Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI)

João Breda, Karen McColl, Marta Buoncristiano, Julianne Williams, Shynar Abdrakhmanova, Zulfiya Abdurrahmonova, Wolfgang Ahrens, Dilorom Akhmedova, Márta Bakacs, Jolanda M.A. Boer, Khadichamo Boymatova, Lacramioara Aurelia Brinduse, Alexandra Cucu, Vesselka Duleva, Ronit Endevelt, Victoria Farrugia Sant'Angelo, Anna Fijałkowska, Aida Filipović Hadžiomeragić, Marta García-Solano, Else Karin GrøholtAndrea Gualtieri, Maria Hassapidou, Tatjana Hejgaard, Jolanda Hyska, Cecily C. Kelleher, Enisa Kujundžić, Päivi Mäki, Eliza Markidou Ioannidou, Marina Melkumova, Isabelle Moyersoen, Sanja Musić Milanović, Eha Nurk, Sergej M. Ostojic, Valentina Peterkova, Aušra Petrauskienė, Iveta Pudule, Ana Isabel Rito, Kenisha Russell Jonsson, Harry Rutter, Benoît Salanave, Nabil Seyidov, Lela Shengelia, Natalia Silitrari, Angela Spinelli, Igor Spiroski, Gregor Starc, Dragana Stojisavljević, Maya Tanrygulyyeva, Ľubica Tichá, Zhamilya Usupova, Daniel Weghuber, Nazan Yardim, Hana Zamrazilová, Vladyslav Zbanatskyi, Francesco Branca, Martin Weber, Ivo Rakovac

Research output: Contribution to journalArticlepeer-review


Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI) has resulted in a surveillance system which provides regular, reliable, timely, and accurate data on children's weight status—through standardized measurement of bodyweight and height—in the WHO European Region. Additional data on dietary intake, physical activity, sedentary behavior, family background, and school environments are collected in several countries. In total, 45 countries in the European Region have participated in COSI. The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI, data are collected according to a common protocol, using standardized instruments and procedures. The systematic collection and analysis of these data enables intercountry comparisons and reveals differences in the prevalence of childhood thinness, overweight, normal weight, and obesity between and within populations. Furthermore, it facilitates investigation of the relationship between overweight, obesity, and potential risk or protective factors and improves the understanding of the development of overweight and obesity in European primary-school children in order to support appropriate and effective policy responses.

Original languageEnglish
Article numbere13215
JournalObesity Reviews
Issue numberS6
StatePublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 World Obesity Federation. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.


  • children
  • methodology
  • obesity
  • surveillance

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Endocrinology, Diabetes and Metabolism


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