Abstract
Objective
To examine the association of overweight/obesity with health, health care utilization,
and expenditures in a national sample of 10- to 17-year-old children and adolescents.
Methods
Secondary analysis of 2005 to 2009 Medical Expenditure Panel Survey data (n = 17,224).
Outcome measures included suboptimal health, emotional/behavioral problems, health
care utilization, and expenditures.
Results
Overweight and obese children and adolescents had greater risk of suboptimal health
(adjusted risk ratio [ARR], 1.4 and 1.7; P < .01), use of prescriptions (ARR, both 1.1; P = .01), and emergency department visits (ARR, 1.2 and 1.1; P = .01); overweight children/adolescents had lower mean out-of-pocket expenditures
(∼$100, P < .01); and obese children/adolescents had greater risk of emotional/behavioral problems
(ARR, 1.2; P < .01) and specialist visits (ARR, 1.1; P = .01). The most common specialty referral among obese children/adolescents was psychiatry.
Overweight and obesity were not associated with office visits or total expenditures.
A greater proportions of children and adolescents with suboptimal health and emotional/behavioral
problems had health care expenditures, and those with suboptimal health were more
likely to have out-of-pocket expenditures.
Conclusions
Pediatric overweight and obesity affect child and adolescent health status, emotional/behavioral
problems, and specific domains of health care utilization, but do not appear to be
associated with total health care expenditures. Out-of-pocket expenditures are lower
among overweight children and adolescents. These findings highlight the need for early
intervention in overweight children/adolescents, when health care expenditures may
not be greater, and suggest that it may prove useful to pay special attention to the
health status and emotional/behavioral problems of overweight and obese children/adolescents
in weight-management interventions.
Keywords
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References
- Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010.JAMA. 2012; 307: 483-490
- Health consequences of obesity in youth: childhood predictors of adult disease.Pediatrics. 1998; 101: 518-525
- The medical cost of cardiometabolic risk factor clusters in the United States.Obesity. 2007; 15: 3150-3158
- Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort.Obesity. 2011; 19: 228-232
- Children’s health care use: a prospective investigation of factors related to care-seeking.Med Care. 2001; 39: 990-1001
- Dynamics of obesity and chronic health conditions among children and youth.JAMA. 2010; 303: 623-630
- Health-related quality of life in obese children and adolescents.Int J Obes. 2009; 33: 387-400
- Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare?.Pediatrics. 2008; 121: e269-e277
- Health-related quality of life of severely obese children and adolescents.JAMA. 2003; 289: 1851-1853
- Association of overweight with academic performance and social and behavioral problems: an update from the Early Childhood Longitudinal Study.J Sch Health. 2007; 77: 5677-5678
- The impact of obesity on health service utilization and costs in childhood.Obesity. 2009; 17: 1749-1754
- Overweight in adolescents: implications for health expenditures.Econ Hum Biol. 2009; 7: 55-63
Agency for Healthcare Research and Quality. Medical expenditure panel survey background. Available at: http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp. Accessed January 16, 2013.
- Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease.Lancet. 2002; 360: 1347-1360
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164-S192
- Childhood overweight prevalence in the United States: the impact of parent-reported height and weight.Obesity. 2009; 17: 1574-1580
- Global measures of impairment for epidemiologic and clinical use with children and adolescents.Int J Methods Psychiatric Res. 1996; 6: 295-307
- The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years.Med Care. 2007; 45: S3-S11
- Parent proxy-report of their children’s health-related quality of life: an analysis of 13,878 parents’ reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales.Health Qual Life Outcomes. 2007; 5: 2-12
- Using information on clinical conditions to predict high-cost patients.Health Serv Res. 2010; 45: 532-552
- The Columbia Impairment Scale (CIS): pilot findings on a measure of global impairment for children and adolescents.Int J Methods Psychiatr Res. 1993; 3: 161-176
- Outcome at 6 months for 50 adolescents with major depression treated in a health maintenance organization.J Am Acad Child Adolesc Psychiatry. 1999; 38: 1340-1346
US Census Bureau. Poverty thresholds, 2003. Updated 2010. Available at: http://www.census.gov/hhes/www/poverty/data/threshld/thresh03.html. Accessed January 16, 2013.
- Generalized modeling approaches to risk adjustment of skewed outcomes data.J Health Econ. 2005; 24: 465-488
- What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.JAMA. 1998; 280: 1690-1691
- When to combine hypotheses and adjust for multiple tests.Health Serv Res. 2006; 41: 804-818
- Primary health care access, continuity, and cost among pediatric patients with obesity hypertension.J Natl Med Assoc. 2009; 101: 223-228
National Institutes of Health, National Heart, Lung, and Blood Institute Obesity Education Initiative. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Accessed January 16, 2013.
Centers for Disease Control. National diabetes fact sheet, 2011. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed January 16, 2013.
- The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.Pediatrics. 2004; 114: 555-576
- Evaluation of a lifestyle modification program for treatment of overweight and nonmorbid obesity in primary healthcare and its influence on health-related quality of life.Nutr Clin Pract. 2011; 26: 316-321
- Exercise-induced dyspnea in children and adolescents: if not asthma then what?.Ann Allergy Asthma Immunol. 2005; 94: 366-371
- Musculoskeletal findings in obese children.J Paediatr Child Health. 2006; 42: 341-344
- Associations between obesity and comorbid mental health, developmental, and physical conditions in a nationally representative sample of US children aged 10 to 17.Acad Pediatr. 2013; 13: 6-13
- Child obesity and self-esteem.Pediatrics. 2000; 105: e15-e20
- Getting worse: the stigmatization of obese children.Obes Res. 2003; 11: 452-456
- Associations between overweight and obesity with bullying behaviors in school-aged children.Pediatrics. 2004; 113: 1187-1194
- Unmet need for mental health care among US children: variation by ethnicity and insurance status.Am J Psychiatry. 2002; 159: 1548-1555
- Use and cost of health services among overweight and obese Canadian children.Int J Pediatr Obes. 2011; 6: 142-148
- Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice.Arch Pediatr Adolesc Med. 2005; 159: 632-638
- Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.Pediatrics. 2002; 110: 210-214
- Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES and NHIS, 2001–2006.BMC Public Health. 2009; 9: 421-431
- Validity of parent-reported weight and height of preschool children measured at home or estimated without home measurement: a validation study.BMC Pediatr. 2011; 11: 63-71
Article info
Publication history
Accepted:
February 9,
2013
Received:
November 13,
2012
Identification
Copyright
© 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
