Vol. 13 No. 1 (2021): Archives of Public Health
Public Health

Changes in weight status of 7-year-old children in North Macedonia between 2010 and 2019

Igor Spiroski
Институт за јавно здравје на Република Македонија

Published 2021-06-20


  • children,
  • weight status,
  • thinness,
  • overweight,
  • obesity,
  • North Macedonia
  • ...More

How to Cite

Spiroski I, Mikik V, Miloradovska N, Veljanovski M, Shaqiri J, Petrova A, Dzikovska B, Shahini B, Kitanovska Spasev J. Changes in weight status of 7-year-old children in North Macedonia between 2010 and 2019. Arch Pub Health [Internet]. 2021 Jun. 20 [cited 2024 Apr. 16];13(1):5-13. Available from: https://id-press.eu/aph/article/view/5828


Childhood obesity is growing as one of the most important public health issues that affects individual and population health but also puts heavy burden on the health systems. It is frequently associated with immediate adverse consequences, such as psychological problems, and a higher risk of many harmful comorbidities later in life, such as type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, hypertension, and coronary heart disease. Comparability of anthropometric data is crucial to track the changes over time. The aim of this paper was to present prevalence of thinness, overweight, and obesity in 7-year-old schoolchildren in North Macedonia in 2010 and 2019, and the changes in their nutritional status during thatperiod. Material and methods: Anthropometric measurements of body height and body weight were performed to the nationally representative sample of 7-year-oldchildren in school years 2010/2011 and 2018/2019. Measurements followed the Childhood Obesity Surveillance Initiative (COSI) protocol and data collecting procedures. In total, 2737 children (1317 girls and 1420 boys) in 2010 and 2059 children (1045 girls and 1014 boys) in 2019 were measured. WHO Growth references were used to determine the growth and nutritional status of children. Results: The average height of children in the observed period has increased by 1.7 cm, weight for 1.2 kg and the BMI for 0.3 kg/m2. As for the weight classification, thinness prevalence is significantly increased for 0.3%. Overweight (including obesity) significantly increased (p=0.0377) from 34.4% (95% CI 32.6%-36.2%) in 2010 to 37.3% (95% CI 35.2%-39.5%) in 2019. Obesity significantly increased (p=0.040) from 16.3% (95% CI 14.9%-17.7%) in 2010 to 18.4% (95% CI 16.7%-20.1%) in 2019. The main driver of that increase was the highly significant (p=0.0004) increase of almost 7% of overweight (including obesity) in girls. Conclusion: There is unfavorable rising trend which indicates deterioration of the situation with childhood obesity in the country. Focused and more comprehensive public health nutrition actions are needed to plateau or reverse the trends. The childhood obesity national monitoring system is well established and should continue to beone of the key public health monitoring systems that provide evidence for actions.



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  1. Food and Agriculture organization. Low level of hunger but high prevalence of moderate food insecurity, overweight, and obesity in Europe and Central Asia. Budapest: FAO; 2019.
  2. Lobstein T, Jackson-Leach R. Planning for the worst: estimates of obesity and comorbidities in school-age children in 2025. Pediatr Obes 2016;11(5):321–5. DOI: https://doi.org/10.1111/ijpo.12185
  3. Farpour-Lambert NJ, Baker JL, Hassapidou Met al. Childhood obesity is a chronic disease demanding specific health care – a position statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obes Facts 2015;8(5):342–9. DOI: https://doi.org/10.1159/000441483
  4. Park MH, Falconer C, Viner RM et al. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012;13(11):985–1000. DOI: https://doi.org/10.1111/j.1467-789X.2012.01015.x
  5. World Health Organization. Childhood overweight and obesity [cited 2019 Dec 14]. Available from: http://www.who.int/dietphysicalactivity/childhood/en/.
  6. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016; 7:125-46. DOI: https://doi.org/10.2147/AHMT.S101631
  7. Pulgarón ER. Childhood obesity: a review of increased risk for physical and psychological comorbidities. Clin Ther 2013; 35(1):A18–32. DOI: https://doi.org/10.1016/j.clinthera.2012.12.014
  8. NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128•9 million children, adolescents, and adults. Lancet 2017;390(10113):2627–42. DOI: https://doi.org/10.1016/S0140-6736(17)32129-3
  9. NCD Risk Factor Collaboration. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020;396(10261):1511-1524. DOI: https://doi.org/10.1016/S0140-6736(20)31859-6
  10. Ahrens W, Pigeot I, Pohlabeln H et al.IDEFICS Consortium: Prevalence of overweight and obesity in European children below the age of 10. Int J Obes (Lond) 2014; 38(suppl 2):S99–107. DOI: https://doi.org/10.1038/ijo.2014.140
  11. World Health Organization. Childhood Obesity Surveillance Initiative (COSI). [cited 2020 Dec 14]. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/activities/who-european-childhood-obesity-surveillance-initiative-cosi/about-cosi.
  12. Ministry of Health. National Annual Program for Public Health. [cited 2021 Jan 8]. Available from: http://zdravstvo.gov.mk/wp-content/uploads/2019/02/9.2019-programi-2019-javno-zdravje.pdf.
  13. World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Protocol. Copenhagen: WHO; 2017.
  14. World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Data collection procedures2018-2019. Copenhagen: WHO; 2018.
  15. Trial Data Solutions. COSIOnline data-collectionusing OpenClinica 3.6. Amsterdam: TDS; 2015.
  16. de Onis M. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85:660–7. DOI: https://doi.org/10.2471/BLT.07.043497
  17. World Health Organization. WHO Reference 2007. Growth reference data for 5–19 years. [cited 2021 Jan 13]. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years.
  18. Spiroski I, Gjorgjev D, Kocubovski M, Kendrovski V, Ristovska G, Dimovska M. Comparative study about the nutritional status of school-aged children in the Republic of Macedonia in the period 2010-2013. Arch Pub Health 2014; 6(1):5-10. [Macedonian]
  19. World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Former YugoslavRepublic of Macedonia. Factsheet. Copenhagen: WHO Europe; 2018.
  20. Lauria L, Spinelli A, Buoncristiano M, Nardone P. Decline of childhood overweight and obesity in Italy from 2008 to 2016: results from 5 rounds of the population-based surveillance system. BMC Public Health 2019; 19:618. DOI: https://doi.org/10.1186/s12889-019-6946-3
  21. Eriksson M, Lingfors H, Golsäter M. Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015. Acta Paediatr 2018; 107(10):1818-25. DOI: https://doi.org/10.1111/apa.14356
  22. O’Donnell A, Buffini M, Kehoe L et al. The prevalence of overweight and obesity in Irish children between 1990 and 2019. Public Health Nutr 2020;23(14):2512-20. DOI: https://doi.org/10.1017/S1368980020000920
  23. Kovacs VA, Bakacs M, Kaposvari C et al. Weight status of 7-year-old Hungarian children between 2010 and 2016 using different classifications (COSI Hungary). Obes facts 2018;11(3):195-205. DOI: https://doi.org/10.1159/000487327
  24. Rito A, Cruz de Sousa R, Mendes S, Graça P. Childhood Obesity Surveillance Initiative: COSI Portugal 2016. National report. Lisbon: National Institute of Health Dr Ricardo Jorge; 2017. [Portuguese]
  25. World Health Organization. Childhood Obesity Surveillance Initiative Highlights 2015-17. Factsheet. Copenhagen: WHO Europe; 2018.
  26. Djordjic V, Radisavljevic S, Milanovic I et al. WHO European Childhood Obesity Surveillance Initiative in Serbia: a prevalence of overweight and obesity among 6-9-year-old school children. J Pediatr Endocrinol Metab 2016;29(9):1025-30. DOI: https://doi.org/10.1515/jpem-2016-0138
  27. Croatian Institute of Public Health. Childhood Obesity Surveillance Initiative, Croatia, 2015/2016 (CroCOSI). Zagreb: HZJZ; 2018.
  28. Moraeus L, Lissner L, Sjöberg A. Stable prevalence of obesity in Swedish schoolchildren from 2008 to 2013 but widening socio‐economic gap in girls. Acta Paediatr 2014; 103(12):1277-84. DOI: https://doi.org/10.1111/apa.12785
  29. Spinelli A, Buoncristiano M, Kovacs VA et al. Prevalence of severe obesity among primary school children in 21 European countries. Obes Facts 2019; 12:244–58. DOI: https://doi.org/10.1159/000500436
  30. Ministry of Health. Institute of Public Health. Nutrition guidelines for the population of the Republic of Macedonia. Skopje: MoH, IPH; 2014. [Macedonian]
  31. Ministry of Education. Rulebook on nutrition standards and meals in primary school. Skopje: MoE; 2018. [Macedonian]
  32. Ministry of Labor and Social Policy. Rulebook on standards and norms for work of the institutions for children. Skopje: MoLSP; 2014. [Macedonian]
  33. World Health Organization. Tackling NCDs: 'best buys' and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.