Advertisement

Health Status, Emotional/Behavioral Problems, Health Care Use, and Expenditures in Overweight/Obese US Children/Adolescents

  • Christy Boling Turer
    Correspondence
    Address correspondence to Christy Boling Turer, MD, MHS, Department of Pediatrics, Division of General Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063.
    Affiliations
    Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex

    Children's Medical Center Dallas, Dallas, Tex
    Search for articles by this author
  • Hua Lin
    Affiliations
    Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
    Search for articles by this author
  • Glenn Flores
    Affiliations
    Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex

    Children's Medical Center Dallas, Dallas, Tex
    Search for articles by this author

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • et al.
        Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010.
        JAMA. 2012; 307: 483-490
        • Dietz W.H.
        Health consequences of obesity in youth: childhood predictors of adult disease.
        Pediatrics. 1998; 101: 518-525
        • Sullivan P.W.
        • Ghushchyan V.
        • Wyatt H.R.
        • et al.
        The medical cost of cardiometabolic risk factor clusters in the United States.
        Obesity. 2007; 15: 3150-3158
        • Bell J.F.
        • Zimmerman F.J.
        • Arterburn D.E.
        • et al.
        Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort.
        Obesity. 2011; 19: 228-232
        • Janicke D.M.
        • Finney J.W.
        • Riley A.W.
        Children’s health care use: a prospective investigation of factors related to care-seeking.
        Med Care. 2001; 39: 990-1001
        • Van Cleave J.
        • Gortmaker S.L.
        • Perrin J.M.
        Dynamics of obesity and chronic health conditions among children and youth.
        JAMA. 2010; 303: 623-630
        • Tsiros M.D.
        • Olds T.
        • Buckley J.D.
        • et al.
        Health-related quality of life in obese children and adolescents.
        Int J Obes. 2009; 33: 387-400
        • Skinner A.C.
        • Mayer M.L.
        • Flower K.
        • et al.
        Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare?.
        Pediatrics. 2008; 121: e269-e277
        • Schwimmer J.B.
        • Burwinkle T.M.
        • Varni J.W.
        Health-related quality of life of severely obese children and adolescents.
        JAMA. 2003; 289: 1851-1853
        • Judge S.
        • Jahns L.
        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
        • Trasande L.
        • Chatterjee S.
        The impact of obesity on health service utilization and costs in childhood.
        Obesity. 2009; 17: 1749-1754
        • Monheit A.C.
        • Vistnes J.P.
        • Rogowski J.A.
        Overweight in adolescents: implications for health expenditures.
        Econ Hum Biol. 2009; 7: 55-63
      1. 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.

        • Ezzati M.
        • Lopez A.D.
        • Rodgers A.
        • et al.
        Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease.
        Lancet. 2002; 360: 1347-1360
        • Barlow S.E.
        • Expert Committee
        Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120: S164-S192
        • Akinbami L.J.
        • Ogden C.L.
        Childhood overweight prevalence in the United States: the impact of parent-reported height and weight.
        Obesity. 2009; 17: 1574-1580
        • Bird H.R.
        • Andrews H.
        • Schwab-Stone M.
        Global measures of impairment for epidemiologic and clinical use with children and adolescents.
        Int J Methods Psychiatric Res. 1996; 6: 295-307
        • Cella D.
        • Yount S.
        • Rothrock N.
        • et al.
        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
        • Varni J.W.
        • Limbers C.A.
        • Burwinkle T.M.
        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
        • Fleishman J.A.
        • Cohen J.W.
        Using information on clinical conditions to predict high-cost patients.
        Health Serv Res. 2010; 45: 532-552
        • Bird H.R.
        • Shaffer D.
        • Fisher P.
        • et al.
        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
        • Hamilton J.D.
        • Bridge J.
        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
      2. 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.

        • Manning W.G.
        • Basu A.
        • Mullahy J.
        Generalized modeling approaches to risk adjustment of skewed outcomes data.
        J Health Econ. 2005; 24: 465-488
        • Zhang J.
        • Yu K.F.
        What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.
        JAMA. 1998; 280: 1690-1691
        • Veazie P.J.
        When to combine hypotheses and adjust for multiple tests.
        Health Serv Res. 2006; 41: 804-818
        • Jerrell J.M.
        • Sakarcan A.
        Primary health care access, continuity, and cost among pediatric patients with obesity hypertension.
        J Natl Med Assoc. 2009; 101: 223-228
      3. 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.

      4. 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.

        • National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents
        The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
        Pediatrics. 2004; 114: 555-576
        • Arrebola E.
        • Gomez-Candela C.
        • Fernandez-Fernandez C.
        • et al.
        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
        • Abu-Hasan M.
        • Tannous B.
        • Weinberger M.
        Exercise-induced dyspnea in children and adolescents: if not asthma then what?.
        Ann Allergy Asthma Immunol. 2005; 94: 366-371
        • de Sa Pinto A.L.
        • de Barros Holada P.M.
        • Radu A.S.
        • et al.
        Musculoskeletal findings in obese children.
        J Paediatr Child Health. 2006; 42: 341-344
        • Hafton N.
        • Larson K.
        • Slusser W.
        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
        • Strauss R.S.
        Child obesity and self-esteem.
        Pediatrics. 2000; 105: e15-e20
        • Latner J.D.
        • Stunkard A.J.
        Getting worse: the stigmatization of obese children.
        Obes Res. 2003; 11: 452-456
        • Janssen I.
        • Craig W.M.
        • Boyce W.F.
        • et al.
        Associations between overweight and obesity with bullying behaviors in school-aged children.
        Pediatrics. 2004; 113: 1187-1194
        • Kataoka S.
        • Zhang L.
        • Wells K.
        Unmet need for mental health care among US children: variation by ethnicity and insurance status.
        Am J Psychiatry. 2002; 159: 1548-1555
        • Kuhle S.
        • Kirk S.
        • Ohinmaa A.
        • et al.
        Use and cost of health services among overweight and obese Canadian children.
        Int J Pediatr Obes. 2011; 6: 142-148
        • Dorsey K.B.
        • Wells C.
        • Krumholz H.M.
        • et al.
        Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice.
        Arch Pediatr Adolesc Med. 2005; 159: 632-638
        • Story M.T.
        • Neumark-Stzainer D.R.
        • Sherwood N.E.
        • et al.
        Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.
        Pediatrics. 2002; 110: 210-214
        • Stommel M.
        • Schoenborn C.A.
        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
        • Huybrechts I.
        • Himes J.H.
        • Ottevaere C.
        • et al.
        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