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Research confirms a commonly held belief about health care costs and obesity, but this time the focus is on children. Obese and overweight children and adolescents have higher health care utilization and average health care charges than their healthy-weight peers. A recent Archives of Pediatric and Adolescent Medicine study followed a cohort of children ages 5–18 in a primary care clinic for 12 months and measured their outpatient service charges.1 Overweight and obese children had higher overall health care charges and laboratory use; however, primary care and emergency department utilization was not increased.
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"There may be some higher costs for diagnosing and following pediatric overweight patients more closely than they've been followed in the past, but these costs will be money well spent if comorbidities are detected and treated earlier and perhaps even prevented," emphasizes Sarah Hampl, MD, assistant professor of pediatrics at Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine and the study's primary researcher. Don't dismiss these obese children and tell them you'll see them next year for another check-up, she advises.
Not only have outpatient charges increased, but the percentage of obesity-related hospitalizations also has grown significantly over the past 20 years, causing a threefold increase in annual hospital costs.2 In children and adolescents, the most common diagnoses associated with obesity are diabetes, asthma, sleep apnea, and gallbladder disease. Diabetic young people also have more depressive and other mental health disorders.
A study published several years ago found that obese children and adolescents reported a notably lower health-related quality of life, similar to children undergoing treatment for cancer.3 The economic burden of these chronic diseases continues into adulthood; in 2002, an estimated $92.6 billion was spent to treat adult obesity and comorbidities.4 The government, through subsidized programs such as Medicaid and Medicare, finances almost half these expenditures. These cost estimates do not take into account the indirect costs of overweight and obesity: decreased productivity, absenteeism, and lost income due to premature death.
TRUE IMPACT DIFFICULT TO MEASURE
The true economic impact of overweight and obesity is difficult to ascertain and likely to be underestimated. One reason this is probably true: Obesity is often a nonreimbursable diagnosis, and clinicians are apt to use associated comorbidities to code for a patient's visit to ensure payment. Hampl's study found the majority of children who qualified as obese, with a body mass index (BMI) >95% for their age and gender, did not have this diagnosis in their medical record.
Combating these skyrocketing costs means addressing the causes of obesity and determining how to manage patients cost-effectively. Caring for overweight and obese children in a cost-efficient manner is particularly challenging for clinicians because specific guidelines for diagnosis, treatment, and prevention are lacking. Longitudinal studies looking at childhood weight and future health outcomes are not available, and many questions are unanswered.
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One approach would be to identify which children are at risk of becoming overweight or obese and target early interventions and prevention. A 1997 study evaluated the primary predictors of obesity and which children are at high risk.5 They found that, for children <10 years, regardless of weight, the presence of an obese parent more than doubles that child's risk of becoming an obese adult. Prior to age 3, future obesity is best predicted by the parents' weight and is independent of the child's weight. At ages 3–9, an obese child has a 24% chance of becoming an obese adult if both parents are a healthy weight, and a 62% chance if either parent is obese. "Obese 3–9-year-olds with obese parents may be the ideal candidates for treatment because the parents still have the opportunity to influence their children's activity and diet positively," researchers conclude. No randomized, controlled trials of clinical interventions for children in this age group are available, however, so determining exactly how to effectively intervene is difficult.
Another team of researchers advises clinicians to address comorbidities as well as any underlying behaviors contributing to obesity, such as sedentary lifestyle and diet. They also recommend promoting family involvement.6 Children with serious comorbidities such as sleep apnea or those who have a possible endocrine etiology for their obesity should be referred to a specialist. Pragmatic approaches such as promoting physical activity, limiting television viewing, and reducing soft drink consumption all make sense, and require family participation. The American Academy of Pediatrics recommends using BMI to follow the weight of children and adolescents and identifying associated health complications of obesity such as hypertension, insulin resistance, dyslipidemias, and psychosocial issues.7
Since children at greatest risk for developing obesity are those with an
obese parent, addressing the parent's weight can be an effective early
intervention but one that requires coordination between the pediatrician and
the parent's primary care provider. "Internists can help with the
parents that they see, to emphasize their role in setting up healthy nutrition
and physical activity habits for their families and being good role models
themselves," advises Hampl. Collaboration between providers can be a
step in the right direction to effect lifestyle changes that will benefit the
entire family. 
Footnotes
The Centers for Disease Control and Prevention lists numerous publications and resources promoting healthy lifestyles, nutrition education, and programs clinicians can implement with patients at www.cdc.gov/nccdphp/dnpa/programs/index.htm.
References
2. Wang G, Dietz WH: Economic burden of obesity in youths aged 6 to 17 years: 1979–1999. Pediatrics 109: E81, 2002.[Medline]
3. Schwimmer JB, Burwinkle TM, Varni JW: Health-related quality of
life of severely obese children and adolescents. JAMA 289: 1813–1819, 2003.
4. Finklestein EA, Fiebelkorn IC, Wang G: State-level estimates of annual medical expenditures attributable to obesity. Obesity Res 12:18–24, 2004.[Medline]
5. Whitaker RC, Wright JA, Pepe MS, et al.: Predicting obesity in
young adulthood from childhood and parental obesity. N Engl J
Med 337:869–873, 1997.
6. Reilly JJ, Wilson ML, Summerbell CD, et al.: Obesity: Diagnosis,
prevention, and treatment; evidence based answers to common questions.
Arch Dis Child, 86:392–394, 2002.
7. Whitlock EP, Williams SB, Gold R, et al.: Screening and interventions for childhood overweight: A summary of evidence for the U.S. Preventive Services Task Force. Pediatrics 116: E125–E144, 2005.[Medline]
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