OKkio alla salute


Project title:Sistema di sorveglianza OKkio alla SALUTE – Surveillance system on childhood obesity

Duration of the project2007 – ongoing


Main Topic

Childhood obesity is a multifactorial disease associated with a wide range of serious health and social consequences, including higher risks for premature death and disability in adulthood.
Since 2007, following the recommendations of the WHO European Ministerial Conference on Counteracting Obesity held in Istanbul, the Italian Minister of Health has promoted and funded the National Nutritional Surveillance System called “OKkio alla SALUTE”. To date, six data collections have been carried out in all Italian regions: 2008/9, 2010, 2012, 2014, 2016 and 2019.
OKkio alla SALUTE is part of the Childhood Obesity Surveillance Initiative (COSI) of the WHO Regional Office for Europe, which allows intercountry comparisons within the European Region.



The objective of OKkio alla SALUTE is to obtain information on nutritional status, by routine measurement of body weight, height and related lifestyle behaviour among primary-school children (8-9 years old).


Type of study

The target population is children in the third grade of all primary schools, who are almost all 8 or 9 year olds. All 21 Italian regions are takingn part with samples representative at regional or, if specifically requested, at Local Health Units level. A stratified cluster sample design with school classes as the primary sampling units is used. A list of schools and classes with the number of children in each class is provided by the Ministry of Education, and classes are sampled using probability proportional to size. Children are weighed and measured with standard equipment and methods by trained local health staff. Body Mass Index (BMI) is calculated and, according to the age and sex-specific International Obesity Task Force cut-offs (IOTF), children are classified as overweight or obese. For an overall comparison, overweight and obesity are also estimated using the WHO cut-off points.
Children and their parents also complete two brief questionnaires. In the questionnaire addressed to the parents, information on their education, nationality, occupation and economic conditions are asked. The information from the two questionnaires are linked through an unique identification code.
The questionnaires are available in Italian and nine other languages. The protocol has been approved by the institutional ethical board of the National Institute of Health.


Description WP/Activity

Disparities in child health are of great concern since poor health in childhood has implications not only during childhood, but also during adolescence and adulthood. In Italy, childhood obesity is a health condition for which there is a growing recognition of both short- and long-term consequences.
OKkio alla SALUTE allows to examine geographic differences in childhood obesity and evaluate their present and future implications for the health care system. Data on BMI and obesity risk factors can also be analysed by parents’ socio-economic conditions.
Each round of data collection involved about 2600 classes, 45000 children, 48000 parents and 2400 schools (response rate always higher than 95%).


Expected results

The analyses of the data on obesity and its risk factors by area of residence (North, Center, South), parents’ education and other their socio-economic conditions allow to evaluate and monitor the health inequalities among children in Italy. For example the six rounds of OKkio alla SALUTE have shown that the prevalence of childhood overweight and obesity
is always higher in the South and when the parents are less educated.



Responsible of the project: Angela Spinelli (angela.spinelli@iss.it), Paola Nardone (paola.nardone@iss.it)

Responsible of the WP/Activity on inequalities: Angela Spinelli (angela.spinelli@iss.it), Paola Nardone (paola.nardone@iss.it), Marta Buoncristiano (marta.buoncristiano@iss.it), Laura Lauria (laura.lauria@iss.it)

Department/Center: CNAPPS

Project website: https://www.epicentro.iss.it/okkioallasalute/