Childhood obesity linked to steep rise in hospitalizations

Hospitalizations for children diagnosed with obesity almost doubled between 1999 and 2005, a new national study reports. Costs have almost doubled too, even though federal figures measuring the prevalence of childhood obesity appeared stable over the same period of time.

A research team led by Dr. Leonardo Trasande of Mount Sinai School of Medicine tracked the increase in hospitalizations of children and adolescents from 2 to 19 years old by analyzing records from the Nationwide Inpatient Sample, the largest database for US hospitalizations. The researchers included obesity as a primary diagnosis as well as obesity when it was secondary to another medical condition, such as asthma, diabetes, or a mental illness.

Hospital stays for these children climbed from 21,743 in 1999 to 42,429 in 2005 while costs in constant dollars rose from $126 million to $238 million. The most common conditions the children had along with obesity were psychiatric disorders, pregnancy-related conditions, asthma, and diabetes. The increase in obesity diagnoses could not be explained by increases in the other conditions, which decreased or stayed the same, except for diabetes.

The obesity diagnoses measured in the study were judgment calls made by physicians that were also reviewed by hospital payers, the authors said. That can make the diagnoses different from other definitions of obesity, such as the one used by the US Centers for Disease Control and Prevention, they said. The study findings may represent trends in obesity diagnoses rather than an increase in obesity-related medical problems serious enough to require hospitalization, they cautioned.

"Even if increased recognition has contributed to these trends, our analysis suggests that obesity has a much more immediate impact on the health of children, especially adolescents, than previously understood," they wrote.

The study also found differences in the obesity diagnoses depending on whether the child had public or private insurance. Private insurers paid most of the bills for obesity when it was the primary diagnosis while Medicaid was more often the payer for obesity as a secondary diagnosis.

"Just as growth in the elderly population has contributed to increases in health care costs, increasing obesity appears to be driving increases in Medicaid spending," the study authors write.

That is a worrying development, Dr. Caroline Apovian, director of nutrition and weight management at Boston Medical Center and associate professor of medicine and pediatrics at Boston University School of Medicine, said in a statement. She was not involved in the study, which was posted online in the journal Health Affairs today.

"This is a very disturbing trend and is heralding an increase in healthcare costs for childhood obesity," she said. "Most obese adolescents become obese adults. Many obese children also become obese adults. We can be assured of obesity causing an increase in healthcare dollars for the next generation based on this news."

The authors and Apovian urge more support for prevention programs. In Congress, legislation to revamp the nation's healthcare system includes some of the measures Apovian favors, as a story in today's Globe explains.

"We need not only an increase in exercise facilities, parks, safe neighborhoods, sidewalks, more bike paths and more gym classes in schools but also an increase in subsidies for fruit and vegetable farming and distribution as well as high taxes for sugar-sweetened beverages and nonessential junk foods," Apovian said.