The Childhood Obesity Surveillance Initiative (COSI) routinely measures height and weight of primary school children aged 6-9 years and calculates overweight and obesity prevalence within the World Health Organization (WHO) European Region using a standard methodology. This study examines the trends in the prevalence of overweight and obesity from the first round of COSI carried out in 2007/2008 to the latest of 2015/2017 in 11 European countries in which data were collected for at least three rounds. In total 303,155 children were measured. In general, the prevalence of overweight and obesity among boys and girls decreased in countries with high prevalence (Southern Europe) and remained stable or slightly increased in Northern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from 40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in 2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in the proportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to 12.2%). The trends were similar for boys and girls in most countries. Several countries in Europe have successfully implemented policies and interventions to counteract the increase of overweight and obesity, but there is still much to be done.

College of Health and Agricultural Sciences University College Dublin Dublin Ireland

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

Department of Nutrition University of Oslo Oslo Norway

Department of Nutritional Sciences and Dietetics International Hellenic University Thessaloniki Greece

Department of Preventive Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Public Health School of Medicine Universidad de Málaga Málaga Spain

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

Faculty of Sport University of Ljubljana Ljubljana Slovenia

Instituto de Investigación Biomédica de Málaga Málaga Spain

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

Norwegian Institute of Public Health Oslo Norway

Obesity Management Centre Institute of Endocrinology Prague Czech Republic

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 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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