August 16, 2026, 6:03 am | Read time: 4 minutes
When children start school, the anticipation of a new phase in life is usually the focus. However, data from school entry examinations reveal a trend that increasingly worries experts: Many children struggle with being overweight even before their first day of school. A recent analysis shows the reasons behind this and the countermeasures experts are calling for.
In many states, summer vacation is over, and about 800,000 first graders are now starting school. Before enrollment, children aged five to seven are assessed for school readiness. These examinations measure cognitive and social skills, as well as height and weight.
A study published in July in the “Journal of Health Monitoring” by the Robert Koch Institute analyzed more than four million data sets from mandatory school entry examinations of children aged four to seven nationwide.1 For Ursula Felderhoff-Müser, president of the German Society for Pediatric and Adolescent Medicine (DGKJ), the result is clear: “The numbers are alarming,” she says.
Every Tenth Preschool Child Is Overweight
The study shows that over a period of 20 years, on average, about every tenth child examined was overweight. Around four percent of the children were considered obese. While boys and girls are similarly affected by being overweight, obesity is slightly more common in boys.
As children age, the situation worsens: Among adolescents, the proportion of those overweight is nearly 20 percent. For Felderhoff-Müser, a lack of physical activity is a major issue. “Children are not moving as they should.” According to surveys, less than 15 percent of elementary school children meet the World Health Organization’s (WHO) recommendation of at least one hour of physical activity daily. The pediatrician believes that preschools and schools could do more to counteract this, such as through closer cooperation with sports clubs. “Children enjoy being active, but they often lack opportunities,” says Felderhoff-Müser.
Pediatrician and spokesperson for the Federal Association of Pediatricians, Jakob Maske, also sees the COVID-19 pandemic as a significant factor. “Obesity is multifaceted,” he says. During the pandemic, many children lacked opportunities for physical activity at school and in their free time. Additionally, for some children, school meals were one of the few regular healthy meals. At the same time, screen time increased significantly.
Also of interest: These examinations and vaccinations are important before starting school
Preventing Overweight Starting in Preschool
During preventive examinations, the development of children’s height and weight is regularly checked, explains Maske. “At every preventive examination, we look at the ratio of height to weight in children,” he says. It often becomes apparent that the so-called Body Mass Index (BMI) in affected children increases significantly even before school entry. Therefore, the pediatrician calls for more education on healthy eating and drinking starting in preschool. He also advocates for a dedicated school subject: “Health Competence.”
Maske is particularly critical of heavily sweetened drinks like sodas or iced tea. These are inexpensive, high in calories, and often consumed in large quantities by children. He believes a sugar tax would be sensible. Drinks with sweeteners are also not a suitable solution in his view. “We shouldn’t get children accustomed to sweet things,” says Maske. It’s fundamentally about the right balance. Sweets don’t need to be completely banned. More importantly, children should develop a taste for healthy foods.
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School Meals as a Possible Lever
Maske sees great potential in school catering. “We need to consider what we are willing to invest here,” he says. Fresh fruits and vegetables incur higher costs but could make an important contribution to a balanced diet. The Association of German School and Preschool Caterers also sees catering as an important component of health promotion. “We view school and preschool catering as part of comprehensive health promotion,” says association chairman Ralf Blauert.
The catering companies claim to follow the standards of the German Nutrition Society. “As an association, we advocate for these quality standards to become mandatory nationwide,” explains Blauert. The association also supports free meals for all children in preschools and schools. They cite a California study from 2024, which found that free school meals are associated with a lower tendency toward being overweight.
Long-term Health Consequences
Overweight and obesity can have far-reaching effects. They increase the risk of chronic diseases such as diabetes or high blood pressure and place a long-term burden on the health care system.
At the same time, Maske warns against attributing all forms of severe overweight solely to dietary habits. “We also check for medical causes in overweight children, such as thyroid dysfunction or lipid metabolism disorders.” Medical causes must also be considered in affected children.