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WHO European Childhood Obesity Surveillance Initiative – COSI WHO European Childhood Obesity Surveillance Initiative COSI Turkmenistan 2016/2017 (Round Four) report on data collection of childhood nutritional status | Ashgabat, Turkmenistan | 2020 ABSTRACT Childhood obesity remains an important public health problem in prevalence of overweight (19.1%) and obesity (3.2%). the World Health Organization (WHO) European Region, where it Family data showed that most mothers (87.3%) breastfed their is unequally distributed within and between European countries children for more than 7 months; of these, 50.5% breastfed from and population groups. Nutritional surveillance data are essential to 13 to 24 months. Children from Turkmenistan reported a high food effectively design, implement and evaluate policies and strategies consumption of fresh fruit (70.1%), vegetables (68.1%), meat (68.3%), aimed at counteracting obesity. Turkmenistan joined the WHO dairy products such as low-fat/semi-skimmed milk (75.7%), but more European Childhood Obesity Surveillance Initiative (COSI) study than 40% of children reported a consumption (> 4 days/week) of in 2016/2017 (fourth round) alongside 34 other countries. This soft drinks (42.5%) and other sugary foods such as candy bars and population-based system involves a standardized, harmonized chocolate (43.9%), and biscuits, cake, doughnuts and pies (48.3%). systematic process of monitoring prevalence of thinness, Regarding physical activity the majority of children reported walking overweight and obesity (based on measured data) among primary or cycling to school (80.5%), and play outside for 1–2 hours per day schoolchildren. during weekdays (65.3%) but sedentary habits such as watching TV COSI Turkmenistan was implemented in five velayats (regions): Ahal, or using electronic devices (1-2h/day) were reported by the majority Balkan, Dashoguz, Lebap, Mary and Ashgabat city. Data collection (79.7%) of children. followed the WHO European COSI common protocol and the In conclusion, COSI Turkmenistan allowed a better understanding data collection procedures manual. A total of 3951 children were of children´s nutritional and clearly showed that prevalence of measured, corresponding to a participation rate of 97% from 159 childhood obesity (2.9%) coexists alongside thinness (4.3%). primary schools. Addressing this important public health issue is therefore essential According to 2007 WHO growth reference criteria, the prevalence to ensure a healthy development of the children of Turkmenistan. of overweight (including obesity) in boys and girls aged 7 years was 11.5% and 11.4%, respectively. Ashgabat city showed the highest KEYWORDS CHILDHOOD OBESITY | COSI TURKMENISTAN | OVERWEIGHT | CHILDREN Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website: http://www.euro.who.int/pubrequest © World Health Organization 2020 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CHILDHOOD OBESITY COSI SURVEILLANCE INITIATIVE Contents Foreword �������������������������������������������������������������������������������������������������������������������������������������������������������������5 Acknowledgements ��������������������������������������������������������������������������������������������������������������������������������������������5 Contributors ��������������������������������������������������������������������������������������������������������������������������������������������������������6 Executive summary ��������������������������������������������������������������������������������������������������������������������������������������������7 Abbreviations7 Main results ��������������������������������������������������������������������������������������������������������������������������������������������������������8 1 Introduction ���������������������������������������������������������������������������������������������������������������������������������������������������10 11 Childhood obesity – a priority public health issue 10 12 WHO European Childhood Obesity Surveillance Initiative (COSI) �����������������������������������������������������������������10 13 COSI Turkmenistan 11 2 Methodology ��������������������������������������������������������������������������������������������������������������������������������������������������12 21 Organizational structure 12 22 Ethical considerations 13 23 Study design and sampling 14 24 Equipment and training procedures 15 25 Data collection forms and procedures 15 26 Data analysis 16 3 Overweight and obesity among children ������������������������������������������������������������������������������������������������������17 31 Participation rate 17 32 Anthropometric indicators 18 33 Prevalence of thinness, overweight and obesity 19 4 Health risk behaviours in children’s eating habits and nutrition ����������������������������������������������������������������21 41 Breastfeeding 21 42 Eating habits 22 5 Behaviours in children’s patterns of physical activity and nutrition�����������������������������������������������������������24 51 Active transportation to school 24 52 Sports and physical activities, in sport clubs or dancing courses 25 53 Children’s time spent playing outside 26 54 Time spent watching TV or using electronic devices ���������������������������������������������������������������������������������28 6 Final remarks �������������������������������������������������������������������������������������������������������������������������������������������������30 7 References �����������������������������������������������������������������������������������������������������������������������������������������������������31 4 CHILDHOOD OBESITY COSI SURVEILLANCE INITIATIVE Foreword Childhood obesity is a major public health problem globally. In the short term, it can negatively influence a child’s health, their Acknowledgements educational attainment and their quality of life. In the longer term, childhood obesity – which often tracks into adulthood – can We wish to express our gratitude to João Breda, Programme increase a person’s risk of developing noncommunicable diseases Manager of Nutrition, Physical Activity and Obesity, for his leadership (NCDs). NCDs are the leading cause of premature mortality in the of the WHO European COSI study, and to Jelena Jakovljevic, COSI World Health Organization (WHO) European Region. expert and Consultant (WHO Regional Office for Europe), who led the first introductory workshop on COSI in Turkmenistan. We Tackling childhood obesity is key for achieving the Sustainable would also like to thank Gerben Rienk Visser (Trial Data Solutions, Development Goals, especially Goal 3, which relates to ensuring Netherlands), for assistance on data system preparation. healthy lives and promoting well-being for all people, at all ages. The WHO’s Report of the Commission on Ending Childhood Obesity calls COSI Turkmenistan is most grateful to all school personnel, families on Member States to ensure data collection on children’s BMI-for- and children for their participation and valuable collaboration in this age (body mass index adjusted for age) and to set national targets study. for obesity – a priority that is echoed in the WHO European Food These activities were fully or partially funded through a grant of the and Nutrition Action Plan and Health 2020, the European policy Russian Government in the context of the WHO European Office for framework and strategy for the 21st century. the Prevention and Control of Noncommunicable Diseases. In 2008, the WHO Regional Office for Europe established the Childhood Obesity Surveillance Initiative (COSI). This unique system uses a standardized protocol to monitor childhood obesity and overweight among primary school-aged children (6–9 years). These data enable public health officials
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