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Costs of rising childhood obesity
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Two studies on current childhood obesity rates and related costs demonstrated that severe adolescent obesity is rising in the United States, and that significant direct costs can be attributed to health problems associated with childhood obesity.
A study published in Pediatrics demonstrated that the lifelong costs of childhood obesity, when compared with health costs of a normal-weight child, are $12,660 to $19,630 per individual; meanwhile, a study from JAMA Pediatrics showed that severe obesity rates have risen for certain adolescent groups.
Both studies noted that accurate estimates of prevalence and costs of obesity are needed to better plan and implement future public policy decisions.
Rising severe obesity rates
Asheley Cockrell Skinner, PhD, of the University of Carolina at Chapel Hill School of Medicine, and colleagues analyzed National Health and Nutrition Examination Survey data to determine the prevalence of US childhood obesity and severe obesity from 1999 to 2012. Previous research showed a dearth of information on severe obesity rates in recent years, although the most recent nationally representative data showed no change in the obesity rate from 2007-2008 and 2009-2010. “Severe obesity is more strongly related to increased cardiometabolic risk than less severe obesity,” Skinner and colleagues wrote.
Asheley Cockrell Skinner
The researchers defined obesity as BMI ≥95th percentile for age and sex. Severe obesity, which the study also called class 2 obesity, was BMI ≥120% of the 95th percentile for age and sex, or a BMI of ≥35, whichever was lower. Class 3 obesity was defined as BMI ≥140% of the 95th percentile for age and sex, or BMI ≥40.
Statistical analysis of NHANES data on 26,690 children aged 2 to 19 years showed that 17.3% were obese in 2011-2012. Within the obese population, 5.9% of children met criteria for class 2 obesity and 2.1% met criteria for class 3 obesity. The researchers noted that these rates were not significantly different from 2009-2010; however, all classes of obesity have increased in the past 14 years.
Data demonstrated significant increases in overweight, obesity and class 2 obesity in Hispanic females and black males. Significant increases in class 3 obesity were seen in white females and black males.
Lifetime $19,000 cost
In a retrospective study of six articles published in the 15 years preceding May 2013, Eric Andrew Finkelstein, PhD, MHA, and colleagues from Duke–NUS Graduate Medical School in Singapore analyzed the lifetime direct medical cost of obesity. The researchers compared incremental health care costs throughout life from the perspective of an obese child at 10 years vs. a healthy-weight child at 10 years.
Eric Finkelstein
Finkelstein and colleagues found that cumulative costs for obese children ranged from $12,660 to $19,630 when statistical analysis accounted for average estimates of weight gain through adulthood in the healthy-weight group. Without that adjustment, estimated lifetime medical costs for obese children ranged from $16,310 to $39,080.
Added lifetime costs for obese children may derive from an added risk for hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease and stroke, the study said.
Overall, the researchers recommended use of an estimate of $19,000 as the incremental lifetime medical cost of obesity when compared with a normal-weight child who maintains a normal weight throughout adulthood. The alternative estimate of $12,660 accounts for the likelihood of some weight gain in adulthood for children who were at normal weight at age 10 years.
By multiplying the $19,000 cost estimate by the current number of obese 10-year-olds in the United States, Finkelstein and colleagues demonstrated that lifetime direct medical costs would total $14 billion for this age alone. The researchers noted that further inquiry into the indirect costs of childhood obesity may reveal added lifetime costs.
The research team also noted that improved obesity-prevention public health measures could benefit healthy-weight children.
“Prevention efforts typically do not just target overweight youth,” the researchers said. “There is the potential to improve weight management among all youth that could last well into adulthood.” — by Reagan Copeland
For more information:
Finkelstein EA. Pediatrics. 2014;doi:10.1542/peds.2014-0063.
Skinner AC. Arch Pediatr Adolesc Med. 2014;doi:10.1001/jamapediatrics.2014.21.
Disclosure:
Skinner and colleagues report receiving support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH.
Finkelstein and colleagues report that their study was funded in part by the Robert Wood Johnson Foundation.
Perspective
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Stephen Cook, MD, MPH, FAAP, FTOS
The article by Skinner and colleagues points to a more accurate finding of the current rates of obesity among children and adolescents. High and rising rates of severe obesity are a major concern because this is the one of the most common chronic diseases among youth, and there are very few services available. The U.S. Preventive Services Task Force (USPSTF) has weighed in and endorsed treatment for obesity among kids and teens, but insurers have largely refused to pay for the appropriate level of intensive services. Subsequently, few children’s hospitals or pediatric centers will offer such services, or if they do, they are running at a loss because of lack of reimbursement.
Those involved with the payment of healthcare services need to take notice. This includes insurers, employers, healthcare exchanges and accountable care organizations, because these are youth from families where obesity and subsequent complications will arise. Providers of services for adults are too busy trying to provide and improve care for middle aged and geriatric populations as well as reduce costs at that end. They don’t have time to spare for moms and dads, but pediatricians see these children and their parents, especially the moms, very regularly. The pediatric health care setting will be at the forefront of maintaining and improving the “health of the population.”
The Medical Home concept started in pediatrics, and we’ve always had a life course approach. I’m not saying the pediatrician specifically will be the key to delivering behavioral, family-based interventions, but it will be based on that trust and on regular encounters that additional providers — like psychologists, applied behavioral specialists, social workers, dieticians or exercise specialists — can provide. This is an approach that addresses many behaviors, family issues and lifestyles. It can also occur at a stage that is key to keep the parents healthy before and as they enter middle age.
Finkelstein and colleagues point out the significant and hidden cost burden of rising severe obesity rates. Public health strategies are needed to help prevent obesity, but there also needs to be treatment for those affected already. Even the best public health strategies currently proposed, at a broad population level, won’t help kids who are already obese. This study didn’t include the indirect cost of loss of productivity, absenteeism, or quality of life. This should get the attention of more than just government healthcare legislators and the Department of Health and Human Services (HHS). All levels of employers need to take notice in regards to supporting the entire family, as well as public health strategies. There are many institutions that can be involved like the Department of Defense, Department of Education and the USDA, not just HHS.
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