tallinn Estonia

Department of Nutritional Sciences and Dietetics International Hellenic University Thessaloniki Greece

Department of Pediatrics Paracelsus Medical University Salzburg Austria

Department of Preventive Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Research and Health Statistics Centre for Disease and Prevention Control Riga Latvia

Department of Science and Professional Development National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan Almaty Kazakhstan

Department of Social and Policy Sciences University of Bath Bath UK

Department of the Organization of Medical Services for Mothers Children and Family Planning Ministry of Health and Social Protection Dushanbe Tajikistan

Division of Noncommunicable Diseases and Promoting Health through the Life course WHO Tajikistan Country Office Dushanbe Tajikistan

Faculty for Sport and Physical Education University of Montenegro Niksic Montenegro

Faculty of Medicine Department of Public Health and Management University of Medicine and Pharmacy Carol Davila Bucharest Bucharest Romania

Faculty of Medicine Ss Cyril and Methodius University Skopje North Macedonia

Faculty of Medicine University of Banja Luka Banja Luka Bosnia and Herzegovina

Faculty of Midwifery and Nursing Discipline of Public health and Health Management University of Medicine and Pharmacy Carol Davila Bucharest Bucharest Romania

Faculty of Sport University of Ljubljana Ljubljana Slovenia

Federal Ministry Social Affairs Health Care and Consumer Protection Division of Mother Child Gender Health and Nutrition Vienna Austria

Health Authority Ministry of Health San Marino San Marino

Health Promotion and Inequality Danish Health Authority Copenhagen Denmark

Hungarian School Sport Federation Budapest Hungary

Institute of Child and Adolescent Health Arabkir Medical Centre Institute of Child and Adolescent Health Yerevan Armenia

Institute of Paediatric Endocrinology National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation Moscow Russian Federation

Institute of Public Health Skopje North Macedonia

Kazakhstan School of Public Health Kazakhstan's Medical University Almaty Kazakhstan

Maternal Child and Reproductive Health National Center for Disease Control and Public Health of Georgia Tbilisi Georgia

Medical Faculty Department of Public Health Hacettepe University Ankara Turkey

Montenegrin Sports Academy Podgorica Montenegro

National Center of Public Health Ministry of Health of the Republic of Kazakhstan WHO Collaborating Center for Promoting Healthy Lifestyle Nur Sultan Kazakhstan

National Centre for Disease Prevention and Health Promotion Italian National Institute of Health Rome Italy

National Centre of Health Promotion and Health Evaluation National Institute of Public Health Bucharest Romania

National Nutrition Surveillance Centre School of Public Health Physiotherapy and Sports Science University College Dublin Dublin Ireland

Nutrition and Food Safety Sector Institute of Public Health Tirana Albania

Nutritional Surveillance and Epidemiology Team University Sorbonne Paris Nord Bobigny France

Obesity Management Centre Institute of Endocrinology Prague Czech Republic

Primary Child Health Unit Primary Health Care Floriana Malta

Public Health and Welfare Finnish Institute for Health and Welfare Helsinki Finland

Public Health Institute of Republic of Srpska Banja Luka Bosnia and Herzegovina

Republican Center for Health Promotion and Mass Communication Ministry of Health of the Kyrgyz Republic Bishkek Kyrgyzstan

School of Medicine University of Zagreb Zagreb Croatia

Scientific Research Institute of Maternal and Child Health Ashgabat Turkmenistan

Spanish Agency for Food Safety and Nutrition Ministry of Consumer Affairs Madrid Spain

WHO Europe Collaborating Center for Nutrition and Childhood Obesity Food and Nutrition Department National Institute of Health Dr Ricardo Jorge Lisbon Portugal

World Health Organization Child and Adolescent Health and Development WHO Regional Office for Europe Copenhagen Denmark

World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases Division of Country Health Programmes WHO Regional Office for Europe Moscow Russian Federation

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