{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:30:10Z","timestamp":1793716210722,"version":"4.6.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Including children's perspectives developing health programs is a priority. This study gathered children's perspectives on outcomes in a Core Outcomes Set (COS), which they believe are important to measure in school-based healthy lifestyle behavioral interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children aged 8\u201312 years from six countries across three continents participated in standardized interactive focus groups. An animation video was used to explain all relevant concepts (e.g., \u201cintervention\u201d, \u201coutcomes\u201d) and showed animated children engaging in a variety of lifestyle behaviors at school. Participating children then brainstormed and proposed outcomes they consider important to measure when evaluating a school-based \u201chealthy lifestyle programme\u201d. Next, children individually rated the importance of the outcomes using a traffic light system (red, \u201cnot important\u201d; orange, \u201cimportant\u201d; green, \u201cvery important\u201d). Similar outcomes (across focus groups and countries) were merged, and an overall importance rating was given to each outcome (across countries and overall). An outcome was considered important for inclusion in a COS if \u226570% of children scored the outcome as \u201cvery important\u201d and &amp;lt;15% scored it as \u201cnot important\u201d.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Children (<jats:italic>n<\/jats:italic> = 159) proposed 170 unique outcomes. Children proposed thirty-six outcomes in at least two countries, of which 20 outcomes received an overall rating of \u201cvery important\u201d in all countries where the outcomes were reported. Of these 20, five outcomes were reported by children in at least four countries: being healthy, healthy diet, concentration, having fun, and feeling happy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children reported a wide range of outcomes related to physical and mental health, as well as enjoyment and social skills, such as having fun and making friends. All outcomes reported by children in at least two countries and considered \u201cvery important\u201d will be considered for inclusion in the consensus stage of developing a COS for school-based intervention studies aimed at childhood overweight and obesity prevention.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1519467","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T04:10:46Z","timestamp":1744776646000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Child opinions related to a core outcome set for school-based healthy lifestyle behavior interventions: the COCOS study"],"prefix":"10.3389","volume":"13","author":[{"given":"Teatske M.","family":"Altenburg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte W.","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kheana","family":"Barbeau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Button","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise de","family":"Lannoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhairi","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowena","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda E.","family":"Staiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Tremblay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre M.","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"B1","volume-title":"Report of the Commission on Ending Childhood Obesity","year":"2016"},{"key":"B2","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1016\/S0140-6736(14)60460-8","article-title":"Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Ng","year":"2014","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2627","DOI":"10.1016\/S0140-6736(17)32129-3","article-title":"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","volume":"390","author":"NCD","year":"2017","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/j.1467-789X.2008.00515.x","article-title":"Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence","volume":"10","author":"Brown","year":"2009","journal-title":"Obes Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1038\/oby.2008.29","article-title":"School-based obesity prevention programs: an evidence-based review","volume":"16","author":"Kropski","year":"2008","journal-title":"Obesity."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1038\/ijo.2011.68","article-title":"te Velde SJ, Brug J, van Mechelen W, Chinapaw MJ, et al. 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