title: Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries.
abstract: BACKGROUND
  The present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries.
  
  
  METHODS
  Data were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children's height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers' attitude, and country-level indicators to examine the correlates of overweight.
  
  
  RESULTS
  Overall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West.
  
  
  CONCLUSIONS
  Prevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions.
authors.affiliation: Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu (Universitat de Barcelona), Sant Boi de Llobregat, Spain. beatriz.olaya@pssjd.org.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. beatriz.olaya@pssjd.org.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olaya
authors.affiliation: Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu (Universitat de Barcelona), Sant Boi de Llobregat, Spain. mvictoria.moneta@pssjd.org.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. mvictoria.moneta@pssjd.org.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Moneta
authors.affiliation: EHESP Rennes, Sorbonne Paris Cité, EA 4069 Université Paris Descartes, Paris, France. pez_ondine@hotmail.com.|Departmental House for Adolescents (Maison Départementale des Adolescents), Hautes-Alpes, France. pez_ondine@hotmail.com.
authors.forename: Ondine
authors.initials: O
authors.lastname: Pez
authors.affiliation: The Romanian League for Mental Health, Bucharest, Romania. adinapetricamd@yahoo.com.
authors.forename: Adina
authors.initials: A
authors.lastname: Bitfoi
authors.affiliation: Liaison Pyschiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy. mgcarta@tiscali.it.
authors.forename: Mauro Giovanni
authors.initials: MG
authors.lastname: Carta
authors.affiliation: Yeniden Health and Education Society, Istanbul, Turkey. ceydaeke@hotmail.com.
authors.forename: Ceyda
authors.initials: C
authors.lastname: Eke
authors.affiliation: Institute of Psychology, University of Koblenz-Landau (Campus Koblenz), Koblenz, Germany. goelitz@uni-koblenz.de.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Goelitz
authors.affiliation: Department of Epidemiology, Columbia University, New York, USA. kmk2104@columbia.edu.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands. r.kuijpers@acsw.ru.nl.
authors.forename: Rowella
authors.initials: R
authors.lastname: Kuijpers
authors.affiliation: Clinic of Psychiatry, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania. sigita.lesinskiene@mf.vu.lt.
authors.forename: Sigita
authors.initials: S
authors.lastname: Lesinskiene
authors.affiliation: New Bulgarian University, Sophia, Bulgaria. zmihova@doctor.bg.
authors.forename: Zlatka
authors.initials: Z
authors.lastname: Mihova
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands. r.otten@bsi.ru.nl.|Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands. r.otten@bsi.ru.nl.
authors.forename: Roy
authors.initials: R
authors.lastname: Otten
authors.affiliation: EHESP Rennes, Sorbonne Paris Cité, EA 4069 Université Paris Descartes, Paris, France. Christophe.Fermanian@ehesp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.affiliation: Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu (Universitat de Barcelona), Sant Boi de Llobregat, Spain. jmharo@pssjd.org.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. jmharo@pssjd.org.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: EHESP Rennes, Sorbonne Paris Cité, EA 4069 Université Paris Descartes, Paris, France. vkovess@gmail.com.
authors.forename: Viviane
authors.initials: V
authors.lastname: Kovess
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D005518:Food Preferences; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D010287:Parent-Child Relations; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D012574:Schools