WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6–9-year-old schoolchildren
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Objective: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. Design: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children’s behavioural data were reported by their parents and children’s weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed. Setting: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic. Subjects: Nationally representative samples of 6–9-year-olds (n 15 643). Results: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating ‘foods like pizza, French fries, hamburgers, sausages or meat pies’ >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity. Conclusions: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.
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How combinations of movement behaviors are associated with obesity is largely unknown, as few studies have examined specific recommendation combinations and obesity, and only a subset have considered sleep duration as a health-related risk behavior in combined analyses.
“How combinations of these movements behaviors are associated with obesity is largely unknown as few studies have examined the influence of meeting specific movement behavior recommendation combinations and obesity, and only a subset have considered sleep duration as a health-related risk behavior in combined analyses [11–18].”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [17]
Most studies on this topic have been conducted in developed countries and only a few have included a multi-country analysis.
“In addition, most of the studies have been conducted in developed countries and only a few have included a multi-country analysis [16–18].”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [17]
The results are similar to those found in the WHO analysis where only 8% of children achieved the best classification in the physical activity-risk behavior score and the Canadian and US studies, with a range of compliance between 5 and 17% of the population.
“The results are similar to those found in the WHO analysis [17] where only 8% of children achieved the best classification in the physical activity-risk behavior score and the Canadian and US studies, with a range of compliance between 5 and 17% of the population [12–14].”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [17]
Wijnhoven et al. found that children with an unhealthier physical activity-risk behavior score were more likely to be obese than children with a better score.
“They found that children with an unhealthier physical activity-risk behavior score (defined as the combination of the use of inactive transportation going to and from school, going to a sports or dancing club less than 2 days/week, playing outside less than 1 h/day, engaging in screen time 2 or more hours/day, and a sleep duration lower than 9 h/day) were more likely to be obese than children with”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [17]
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- Authors
- Wijnhoven, T. M., van Raaij, J. M., Yngve, A., Sjöberg, A., Kunešová, M., Duleva, V., Petrauskiene, A., Rito, A. I., & Breda, J.
- Affiliations
- World Health Organization Regional Office for Europe (DK)
- Örebro University (SE)
- University of Gothenburg (SE)
- Institute of Endocrinology (CZ)
- National Center of Public Health and Analyses (BG)
- National Institute of Health Dr. Ricardo Jorge (PT)
- Corresponding author
- Wijnhoven, Trudy MA
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-07-01
- Volume
- 18
- Issue
- 17
- Pages
- 3108-3124
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC4642225
- OpenAlex
- W2106863525
- Cited by
- 122
- References
- 57
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 14 · 2019: 14 · 2018: 13 · 2017: 15 · 2016: 3 · 2015: 4 · 2014: 10 · 2013: 6
- FWCI
- 12.37
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Public Health Nutrition (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by)
- Lithuanian University of Health Sciences (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Funders
- World Health Organization
- Vetenskapsrådet
- Lietuvos Mokslo Taryba
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- Lietuvos Sveikatos Mokslų Universitetas
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- childhood obesity, health risk behaviors, breakfast skipping, screen time, sleep duration, physical activity, unhealthy diet, fast food consumption, elementary school students, multiple risk behaviors, cross-national comparison
- MeSH terms
- Child, Child Behavior, Child Nutritional Physiological Phenomena, Cross-Sectional Studies, Diet, Europe, Female, Health Promotion, Humans, Male, Motor Activity, Nutrition Surveys, Parents, Patient Compliance, Risk, World Health Organization, Body Mass Index, Prevalence, Sedentary Behavior, Breakfast, Epidemiological Monitoring, Pediatric Obesity
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