Cosy Up With COSI

The concept of Childhood Obesity Awareness Month contains a cruel irony. One might be tempted to say, “Oh, really? Childhood obesity is still a thing? Glad you brought it up. I wouldn’t have guessed, just from seeing all these, you know, severely obese and ominously overweight children everywhere.”

Are more children dangerously heavy than ever before?

“Surveillance” is not everyone’s favorite word, but the European Childhood Obesity Surveillance Initiative (COSI) is trying to do something useful.

The system was established by the World Health Organization with the intention of providing “regular, reliable, timely, and accurate data on children’s weight status.” This is accomplished by recording the weight and height of every child in 45 European Region countries, according to a standardized measurement system.

Much information is gathered, on the kids’ family backgrounds, school environments, diet, activity, proneness to a sedentary lifestyle, and so forth. The goal is to “standardize conditions around data collection as much as possible, while still allowing participating countries some flexibility to adapt the system to their national context”:

Data are collected according to a common protocol devised by the WHO Regional Office for Europe and Member States… The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children…

The system they have worked out to avoid being rejected by some countries, while still keeping up the standard, is very interesting. Even the translation protocols are elaborate and demanding. COSI’s most recent research indicates that…

Overall, the prevalence of overweight (including obesity) was 29% in boys and 27% in girls aged 6 to 9 years; the prevalence of obesity was 13% in boys and 9% in girls.

The highest proportions of childhood overweight and obesity were observed in Mediterranean countries such as Cyprus, Greece, Italy and Spain…

The lowest […] were observed in central Asian countries such as Kyrgyzstan, Tajikistan and Turkmenistan.

Bear in mind that it takes a burdensome amount of time to collect and collate all the numbers involved, from so many different places and bureaucracies, and in various different languages. So, nothing about this is up-to-the-minute. But anyone who assumes that since the information was gathered, the situation has only become worse, will probably be correct.

Your responses and feedback are welcome!

Source: “Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI),”, 11/04/21
Source: “WHO Joint Session Including the Results of the Latest Childhood Obesity Surveillance Initiative (COSI) Report,”, 04/11/21
Image by Mohd Fazlin Mohd Effendy Ooi/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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