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Journal of Pediatric Endocrinology and Metabolism

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Volume 29, Issue 9


WHO European Childhood Obesity Surveillance Initiative in Serbia: a prevalence of overweight and obesity among 6–9-year-old school children

Visnja Djordjic / Snezana Radisavljevic / Ivana Milanovic / Predrag Bozic / Miljana Grbic / Jagoda Jorga / Sergej M. Ostojic
  • Corresponding author
  • Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
  • University of Belgrade School of Medicine, Belgrade, Serbia
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  • Other articles by this author:
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Published Online: 2016-08-22 | DOI: https://doi.org/10.1515/jpem-2016-0138



The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) is a public health program established in order to understand the progress of the obesity epidemic in young populations and gain inter-country comparisons within the European region, yet the data from a number of East European countries, including Serbia, were not available then. Therefore, the main aim of this cross-sectional study was to collect data about the prevalence of overweight and obesity among 6–9-year-old school children in Serbia according to the standardized protocol during the Fourth COSI Implementation Round.


From September 2015 to November 2015, 5102 first- and second-grade primary-school children (age 7.7±0.6 years) were assessed for weight, height, and body mass index (BMI) in 14 Serbian school districts.


The prevalence rates of obesity, as calculated using the International Obesity Task Force (IOTF) cut-off points, vary across different age groups, with the lowest obesity rates reported in 7-year-old boys (6.2%), while the highest obesity prevalence rates were observed in 6-year-old boys (9.7%). In addition, being overweight was strongly associated with poor local community development and lower level of urbanization. The overall prevalence of overweight (23.1%, including obesity) and obesity (6.9%) in Serbian primary-school children seem to be comparable to rather high rates previously reported in other countries participating in the COSI program, indicating an obesity epidemic in Serbian children.


This surveillance system should be regularly implemented throughout Europe, providing comparable data on rates of overweight/obesity in primary schools that might drive prudent actions to reverse the pandemic trend of childhood obesity.

Keywords: body weight; children; height; north-south gradient; obesity; overweight; public health surveillance


  • 1.

    UNICEF, WHO, World Bank. Levels and trends in child malnutrition: UNICEF-WHO-World Bank joint child malnutrition estimates. New York: UNICEF; Geneva: WHO; Washington: World Bank, 2015.Google Scholar

  • 2.

    Datar A, Chung PJ. Changes in socioeconomic, racial/ethnic, and sex disparities in childhood obesity at school entry in the United States. JAMA Pediatr 2015;169:696–7.Google Scholar

  • 3.

    Brown CL, Halvorson EE, Cohen GM, Lazorick S, Skelton JA. Addressing childhood obesity: opportunities for prevention. Pediatr Clin North Am 2015;62:1241–61.Google Scholar

  • 4.

    Wijnhoven TM, van Raaij JM, Spinelli A, Starc G, Hassapidou M, 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.Google Scholar

  • 5.

    Ostojic SM, Stojanovic MD, Stojanovic V, Maric J, Njaradi N. Correlation between fitness and fatness in 6–14-year old Serbian school children. J Health Popul Nutr 2011;29:53–60.Google Scholar

  • 6.

    Wang Y. Epidemiology of childhood obesity – methodological aspects and guidelines: what is new? Int J Obes Relat Metab Disord 2004;28(S3):S21–8.Google Scholar

  • 7.

    Member States Consultation. Copenhagen: WHO Regional Office for Europe, 2006.Google Scholar

  • 8.

    Wijnhoven T, van Raaij J, Breda J. WHO European Childhood Obesity Surveillance Initiative. Copenhagen: WHO Regional Office for Europe; 2014.Google Scholar

  • 9.

    Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 2012;7:284–94.Google Scholar

  • 10.

    [Act on Estimating Local Community Development Methodology]. Official Gazzete. 2011;68. In Serbian.

  • 11.

    Cattaneo A, Monasta L, Stamatakis E, Lioret S, Castetbon K, et al. Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev 2010;11:389–98.Google Scholar

  • 12.

    Lobstein T, Frelut ML. Prevalence of overweight among children in Europe. Obes Rev 2003;4:195–200.Google Scholar

  • 13.

    Binkin N, Fontana G, Lamberti A, Cattaneo C, Baglio G, et al. A national survey of the prevalence of childhood overweight and obesity in Italy. Obes Rev 2010;11:2–10.Google Scholar

  • 14.

    Rito AI, Paixăo E, Carvalho MA, Ramos C. Childhood Obesity Surveillance Initiative: COSI Portugal 2008. Lisbon: National Institute of Health Dr Ricardo Jorge, 2011.Google Scholar

  • 15.

    Sjöberg A, Moraeus L, Yngve A, Poortvliet E, Al-Ansari U, et al. Overweight and obesity in representative sample of schoolchildren – exploring the urban–rural gradient in Sweden Obes Rev 2011;12:305–14.Google Scholar

  • 16.

    Sant Angelo VF, Grech V. Comparison of body mass index of a national cohort of Maltese children over a 3-year interval. Malta Med J 2011;23:34–9.Google Scholar

  • 17.

    Özkan S, Özcebe H, Yardim N, Tülay A. Turkey Childhood (Ages 7–8) Obesity Surveillance Initiative (COSI-TUR) 2013. Ankara: Republic of Turkey Ministry of Health, 2014.Google Scholar

  • 18.

    Williams G, Frühbeck G. Obesity: Science to practice. Chicester: Wiley-Blackwell, 2009.Google Scholar

  • 19.

    Biehl A, Hovengen R, Groholt EK, Hjelmesæth J, Strand BH, et al. Adiposity among children in Norway by urbanity and maternal education: a nationally representative study. BMC Public Health 2013;13:842.Google Scholar

  • 20.

    Moraeus L, Lissner L, Yngve A, Poortvliet E, Al-Ansari U, et al. Multilevel influences on childhood obesity in Sweden: societal factors, parental determinants and child’s lifestyle. Int J Obes 2012;36:969–76.Google Scholar

  • 21.

    Thornorisdottir IE, Kristjansson AL, Sigfusdottir ID, Allegrante JP. The landscape of overweight and obesity in icelandic adolescents: geographic variation in body-mass index between 2000 and 2009. J Community Health 2012;37:234–41.Google Scholar

  • 22.

    World Health Organisation. Social determinants of health: key concepts. Geneva: WHO, 2011.Google Scholar

  • 23.

    Winkler A. Measuring regional inequality: an index of socio-economic pressure for Serbia. Collection of Papers – Faculty of Geography at University of Belgrade 2012;60:81–102.Google Scholar

  • 24.

    Robertson A, Lobstein T, Knai C. Obesity and socio-economic groups in Europe: evidence review and implications for action. Brussels: European Commission, 2007.Google Scholar

  • 25.

    Lipek T, Igel U, Gausche R, Kiess W, Grande G. Obesogenic environments: environmental approaches to obesity prevention. J Pediatr Endocrinol Metab 2015;28:485–95.Google Scholar

  • 26.

    Hirschler V, Calcagno ML, Clemente AM, Aranda C, Gonzalez C. Association between school children’s overweight and maternal obesity and perception of their children’s weight status. J Pediatr Endocrinol Metab 2008;21:641–9.Google Scholar

About the article

Corresponding author: Professor Sergej M. Ostojic, MD, PhD, Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Lovcenska 16, Novi Sad 21000, Serbia, Phone: (+381)-21-450-188, Fax: (+381)-21-450-199

Received: 2016-04-07

Accepted: 2016-07-18

Published Online: 2016-08-22

Published in Print: 2016-09-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This study was supported by the World Health Organization (Ref. File 2015-540940), the Serbian Ministry of Education, Science and Technological Development (Grant No. 175037), the Faculty of Sport and Physical Education, University of Novi Sad (2015 Annual Award) and the Center for Health, Exercise and Sports Sciences (Award No. 16-08-15).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 29, Issue 9, Pages 1025–1030, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2016-0138.

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