Ministry of Health, WHO CHILDHOOD OBESITY SURVEILLANCE Ministry of Education INITIATIVE: Health Authority Social Security Institute Health Authority and Institut of Social Security San Marino BACKGROUND AND AIMS

San Marino in collaboration with Italian MoH (Ministery of Health) and ISS (Istituto superiore di sanità) realized “Okkio alla Salute” survey. San Marino carried out four rounds in the years: 2010-2012-2014-2016. The survey was introduced in the country because there was a high percentage of overweight and obese children. This childhood obesity surveillance allows to monitor the phenomenon and evaluate whether the interventions implemented have worked or not.

METHODS

San Marino has a population of around 32,000 inhabitants. The population in the age of primary school from first grade to fifth grade is composed approximately by 1,500 students. In line with what has been done in Table 1. Selected Schools for survey in april ‐ may 2016 Italy, San Marino in all rounds decided to interview all the students of the three grades of primary school. Class school student

Entire target population has been surveyed. In San Marino there are 14 primary schools, and the students school of of

of

of involved were about 300 each round. Management number CAP City Locality Number Address Cod Name 001 Faro Bianco via della Margheritina, 1 47892 2 32 Public Before the survey, San Marino held a training initiative aimed to health personnel, involving teaching staff 002 La Rocca via dei Boschetti, 1 47893 Borgo Maggiore 2 42 Public from Italian ISS, who explained in detail the questionnaires and the materials to be distributed and how to 003 La Ginestra via Ca' Ragni, 9 47891 Ca' Ragni 1 20 Public 004 Arcobaleno via Pradacci, 1 47893 Borgo Maggiore 1 21 Public involve teachers. Dr. Gualtieri, San Marino Responsible for “Okkio”, presented the survey to the teachers 005 Il Giardino dei Ciliegi via Fonte del Poggio, 8 47894 1 12 Public involved, explaining them exactly what they should do and how to explain to parents the initiative and 006 Il Torrente via Consiglio dei Sessanta, 1 47891 Serravalle 1 21 Public 007 Scuola Più via Ca' Pirazzone 47895 2 33 Public agreeing with the teachers the dates for the survey in their classes. 008 Il Mulino via C. Villani 47896 1 18 Public 009 L'Olivo Strada la Zanetta, 6 47891 Serravalle 1 21 Public 010 Il Nostro Mondo via G. Corbelli, 93 47897 1 21 Public Before the survey, teachers distributed and then collected the questionnaire for parents to the families of 011 L'Olmo Strada Scalbati 47898 1 9 Public 012 La Quercia via Erviano, 20 47890 San Marino 1 21 Public their students. The parental questionnaires were collected anonymously, on the day of the survey in class. 013 La Sorgente via J.H. Dabrowski 47890 San Marino 1 18 Public 014 La Primavera via Ca' Pontoso 47899 Serravalle 2 40 Public The survey was conducted by health professionals (2 nutritionists,2 health assistants of Pediatrics, 2 medical doctors and other staff from Health Authority). They went at the plexus and submitted a questionnaire to the children and then took the anthropometric measures, considering the age and sex, were taken. . Health and social plan RESULTS

The results of the survey held in 2016 are not yet available. We will illustrate the results of survey in 2014. Results San Marino ‐ 2014 Results: 2010‐2012‐2014 trend Overweight and obesity, San Marino • Stabilization of overweight and obesity among 8‐9 year olds

• Previous data on nutrition, physical activity, mother’s perception are comparable to 2014 data ......

DISCUSSION AND CONCLUSIONS

Opportunities & Challenges Key Messages

• 2013: Multisectoral working group on health education • Need to further improve the multisectoral approach and the collaboration with school through the working group on health education and other tools • Small countries initative (less 1 million inhab.) ‐> work together to simplify modalities to participate and be part of the final report • Seek out support from the WHO to facilitate the resolution of the most common problems faced by small countries • WHO support to formalize collaboration with bigger neighboring countries (e.g. Italy) • Create a stronger network between the WHO, small countries and neighboring the results of the bigger countries to share know‐how and experiences • COSI data as a source and included into the San Marino 2015‐2017 NHP ‐> starting point to tackle childhood obesity REFERENCES

[1] Health and Social plan 2015‐2017 –San Marino [2] Okkio alla salute – risultati dell’indagine 2014 a San Marino Thank for support to: [3] Okkio alla salute – risultati dell’indagine 2012 a San Marino Istituto Superiore di Sanità Italia [4] Okkio alla salute – risultati dell’indagine 2010 a San Marino [5] Cole Tj Lobstein T – Extended International (IOFT)Aa body mass index cut ‐offs for thinness, overweight and obesity.