Children and adolescents who are obese or overweight have higher health care utilization and a significantly higher average of health care charges than their healthy-weight peers, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to background information in the article, 30 percent of children in the United States are obese or overweight with six in ten having at least one risk factor for cardiovascular disease and 25 percent having more than two risk factors for the disease. The authors note that more than 80 percent of obese 12-year-olds will carry their overweight status into adulthood.
Sarah E. Hampl, M.D., and colleagues at Children's Mercy Hospitals and Clinics and the University of Missouri--Kansas City School of Medicine analyzed data from 8,404 patients age 5 to 18 who attended a primary care clinic in the Midwest for well-child care visits during 2002 and 2003. Body mass index (BMI) was calculated with patients' height and weight information. Four weight categories were used in the study: patients with a BMI in the 95th percentile or higher for their age and sex with a discharge diagnosis of obesity, patients with a BMI in the 95th percentile or higher for their age and sex without a diagnosis of obesity, patients with BMI between the 85th and 94th percentiles classified as overweight and patients with BMIs lower than the 85th percentile classified as healthy weight.
Health care resource utilization was measured for each category and included the number of health care visits and blood tests that occurred within a year from each patient's initial visit. Health care expenditures were determined by charge data obtained through the billing system of health care resources. Factors associated with the diagnosis of obesity were also examined.
Based on the patients' BMI, 17.8 percent were overweight and 21.9 percent were obese. Of the obese children, only 42.9 percent had a discharge diagnosis of obesity, suggesting a significant rate of underdiagnosis. "When obesity was present, being female, older and insured by Medicaid were associated with a higher probability of having diagnosed obesity," the authors write.
A significantly higher rate of utilization of laboratory services by overweight and obese children was found when compared to their healthy-weight peers. This increase was most notable for children with diagnosed obesity. "We speculate that this increase reflects primary care provider compliance with expert committee recommendations for laboratory evaluation of obese children and adolescents," the authors write. "Compared with their healthy-weight peers, children with overweight, diagnosed obesity and undiagnosed obesity had significantly higher charges, with the highest for the diagnosed obesity category," with an average adjusted difference of $172.
"This finding is perhaps reflective of primary care provider intent to detect and treat comorbid conditions. This trend of increased health care utilization, observed even in children younger than 10 years, is similar to the trends seen in adult patients," the authors conclude. "Efforts to continue to educate primary care providers regarding the diagnosis of obesity and early interventions to address obesity in children are warranted."
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