ORIGINAL ARTICLE
Prevalence of overweight, obesity and low weight
in the Czech child population up to 18 years of age
in the last 50 years
J. Vignerová & L. Humeníková & M. Paulová &
J. Riedlová
Received: 25 October 2007 /Accepted: 11 April 2008 /Published online: 27 May 2008
# Springer-Verlag 2008
Abstract
Aim The main purpose of the study was to analyze the
changes in the prevalence of underweight, overweight, and
obesity among Czech children and adolescents aged 3–18
within the last 50 years. The secondary purpose of the study
was to determine the prevalence of overweight and obesity
among children and adolescents in 2001 and compare it to
the reference standards recommended by the International
Obesity Task Force (IOTF).
Subject and methods Anthropometric data collected from
nationally representative samples of 3–18-year-old children
and adolescents in the Czech Republic in 1951, 1981, 1991,
and 2001 were analyzed in the study. The prevalence of
child overweight and obesity among Czech children using
data from the most recent 2001 National Anthropological
Survey was estimated using the 1991 Czech reference
values and the IOTF standards.
Results There has been a gradual increase in the number of
children in both extreme categories of BMI values in most
age categories, including underweight (<10th percentile),
overweight (>90th percentile), and obesity (>97th percentile)
between 1951 and 2001. In both genders, the number
of underweight children increased dramatically in the
lowest age categories. At the same time, the rates of
overweight and obesity increased among 6–11- and 11–15year-old
individuals. The prevalence of underweight has
also increased among older adolescents. However, our
study indicated that the 2001 prevalence of overweight/
obesity among Czech adolescents, especially in older age
categories and among girls, was lower compared to the
1991 reference values.
Conclusion Given the continuous increase in child obesity
rates in the US and most of Europe, it is interesting that the
prevalence of overweight and obesity has remained
relatively low among children and adolescents in the Czech
Republic. Given the increased number of Czech schoolaged
children with excess adiposity, a gradual rise in the
prevalence of overweight and obesity among Czech
adolescents could be expected.
Keywords Underweight . Overweight . Obesity.
Prevalence . Czech Republic
Introduction
In the last several decades, obesity has become one of the
most prevalent chronic diseases in the developed world,
and the rates of obesity continue to rise in many countries
(Jackson-Leach & Lobstein 2006). While genetic background
may influence the development of excessive
adiposity, researchers agree that other factors, such as
J Public Health (2008) 16:413–420
DOI 10.1007/s10389-008-0193-x
J. Vignerová (*) :M. Paulová
Public Health Worker,
Department of Biostatistics and Informatics,
National Institute of Public Health,
Šrobárova 48,
100 42 Praha 10, Czech Republic
e-mail: jvig@szu.cz
L. Humeníková
Department of Nutritional Sciences,
311 Human Environmental Sciences,
Oklahoma State University,
Stillwater, OK 74078, USA
J. Riedlová
Departmentt of Anatomy,3th Medical Faculty,
Charles University in Prague,
Ruská 87,
100 00 Praha 10, Czech Republic
parental food habits and weight status, physical activity,
socio-economic status, and breast feeding, play more
important roles in obesity prevention and development than
individuals’ genetic makeup (Rennie et al. 2005). For
instance, the global increase in the prevalence of obesity is
largely contributed to by a gradual increase in energy
intakes and a decrease in physical activity over the last 30
years (Institute of Medicine 2002; Reilly 2007). These and
other changes in individuals’ behaviors and lifestyle have
contributed to a positive energy balance and thus the
increased prevalence of obesity in many developed
countries around the world (Reilly 2007).
While obesity represents a serious health risk in adult
populations, the consequences of excessive adiposity are
even more alarming for children. Children who become
overweight early in life are more likely to become
overweight as adolescents and adults (Reilly et al. 2003).
Furthermore, the risk of developing obesity-related health
problems is substantially higher for children with excess
adiposity compared to non-overweight children (Reilly
2007; Reilly et al. 2003).
To date, the prevalence of child overweight is highest
among American children, with nearly 32% of 6–19-yearold
children being overweight or at risk for overweight
(Hedley et al. 2004). In contrast to the alarming rates of
child overweight in the US and several European countries,
children in the Czech Republic have relatively low rates of
overweight and obesity (Kobzova et al. 2004). The Czech
Republic, a former communist country in Eastern Europe,
has a long tradition of national anthropometric surveys that
allow for a continuous monitoring of growth and development
of Czech children and adolescents. The first national
anthropological survey of children and adolescents with a
major focus on health and nutritional status was conducted
in 1951. The subsequent national surveys were conducted
at 10-year intervals to primarily provide the reference data
and growth charts for basic body parameters of the Czech
population of children and adolescents from 0–18 years of
age. The latest survey was the 6th National Anthropological
Survey (NAS) and was conducted in 2001 (Kobzova et al.
2004).
The current weight status of Czech children and
adolescents is determined using the growth charts that were
constructed based on the results of the 5th NAS in 1991
(Lhotská et al. 1993). Due to the increasing prevalence of
child overweight and obesity between 1991 and 2001, the
reference standards were not updated based on the latest 6th
NAS in 2001 (Vignerová 2006b). Because populationbased
growth charts and reference standards are currently
used in the Czech Republic, the BMI values associated with
the cut-offs for overweight and obesity differ from the BMI
values that were established by the International Obesity
Task Force (IOTF) as an international standard for child
overweight in 2000 (Cole et al. 2000). Thus, the prevalence
of obesity as well as comparisons between Czech children
and children from other countries is influenced by the type
of reference standards that are used for identifying
overweight and obese individuals.
Given the unique anthropological data available in the
Czech Republic, the main purpose of the study was to
analyze the changes in the prevalence of underweight,
overweight, and obesity among Czech children and
adolescents aged 3–18 within the last 50 years. The
secondary purpose of the study was to determine the
prevalence of overweight and obesity among children and
adolescents in 2001 and compare it to the reference
standards recommended by the IOTF (Cole et al. 2000).
Methods
Anthropometric data collected from nationally representative
samples of 3–18-year-old children and adolescents in
the Czech Republic in 1951, 1981, 1991, and 2001 were
analyzed in the study. The first post–World War II
nationwide anthropological study of children and adolescents
was carried out in 1951. While the subsequent
anthropometric measures were collected from children and
adolescents at 10-year intervals, raw data from 1961 and
1971 were not available for the analysis. The number of
children investigated in each survey represented approximately
3–5% of the children population in a given age
category (Table 1). The most recent anthropometric survey
(the 6th National Anthropometric Survey) was conducted in
2001 (Vignerová et al. 2006b).
Data on height, weight, and other anthropometric
characteristics were collected during each of the four
National Anthropological Surveys. Children’s anthropometric
characteristics were measured in a variety of settings
depending on the age of the participating children.
Preschool children were evaluated by pediatricians at
health-care facilities, while school-aged children were
measured by teachers and university students of anthropology
at schools. Both pediatricians and teachers were
provided with written instructions and anthropology students
were carefully trained by professional anthropologists
before the data collection (Kobzová et al. 2004). A
Table 1 The number of subjects included in the study analysis
Year of the survey 1951 1981 1991 2001
Boys
Age 3–18 years 48 173 37 896 30 980 19 505
Girls
Age 3–18 years 44 251 37 354 32 084 22 232
414 J Public Health (2008) 16:413–420
questionnaire containing items related to the socio-economic
status, parental education, family size, parental BMI, and
other variables was administered to parents or children
during each of the national surveys.
Due to the increased prevalence of child obesity
identified in the 2001 National Anthropological Survey,
the weight status of children and adolescents in the Czech
Republic is currently determined using the growth charts
that were constructed utilizing the LMS method (Cole et al.
1998) based on the results of the 5th National Anthropological
Survey in 1991 (Lhotská et al. 1993). The BMI-forage
percentile of 90 is presently used as a cut-off for child
overweight, and the BMI-for-age percentile of 97 is used to
identify obese children. Children whose BMI-for-age is
below the tenth percentile are considered underweight.
These cut-offs were used to classify children and adolescents
as underweight, normal weight, overweight, or obese.
International reference standards for determining child
overweight were developed by the International Obesity
Task Force (IOTF) in previous research (Cole et al. 2000).
The BMI values corresponding to the 90th and 97th
percentile cut-offs differ between the Czech reference
standards and the IOTF recommendations, especially at
the 97th percentile that indicates child obesity (Table 2, 3).
Because significant differences exist among the Czech and
the IOTF reference standards, the prevalence of child
overweight and obesity among Czech children using data
from the most recent 2001 National Anthropological
Survey was estimated using both the 1991 Czech reference
values and the IOTF standards.
Results
The comparison of the BMI values corresponding to the
10th, 50th, and 90th between the 1951 and 1991 growth
charts is shown in Fig. 1 and 2. The range of the BMI
values corresponding to the underweight and overweight/
obese percentile categories expanded, with the exception of
adolescent girls, between 1951 and 1991, indicating that the
prevalence of underweight as well as overweight/obese
children have increased in the Czech Republic in the last
several decades (Vignerová et al. 2007). As indicated in
previous research, the results showed significant changes in
BMI values at the 50th percentile and a shift of adiposity
rebound to earlier ages among Czech children since 1951
(Vignerová et al. 2006a).
Table 2 Cut-off points for selected age by the 1991 Czech references
and the IOTF recommendations among boys
90th centile cut-off points 97th centile cut-off points
Age (years) CzechI
IOTFII
CzechI
IOTFII
3 17.9 17.9 19.1 19.6
6 17.6 17.6 18.9 19.8
11 20.8 20.6 23.3 25.1
15 23.5 23.3 25.9 28.3
18 25.4 25.0 27.7 30.0
I
Lhotska et al. 1993
II
Cole et al. 2000
Table 3 Cut-off points for selected age by the 1991 Czech references
and the IOTF recommendations among girls
90th centile cut-off points 97th centile cut-off points
Age (years) CzechI
IOTFII
CzechI
IOTFII
3 17.5 17.6 18.5 19.4
6 17.6 17.3 18.9 19.7
11 20.9 20.7 23.3 25.4
15 23.6 23.9 26.0 29.1
18 25.0 25.0 27.6 30.0
I
Lhotska et al. 1993
II
Cole et al. 2000
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age years
1951 1991
90
50
10
Percentile(kg/m2
)
Fig. 1 BMI centile charts. 1951 and 2001 comparison. Boys
J Public Health (2008) 16:413–420 415
The prevalence of underweight, overweight, and obesity
among Czech children and adolescents in each of the four
national surveys, according to individual ages, is shown in
Tables 4, 5. Because the results of the 1991 survey were
used for establishing the Czech reference standards (Lhotska
et al. 1993), the number of children and adolescents in each
weight category was constant in 1991 across the age and
gender categories, with 10% of children being underweight,
7% overweight, and 3% obese.
The overall prevalence of underweight, normal weight,
overweight, and obesity in the combined age categories
from the 1951, 1981, and 2001 National Anthropological
Surveys is shown in Tables 4 and 5. The results of our
analysis indicated that there has been a gradual increase in
the number of children in both extreme categories of BMI
values in most age categories, including underweight
(<10th percentile), overweight (>90th percentile), and
obesity (>97th percentile) between 1951 and 2001.
In both genders, the number of underweight children
increased dramatically in the lowest age categories. At the
same time, the rates of overweight and obesity increased
among 6–11- and 11–15-year-old individuals (Table 4, 5).
The prevalence of underweight has also increased among
older adolescents. This trend is particularly apparent among
adolescent girls where the prevalence of underweight
increased from 3.7% in 1951 to 10% in 1991 and 13.3%
in 2001 (Table 5). As the number of underweight girls
increased, the prevalence of overweight and obesity in the
adolescent category have decreased from 14.6% in 1951 to
8.5% in 2001 (Table 5). The reported changes were
confirmed by statistically significant odd ratios that were
related to the reference values from 1991 (Lhotská et al.
1993).
Given the significant differences between the 1991
Czech and the IOTF standards, the prevalence of overweight
and obesity among Czech children was compared
by gender using both sets of the reference values (Table 2,
3). The results of our study indicated that the use of the
international reference values led to an increase in the
number of Czech children that were categorized as
overweight and a decrease in the number of children that
were found to be obese. Using the IOTF reference standards,
the prevalence of obesity among Czech children in
2001 thus exceeded the expected 3% from 1991 only
among 3–11-year-old boys and girls (Table 6, 7). In
addition, only 0.8% of 15–18-year-old adolescent girls
were identified as obese in 2001 based on the IOTF
reference values (Table 6). According to the 1991 Czech
reference values, the prevalence of obesity among Czech
children exceeded 3% in both genders and all age
categories, with the exception of 15–18 year old girls,
where the prevalence of obesity was 2.5% (Table 7).
Discussion
The main purpose of the study was to identify changes in
the prevalence of underweight, overweight, and obesity that
have occurred among Czech children and adolescents from
1951 to 2001 and compare them to the 1991 Czech growth
reference standards. The results of our study clearly
indicated that dramatic weight-related changes have occurred
among children in the Czech Republic in the last
several decades. As the prevalence of the obesity epidemic
continues to increase in the US and many European
countries, the Czech children population has experienced
a variety of growth-related changes since 1951.
Our study builds upon previous research that closely
investigated historical and anthropological trends related to
the growth and development of the child population in the
Czech Republic within the past 50 years (Vignerová et al.
2006a). A shift of adiposity rebound to lower age categories
and earlier occurrence of puberty among both Czech boys
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age years
1951 1991
90
50
10
Percentile(kg/m2
)
Fig. 2 BMI centile charts. 1951 and 2001 comparison. Girls
416 J Public Health (2008) 16:413–420
and girls was demonstrated in previous studies (Vignerová
et al. 2006b, Vignerová et al. 2007). The goal of our study
was to analyze changes in the prevalence of underweight,
overweight, and obesity among Czech children in relation
to an accelerated development of individuals rather than
changes in lifestyle and socio-economic conditions that
have occurred in the Czech society within the past several
decades.
Table 5 The prevalence of underweight, normal weight, overweight, and obesity among girls by age groups in 1951, 1981, and 2001 as
compared to the 1991 Czech References (Lhotská et al. 1993)
Age years Numbers BMI categories (%, OR)
<10th percentile 10th–90th percentile 90th percentile < 97th percentile<
Underweight Normal Overweight and obese Obese
1951 survey
3.00–5.99 8,721 5.6 [0.60 **] 84.2 10.2 [1.09 n.s.] 3.3
6.00–10.99 12,809 4.6 [0.46 **] 90.2 5.2 [0.52 **] 1.5
11.00–14.99 17,734 7.9 [0.84 **] 84.9 7.2 [0.76 **] 1.7
15.00–17.99 4,987 3.7 [0.41 **] 81.7 14.6 [1.61 **] 3.1
1981 survey
3.00–5.99 8,174 11.7 [1.33 **] 79.3 9.0 [1.02 n.s.] 3.1
6.00–10.99 11,480 7.4 [0.80 **] 83.1 9.4 [1.02 n.s.] 3.3
11.00–14.99 9,288 8.4 [0.95 n.s.] 79.4 12.2 [1.38 **] 4.2
15.00–17.99 8,412 6.7 [0.74 **] 81.5 11.8 [1.30 **] 3.4
2001 survey
3.00–5.99 2,029 13.1 [1.57 **] 75.3 11.6 [1.38 **] 5.0
6.00–10.99 5,931 8.0 [0.92 n.s.] 77.9 14.1 [1.63 **] 5.6
11.00–14.99 6,376 10.3 [1.20 **] 77.4 12.2 [1.42 **] 4.4
15.00–17.99 7,896 13.3 [1.53 **] 78.2 8.5 [0.98 n.s.] 2.5
n.s. non significant
*p<0.05
**p<0.01
In parenthesis OR and statistical significance compared to 1991 references
Table 4 The prevalence of underweight, normal weight, overweight, and obesity among boys by age groups in 1951, 1981, and 2001 as
compared to the 1991 Czech references (Lhotská et al. 1993)
Age years Numbers BMI categories (%, OR)
<10th percentile 10th–90th percentile 90th percentile < 97th percentile<
Underweight Normal Overweight and obese Obese
1951 survey
3.00–5.99 7680 5.1 [0.53 **] 86.8 8.1 [0.84 **] 2.1
6.00–10.99 12,126 5.3 [0.53 **] 90.0 4.7 [0.47 **] 1.4
11.00–14.99 21,180 9.9 [1.04 n.s.] 86.0 4.1 [0.43 **] 1.0
15.00–17.99 7,187 8.7 [0,91 n.s.] 86.9 4.5 [0.47 **] 0.9
1981 survey
3.00–5.99 10,523 10.0 [1.09 n.s.] 82.8 7.2 [0.78 **] 2.1
6.00–10.99 11,324 7.4 [0.80 **] 83.0 9.5 [1.03 n.s.] 3.5
11.00–14.99 8,733 10.2 [1.15 **] 79.9 9.8 [1.10 *] 3.1
15.00–17.99 7,316 8.7 [0.93 n.s.] 83.9 7.5 [0.81 **] 2.4
2001 survey
3.00–5.99 2,103 14.1 [1.66 **] 76.6 9.2 [1.08 n.s.] 4.6
6.00–10.99 5,930 7.5 [0.88 *] 77.0 15.5 [1.81 **] 6.6
11.00–14.99 6,341 9.5 [1.13 *] 75.7 14.9 [1.77 **] 5.6
15.00–17.99 5,131 11.9 [1.37 **] 78.6 9.5 [1.09 n.s.] 3.6
n.s.-non significant
* p<0.05
** p<0.01
In parenthesis OR and statistical significance compared to 1991 references
J Public Health (2008) 16:413–420 417
Given the primary goal of our study, our efforts to
compare the rates of child underweight, overweight, and
obesity between the four national surveys were somewhat
limited. For instance, it is likely that the accelerated
development of children and adolescents in recent years
has influenced the number of individuals in the underweight,
overweight, as well as obese weight category. The
downward shift of adiposity rebound by more than 1 year
since 1951 has changed the BMI values corresponding to
the BMI percentile cutoffs among 3–6 year olds.
On the other hand, the shape of the weight-for-height
curve has not changed substantially (Vignerová at al. 2007).
This illustrates the importance of proper height adjustment
in the historical population obesity assessments–especially
when a non-negligible secular height trend is present. The
number of underweight, overweight, as well as obese
adolescents aged 11–15 has been likely influenced by the
earlier puberty onset in the last several years (Vignerová et
al. 2006a). Thus, a long-term comparison of the prevalence
of underweight, overweight, and obesity in the Czech
children population in our study was limited, especially
among pre-school children and young adolescents.
Given the increased number of Czech school-aged
children with excess adiposity, a gradual rise in the
prevalence of overweight and obesity among Czech
adolescents would be expected. However, our study shows
that there is a clear trend of decreasing prevalence of
overweight and obesity and increasing prevalence of
underweight among girls aged 14 and older between 1951
and 1991. Because these findings cannot be influenced by
the earlier occurrence of puberty, the results clearly indicate
that older adolescent girls used to be more robust than in
the present time. Our findings are also consistent with
previous research indicating that the number of mothers of
children investigated during the Czech National Anthropological
Surveys whose BMI was below 20 increased from
4.6% in 1951 to 13.5% in 2001. On the contrary, the rate of
mothers whose BMI was over 30 decreased from 45% in
1951 to 27.6% in 2001. (Vignerová et al. 2006b).
Previous research suggests that child obesity is strongly
associated with low socio-economic status and education,
high parental BMI, limited breastfeeding, high birth weight,
and other variables (Lioret et al. 2007; Owen et al. 2005;
Padez et al. 2005; WHO 2007). While these factors could
be contributing to the increased prevalence of overweight
and obesity among Czech school-aged children, recent
studies demonstrated that the educational level of Czech
parents have been increasing, and the socio-economic and
lifestyle differences have begun to diminish between urban
and rural areas of the Czech Republic in recent years
(Vignerová et al. 2006b). In addition, positive trends in
terms of obesity prevention have been identified in the
Czech Republic, including increased length of exclusive
breastfeeding (Vignerová et al. 2006b). While further
research in this area is warranted, it is likely that a
combination of lifestyle, behavioral, and socio-economic
factors are responsible for the changes in the prevalence of
overweight and obesity among Czech children in recent
decades. Although the prevalence of child overweight is
clearly increasing among Czech children in certain age
categories, it is important to note that the rates of
overweight and obesity among 5–17-year-old children
Table 6 BMI categories of
children in 2001 by age
groups-boys
I
Czech references 1991
(Lhotská et al. 1993)
II
Cole et al. 2000
Age years Numbers BMI categories (%)
90–97th percentile 97th percentile <
CRI
ColeII
CRI
ColeII
3.00–5.99 2,103 4.6 6.0 4.6 3.4
6.00–10.99 5,933 8.9 13.1 6.6 3.6
11.00–14.99 6,341 9.3 13.9 5.6 2.4
15.00–17.99 5,131 5.9 9.2 3.6 1.7
Table 7 BMI categories of
children in 2001 by age
groups-girls
a
Czech references 1991
(Lhotská et al. 1993)
b
Cole et al. 2000
Age years Numbers BMI categories (%)
90–97th percentile 97th percentile <
CRa
Coleb
CRa
Coleb
3.00–5.99 2029 6.6 9.6 5.0 3.3
6.00–10.99 5931 8.5 13.4 5.6 3.2
11.00–14.99 6376 7.8 10.4 4.4 1.6
15.00–17.99 7896 6.0 6.9 2.5 0.8
418 J Public Health (2008) 16:413–420
remain relatively low (13% in 2001) compared to 32% in
the US and 19% in Europe for children in the same age
category (Lobstein et al. 2004).
Because the last National Anthropological Survey was
conducted in 2001, the Lifestyle and Obesity Survey was
implemented in 2005 in order to determine the current
prevalence of overweight and obesity among Czech children
and thus update the 2001 anthropometric data (Kunešová et
al. 2007). The Lifestyle and Obesity Survey examined a
total of 1,417 children and adolescents aged 6–18 years
(Kunešová et al. 2007). The results of the survey identified
an increasing trend towards overweight and obesity among
Czech children, especially in the age category of 6–11yearold
individuals (33.5% among boys compared to 16.5% in
2001; 37.7% among girls compared to 16.6% in 2001).
Given the drastic increase in the prevalence of overweight
and obesity reported by the Obesity and Lifestyle Survey,
however, it is likely that the validity of the survey results
was influenced by several factors, including a relatively
small sample size and the use of entirely different
methodology compared to the National Anthropological
Surveys. Thus, the prevalence of overweight and obesity
found in the 2005 Obesity and Lifestyle Survey cannot be
directly compared to the results of the National Anthropological
Surveys that utilize the same methodology and are
conducted every 10 years in the Czech Republic.
Given the gradual increase in the prevalence of child
overweight and obesity in certain age categories, it is
critical to continue monitoring weight-related trends among
children population in the Czech Republic in the upcoming
years. The National Committee for Obesity, founded by the
Ministry of Health in the Czech Republic, is currently
developing new methodological approaches for screening
overweight and obese children in the Czech Republic. The
methodology is intended for pediatricians who complete
mandatory preventive screening of children and adolescents
on a regular basis.
The Czech Republic is also considering the implementation
of the new growth standards for children under the
age of 5 that were developed by the World Health
Organization (WHO 2006). The implementation of the
WHO standards would allow for direct comparisons of
underweight, overweight, and obesity rates between Czech
children and children from other countries. Finally, public
health efforts are warranted in order to improve food
choices, increase physical activity, and emphasize the
importance of other effective measures against obesity such
as long-term breastfeeding (Reilly 2007; Owen et al. 2005;
WHO 2007).
Acknowledgement The study was supported by the grant No. NR/
7857–3 of the Internal Grant Agency of Ministry of Health, Czech
Republic.
Conflcit of interest statement The authors disclose any relevant
associations that might pose a conflict of interest.
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