The Economic Burden Placed on Healthcare Systems by Childhood Obesity

Leonardo Trasande; Brian Elbel

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(1):39-45. 

In This Article

Abstract and Introduction

Abstract

The obesity epidemic has transformed children's healthcare, such that diabetes, hypertension and the metabolic syndrome are phrases more commonly used by child health providers than ever before. This article reviews the economic consequences of this epidemic for healthcare delivery systems, both in the short term when obesity has been associated with increased utilization, and in the long term where increased likelihood of adult obesity and cardiovascular disease is well documented. Large investments through research and prevention are needed and are likely to provide strong returns in cost savings, and would optimally emerge through a cooperative effort between private and government payers alike.

Introduction

Obesity is now epidemic among children in most of the industrialized world. Data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES) suggest that 18.1% of US children 2–19 years of age are obese (BMI ≥ 95th percentile, using the American Medical Association expert panel definition[101]) while another 16.1% are overweight (BMI 85–94th percentile).[1] Industrializing countries are also beginning to detect increases in prevalence. Among preschool children worldwide, while 4.2% were overweight (defined as >2 standard deviations above the WHO standard median) or obese (defined >3 standard deviations) in 1990, 6.7% were overweight or obese in 2010, and 9.1% are expected to be overweight or obese by 2020.[2]

The major causes of this epidemic remain incompletely understood, although diet and physical activity in childhood are the leading suspected causes of the epidemic. Increasing prevalence of obesity is now understood to reflect not only changes in individual behaviors but also changes in community structure and the 'built environment', as well as possibly exposures to synthetic chemicals (e.g., endocrine disruptors) that may disrupt energy balance.[3]

The consequences of obesity in childhood include diabetes,[4,5] hypertension,[6] early cardiovascular disease,[7,8] gallbladder disease,[9] obstructive sleep apnea[10] and slipped capital femoral epiphysis.[11] Social stigma and mental health consequences are also prominent.[12,13] In fact, the greatest predictor of obesity in adulthood is childhood obesity,[14–17] and those who are obese/overweight as children are more likely to suffer consequences in adulthood, even if the excess childhood weight is lost.[18] Infancy and adolescence have long been recognized as critical windows in formalizing eating and physical activity behaviors, which are heavily influenced by environmental factors.[19] As such, addressing obesity in childhood will probably be the most effective and cost-effective way to address the larger epidemic.

This article reviews current knowledge about the economic burden placed on healthcare systems by obesity in childhood. An analysis of PubMed on 7 November 2011 using the search terms 'childhood', 'obesity' and 'economic' by the authors identified 381 potential articles for analysis. The articles included in this review were identified on the basis of relevance to the topics below, as judged by the authors. In addition, other articles were included by the authors based upon the familiarity of the authors with the field. The 27 references that form the basis of the review are described in subsequent sections, as are other relevant related references.

It is important to note that we do not completely address the larger societal economic burden related to childhood obesity, including costs indirectly related to comorbidities, whether to the individual (e.g., reduced income), employer (e.g., decreased productivity and days of work lost) or governments (reduced tax revenues and increases in other government expenditures).[20] We begin with a focus on the consequences of childhood obesity as they manifest in childhood, and then reflect on the relatively under-recognized consequences of childhood obesity that manifest in adulthood. We then examine the types of healthcare utilization affected, and identify a series of research gaps, with attention to the underuse of the International Classification of Diseases (ICD) code for obesity. A final section describes opportunities for policy action, and potential economic benefits for the healthcare system.

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