title: WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic.
  
  
  METHODS
  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.
authors.affiliation: 1Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe,UN City,Marmorvej 51,DK-2100 Copenhagen Ø,Denmark.
authors.forename: Trudy M A
authors.initials: TM
authors.lastname: Wijnhoven
authors.affiliation: 2Centre for Nutrition,Prevention and Health Services,National Institute for Public Health and the Environment,Bilthoven,The Netherlands.
authors.forename: Joop M A
authors.initials: JM
authors.lastname: van Raaij
authors.affiliation: 4School of Hospitality,Culinary Arts and Meal Science,Örebro University,Grythyttan,Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Yngve
authors.affiliation: 5Department of Food and Nutrition and Sport Science,University of Gothenburg,Gothenburg,Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Sjöberg
authors.affiliation: 6Obesity Management Centre,Institute of Endocrinology,Prague,Czech Republic.
authors.forename: Marie
authors.initials: M
authors.lastname: Kunešová
authors.affiliation: 7Department of Food and Nutrition,National Center of Public Health and Analyses,Sofia,Bulgaria.
authors.forename: Vesselka
authors.initials: V
authors.lastname: Duleva
authors.affiliation: 8Department of Preventive Medicine,Lithuanian University of Health Sciences,Kaunas,Lithuania.
authors.forename: Ausra
authors.initials: A
authors.lastname: Petrauskiene
authors.affiliation: 9National Health Institute Doutor Ricardo Jorge,Lisbon,Portugal.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Rito
authors.affiliation: 1Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe,UN City,Marmorvej 51,DK-2100 Copenhagen Ø,Denmark.
authors.forename: João
authors.initials: J
authors.lastname: Breda
mesh_terms: D015992:Body Mass Index; D062408:Breakfast; D002648:Child; D002652:Child Behavior; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects*; D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D009043:Motor Activity; D009749:Nutrition Surveys; D010290:Parents; D010349:Patient Compliance; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D012306:Risk; D057185:Sedentary Behavior; D014944:World Health Organization
keywords: Europe; Food consumption; Obesity; Physical activity; Schoolchildren