The impact of BMI on direct costs in children and adolescents: empirical findings for the German Healthcare System based on the KiGGS-study

Overweight and obesity and associated factors among public and private secondary school adolescent students in Harar city, Eastern Ethiopia: A comparative cross-sectional study

Adolescent overweight and obesity are growing public health concerns in developing nations like Ethiopia. They are closely linked to an increased risk of non-communicable diseases, a deterioration in health-related quality of life, subpar academic performance, and a decline in social and emotional well-being. There is, however, little research in this field. Thus, this study aimed to assess overweight and obesity and associated factors among public and private secondary school adolescent students in Harar city, Eastern Ethiopia. A school-based comparative cross-sectional study was conducted among 781 secondary school adolescents in Harar city from February to March 2022. Multi-stage sampling was used to identify 781 study participants (586 in public and 195 in private schools). Anthropometric measures and self-administered structured questionnaires were used to obtain the data. Bivariate and multivariate logistic regression were used to determine the association between independent variables and overweight and obesity. Statistical significance was declared at P < .05. The overall magnitude of overweight and obesity was 9.3% [95% confidence interval (CI) = 7.2-11.4%] with 16.2% in private schools. Being female [adjusted odd ratio (AOR) = 2.04, 95% CI: 1.17-3.55], late adolescent age [AOR = 0.53, 95% CI: 0.31-0.90], bigger family size [AOR = 0.55, 95% CI: 0.31-0.97], high paternal education level [AOR = 2.03, 95% CI: 1.08-3.81], eating meat [AOR = 3.41, 95% CI: 1.27-9.17] and not consuming breakfast daily [AOR = 2.13, 95% CI: 1.24-3.67] were factors associated with overweight and obesity among all secondary school adolescents. A high maternal educational level, not eating breakfast and dinner daily in private secondary school adolescents and having a feminine gender, eating eggs, and not walking or riding a bicycle for at least 10 minutes continuously in public secondary school adolescents were factors associated with overweight and obesity. The extent of overweight and obesity was notably higher in the study area. Communities and educational institutions should work together to promote healthy lifestyle choices among adolescents, with a special emphasis on girls and students enrolled in private schools.

Pathways of Parental Education on Children's and Adolescent's Body Mass Index: The Mediating Roles of Behavioral and Psychological Factors

Aim

The increasing body mass index (BMI) often followed by overweight and obesity is a global health problem of the 21st century. Children and adolescents with lower socioeconomic status are more affected than their counterparts. The mechanisms behind these differences must be well understood to develop effective prevention strategies. This analysis aims at examining the association of parental education as an indicator of the socioeconomic status on children's and adolescent's body mass index and the role of behavioral and psychological risk factors for a higher BMI longitudinally.

Methods

The analysis was based on a nationwide sample of N = 460 children and adolescents, aged 11 to 17 at baseline (2009-2012), who took part in the representative BELLA study, the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). A follow-up was conducted 5 years later. Using mediation analyses, the mediating effects of breakfast consumption, consumption of sugar-sweetened beverages, screen time, physical activity, mental health problems (Strengths and Difficulties Questionnaire), and health-related quality of life (KIDSCREEN-10) on the association of parent's years of education on their children's BMI were investigated.

Results

A lower level of parental education was significantly associated with a higher BMI in children and adolescents 5 years later. The association was partially mediated by breakfast consumption and total screen time, with breakfast consumption mediating 16.7% and total screen time 27.8% of the association. After controlling for age, gender, and migration status, only breakfast consumption remained a partial mediator (8.5%). Other included variables had no mediating effects.

Conclusions

Preventive measures should be mainly targeted at children and adolescents of parents with lower educational levels. Tailored strategies to prevent the development of overweight and obesity in this population among children and adolescents should promote daily breakfast consumption at home and reducing screen time.

Healthcare utilisation in overweight and obese children: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood.

DATA SOURCES

PubMed, MEDLINE, CINAHL, EMBASE and Web of Science.

METHODS

Observational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies.

OUTCOME MEASURES

Included studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay.

RESULTS

Thirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children.

CONCLUSIONS

Obesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity.

PROSPERO REGISTRATION NUMBER

CRD42018091752.

Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany

OBJECTIVES

Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs.

STUDY DESIGN

All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program.

METHODS

Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease.

RESULTS

On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%.

CONCLUSIONS

This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.

Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity

BACKGROUND

Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity.

METHODS

Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants.

RESULTS

General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181).

CONCLUSIONS

Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies.

TRIAL REGISTRATION

DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.

Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia

Objective Arguments to fund obesity prevention have often focused on the growing hospital costs of associated diseases. However, the relative contribution of overweight and obesity to public hospital expenditure growth is not well understood. This paper examines the effect of overweight and obesity on acute public hospital in-patient expenditure in South Australia over time compared with other expenditure drivers. Methods Annual inflation-adjusted acute public admitted expenditure attributable to a high body mass index was estimated for 2007-08 and 2011-12 and compared with other expenditure drivers. Results Expenditure attributable to overweight and obesity increased by A$45million, from 4.7% to 5.4% of total acute public in-patient expenditure. This increase accounted for 7.8% of the A$583million total expenditure growth, whereas the largest component of total growth (62.4%) was a real increase in the average cost per separation. Conclusions The relatively minor contribution of overweight and obesity to expenditure growth over the time period examined invites reflection on arguments to boost preventive spending that centre upon reducing hospital costs. These arguments may inadvertently detract attention from the considerable health and social burdens of overweight and obesity and from unrelated sources of expenditure growth that reduce opportunities for state governments to fund obesity prevention programs despite their comparative benefits to population health. What is known about the topic? Stand-alone estimates suggest that overweight and obesity are placing a considerable financial burden on the Australian public healthcare system. What does this paper add? Our findings challenge common perceptions about the relative importance of overweight and obesity in the context of rising public in-patient expenditure in Australia. What are the implications for practitioners? Consistent serial estimates of overweight- and obesity-attributable expenditure enable its tracking and comparison with other potentially controllable expenditure drivers that may also warrant attention. Explicit consideration of population health trade-offs in expenditure-related decisions, including in enterprise bargaining, would enhance transparency in priority setting.

The health care costs of childhood obesity in Australia: An instrumental variables approach

The effect of childhood obesity on medical costs incurred by the Australian Government is estimated using five waves of panel data from the Longitudinal Study of Australian Children, which is linked to public health insurance administrative records from Medicare Australia. Instrumental variables estimators are used to address concerns about measurement error and selection bias. The additional annual medical costs due to overweight and obesity among 6 to 13 year olds is about $43 million (in 2015 AUD). This is driven by a higher utilisation of general practitioner and specialist doctors. The results suggest that the economic consequences of childhood obesity are much larger than previously estimated.

Body weight regulation, socioeconomic status and epigenetic alterations

Obesity is a complex disease which has reached epidemic dimensions. Thus, prevention of excessive weight gain and associated metabolic and cardiovascular diseases has to start as early in life as possible. The impact of epigenetic mechanisms on the regulation of genes involved in obesity is increasingly recognized. On the other hand, it is well known that socioeconomic factors influence the risk for obesity. These factors can also have an impact on epigenetic gene regulation. There is increasing body of evidence that several factors and interventions addressing extragenetic causes of obesity may not only improve individual health, but also the health of future generations by epigenetic alterations. Our current understanding of epigenetic changes has shown that many of them are potentially reversible, i.e. by physical exercise, by pharmacological treatment, by environmental factors or nutrition, or even by influencing socioeconomic factors, which might have impact on improving health in future generations by avoiding epigenetic dysregulation. In this review we present the current state of the art with regard to the interplay between social determinants, weight status and epigenetic alterations.

Healthcare utilisation and expenditure of overweight and non-overweight children

BACKGROUND

Quantification of the burden of overweight on the healthcare system is becoming increasingly urgent for health policy, but accurate estimates are hard to obtain.

METHODS

In order to assess healthcare utilisation and expenditure of overweight and non-overweight children, we linked, on an individual basis, data on body mass index from a birth cohort study with administrative health insurance claims data. In children aged 14-15 years, we compared utilisation and expenditure on general practice care, dental care, hospital/specialist care, prescribed medication, allied healthcare and mental healthcare of overweight children (overweight at age 11 and 14, n=80) and non-overweight children (no overweight at age 11 and 14, n=1253).

RESULTS

For overweight children, mean 1-year healthcare expenditure was €837 per child and for non-overweight children €616. This difference was mainly due to significant differences in utilisation of hospital care (49% vs 37%) and mental healthcare (14% vs 7%) and to a lesser extent to higher expenditure per user.

CONCLUSION

Our results indicate the potential value of linking survey data to claims data in order to obtain insight into the healthcare costs of childhood overweight. Further studies should elucidate whether the observed differences are causally related to overweight.

The impact of childhood overweight and obesity on healthcare utilisation

Rising levels of childhood overweight and obesity represent a major global public health challenge. A number of studies have explored the association between childhood overweight and obesity and healthcare utilisation and costs. This paper adds to the literature by estimating the causal effect of child overweight and obesity status on use of general practitioner (GP) and hospital inpatient stays at two time points using instrumental variable (IV) methods The paper uses data from two waves of the Growing Up in Ireland survey of children when they are 9 and 13 years respectively and uses the biological mother's body mass index (BMI) as an instrument for the child's BMI. Our results demonstrate that child overweight and obesity status do not have a significant effect on healthcare utilisation for children when they are 9 years, but do have a large and significant effect at 13 years. Across all our models, the effects on both GP and hospital inpatient stays are found to be larger when endogeneity in childhood BMI status is addressed. Previous studies that did not address endogeneity concerns are likely to have significantly underestimated the impact of child overweight and obesity status on healthcare utilisation.

Cardiometabolic risk markers, adipocyte fatty acid binding protein (aFABP) and the impact of high-intensity interval training (HIIT) in obese adolescents

OBJECTIVE

The impact of high-intensity interval training (HIIT) as well as the association between the adipocyte fatty binding protein (aFABP) and cardiometabolic risk factors in overweight adolescents was investigated.

METHODS

Twenty-eight adolescents (13-18years; BMI≥90th percentile according to German reference values) were offered HIIT twice weekly for 6months. At baseline and after program completion, anthropometric, clinical and metabolic characteristics were assessed and a fasting blood sample was obtained. Leptin, adiponectin, visfatin and aFABP were measured using commercially available kits. DNA methylation at RALBP1 was assessed using pyrosequencing. Descriptive statistics, Pearson's correlation and linear models were calculated.

RESULTS

Mean age at start of the program was 15.5±1.4years (53.5% females) and 20/28 (71%) provided follow-up data. At baseline, aFABP was correlated with BMI-SDS (0.48 [0.13,0.72]; p=0.0095), waist-to-height-ratio (0.63 [0.33,0.81], p=0.00036) and body fat content (0.55 [0.21, 0.77]; p=0.0031). Certain markers of metabolic risk were significantly correlated with aFABP (HOMA-IR 0.52 [0.19, 0.75], p=0.0044; γGT 0.48 [0.13, 0.73], p=0.0091; uric acid 0.46 [0.11, 0.71] p=0.013; HDL-C -0.39 [-0.66, -0.01] p=0.043; triglycerides 0.38 [0.01, 0.66], p=0.047). With the exception of triglycerides, these associations vanished after adjusting for BMI-SDS. aFABP did not depend on sex, age or pubertal stage in obese adolescents. After the HIIT program, small but significant reductions were observed in waist-to-height-ratio, (0.013 [0.0025, 0.024]; p=0.023), skin-fold based body fat content (2.0% [0.6, 3.5]; p=0.011), and standard deviation score of systolic blood pressure (0.69 [0.26 to 1.1]; p=0.0036). No changes were observed in adipokines or epigenetic markers following the program.

CONCLUSION

HIIT may have beneficial effects on body composition and cardiometabolic health in overweight adolescents. Like in adults, aFABP seems to be associated with markers of metabolic risk in obese adolescents.

Cost-of-illness studies based on massive data: a prevalence-based, top-down regression approach

Despite the increasing availability of routine data, no analysis method has yet been presented for cost-of-illness (COI) studies based on massive data. We aim, first, to present such a method and, second, to assess the relevance of the associated gain in numerical efficiency. We propose a prevalence-based, top-down regression approach consisting of five steps: aggregating the data; fitting a generalized additive model (GAM); predicting costs via the fitted GAM; comparing predicted costs between prevalent and non-prevalent subjects; and quantifying the stochastic uncertainty via error propagation. To demonstrate the method, it was applied to aggregated data in the context of chronic lung disease to German sickness funds data (from 1999), covering over 7.3 million insured. To assess the gain in numerical efficiency, the computational time of the innovative approach has been compared with corresponding GAMs applied to simulated individual-level data. Furthermore, the probability of model failure was modeled via logistic regression. Applying the innovative method was reasonably fast (19 min). In contrast, regarding patient-level data, computational time increased disproportionately by sample size. Furthermore, using patient-level data was accompanied by a substantial risk of model failure (about 80 % for 6 million subjects). The gain in computational efficiency of the innovative COI method seems to be of practical relevance. Furthermore, it may yield more precise cost estimates.

Health-care costs of underweight, overweight and obesity: Australian population-based study

AIM

Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity.

PARTICIPANTS

Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children.

OUTCOME

Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays.

PREDICTOR

biennial BMI measurements over the same period.

RESULTS

Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years.

CONCLUSIONS

Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Association between childhood obesity and use of regular medications in the UK: longitudinal cohort study of children aged 5-11 years

OBJECTIVES

Increasing rates of childhood obesity have been suggested as a possible cause for the increasing prevalence of chronic conditions among adults and children. Few studies have examined whether obese children are more likely to use medications than normal weight children. We investigate this association in the UK.

DESIGN

A panel study with repeated observations at ages 5, 7 and 11.

SETTING

A general population sample drawn from the Millennium Cohort Study, a UK-based birth cohort.

PARTICIPANTS

A sample of 9667 children.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our primary outcomes were crude and adjusted probabilities of taking any regular medications and the number of medications among overweight and obese children compared with normal weight children. Our secondary outcome was the distribution of medication use by therapeutic classification across body mass index (BMI) groups.

RESULTS

Obese children were more likely to use any medication (marginal effect (ME)=0.02, 95% CI 0.01 to 0.03) and to use more medications (ME=0.08, 95% CI 0.04 to 0.12) than normal weight children. Obese children used more medications for respiratory conditions than those of other BMI groups.

CONCLUSIONS

Obese children are more likely to use regular medications and have comorbid conditions, even at young ages. This suggests that the cost of prescriptions should be considered when evaluating the economic burden of childhood obesity and that preventative strategies to reduce childhood obesity could be cost-effective in the short as well as in the long term. While more research is needed, both clinicians and policymakers should be aware of these findings when planning prevention and treatment strategies.

The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies

Background

Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children.

Methods

Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥7 h/week) versus a lower (<7 h/week) level of moderate-to-vigorous physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group.

Results

The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥7 h/week) compared with lower MVPA (<7 h/week) total direct costs accounted for 392 EUR (95% CI: 342–449 EUR) versus 398 EUR (95% CI: 309–480 EUR) and indirect costs accounted for 138 EUR (95% CI: 124–153 EUR) versus 127 EUR (95% CI: 111–146 EUR).

Conclusions

The results indicate that childhood might be too early in life, to detect significant preventive effects of physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

Parents' willingness to pay for the prevention of childhood overweight and obesity

OBJECTIVE

To determine parental willingness-to-pay (WTP) for childhood obesity prevention.

METHODS

Cross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann-Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP.

RESULTS

From 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was <euro>23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity.

CONCLUSIONS

Nearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents.

Factors associated with obesity and overweight in school-aged children

To assess the factors associated with excess weight (overweight/obese) in school children enrolled in the public education network in Divinópolis, Minas Gerais, Brazil. Cross-sectional study with 1187 children between 6 and 14 years of age from municipal schools in Divinópolis, Minas Gerais. The prevalence of obesity and overweight was calculated based on the parameters of the World Health Organization, using the WHO Anthro-Plus Program. Logistic regression was used to identify the variables associated with excess weight, at a significance level of 5%. A prevalence of 24.4% of excess weight was identified. Family income and maternal education were determinants of overweight in the study population (p<0.05). Excess weight was configured as an important health problem among the students. The public power needs to implement intersectoral measures with a view to the prevention and reduction of the prevalence of overweight and obesity among school-aged children.

The impact of overweight and obesity on pediatric medical expenditures

BACKGROUND

Published studies do not consistently find overweight and obesity to be associated with higher medical expenditures for US children. Previous analyses use varying samples and methods, making results difficult to compare.

OBJECTIVE

To examine whether methodological choices or temporal trends are driving differences in estimates of the association between weight and pediatric medical expenditures.

METHODS

We analyzed the medical expenditures and use of 6- to 17-year-old individuals in the 2006-2010 US Medical Expenditure Panel Surveys. The impact of overweight and obesity on annual medical expenditures and use was assessed, controlling for age, income, race, sex, geographic region, urban/rural residency, insurance status, and survey year. A two-part regression model, in which part one estimated the likelihood of incurring any expenditure and part two estimated non-zero expenditures, was used to predict total expenditures. Expenditures were inflated to 2012 dollars using the medical care component of the Consumer Price Index. Poisson and logistic regression models were used to predict differences in healthcare use between normal weight, overweight, and obese youth.

RESULTS

We found that overweight and obese youth have higher, but not significantly higher medical expenditures than normal weight youth. Conclusions were robust to various methodological assumptions. We found that obese adolescents have a higher use of prescriptions drugs and healthcare visits compared with normal weight youth (0.04-1.3 visits), but differences in use only translated into marginally higher expenditures.

CONCLUSIONS

These findings may reflect new trends in healthcare use among obese youth. Future research should assess whether services are being underused by obese youth and the impact of persistent obesity on long-term medical expenditures.

Illness and determinants of health-related quality of life in a cross-sectional sample of schoolchildren in different weight categories

Aim: To study associations between health-related quality of life (HRQoL), frequency of illness, and weight in primary school children in southern Germany.

Methods: Data from baseline measurements of the outcome evaluation of a teacher based health promotion programme (“Join the Healthy Boat”) were analysed. Parents provided information about their children’s HRQoL (KINDL^R, EQ5D-Y Visual Analogue Scale). The number of visits to a physician, children’s days of absence because of sickness, and parental days of absence from work due to their children’s illness during the last year of school/kindergarten were queried. Children’s weight status was determined by body mass index (BMI), central obesity by waist to height ratio (WHtR ≥0.5).

Results: From 1,888 children (7.1±0.6 years), 7.8% were underweight, 82% had normal weight, 5.7% were overweight and 4.4% obese. 8.4% of all children were centrally obese. Bivariate analysis showed no significant differences for parental absence and visits to a physician in weight groups classified by BMI, but obese children had more sick days than non-obese. Centrally obese children differed significantly from the rest in the number of sick days and visits to a physician, but not in the frequency of parental absence. In regression analyses, central obesity correlated significantly with EQ5D-Y VAS, KINDL^R total score and the subscales of “psyche”, “family” and “friends”. BMI weight groups showed no significant associations.

Conclusions: Central obesity but not BMI derived overweight and obesity is associated with HRQoL and visits to a physician in primary school children. Future studies should include WHtR. Preventive measures for children should focus on a reduction of or slowed increase in waist circumference.

Development of BMI values of German children and their healthcare costs

The aim of this study is to assess the association between different patterns of Body Mass Index (BMI) development from birth on and later healthcare utilisation and costs in children aged about 10 years based on two birth cohort studies: the GINIplus study (3287 respondents) and the LISAplus study (1762 respondents). Direct costs were estimated using information on healthcare utilisation given by parents in the 10-year follow-up. To meet this aim, we (i) estimate BMI-standard deviation score (BMIZ) trajectories using latent growth mixture models and (ii) examine the correlation between these trajectories and utilisation of healthcare services and resulting costs at the 10-year follow-up. We identified three BMI-trajectories: a normative BMIZ growth class (BMI development almost as in the WHO growth standards), a rapid BMIZ growth up to age 2 years class (with a higher BMI in the first two years of life as proposed by the WHO growth standards) and a persistent rapid BMIZ growth up to age 5 years class (with a higher BMI in the first five years of life as proposed by the WHO growth standards). Annual total direct medical costs of healthcare use are estimated to be on average €368 per child. These costs are doubled, i.e. on average €722 per child, in the group with the most pronounced growth (persistent rapid BMIZ growth up to age 5 years class).

Impact of BMI and BMI change on future drug expenditures in adults: results from the MONICA/KORA cohort study

BACKGROUND

The evidence on the long-term economic effects of obesity is still scarce. This study aims to analyse the impact of body mass index (BMI) and BMI-change on future pharmaceutical utilisation and expenditures.

METHODS

Based on data from 2,946 participants in a German population-based health survey (MONICA/KORA, 1994/95) and the follow-up study (2004/05), drug intake and expenditures were estimated using a bottom-up approach. Using univariate and multivariate methods, we analysed the impact of baseline BMI and BMI-change on drug utilisation and expenditures after 10 years.

RESULTS

The use of pharmaceuticals was more likely in moderately and severely obese compared to the normal weight group (OR 1.8 and 4.0, respectively). In those who reported pharmaceutical intake, expenditures were about 40% higher for the obese groups. A 1-point BMI-gain in 10 years was, on average, associated with almost 6% higher expenditures compared to a constant BMI.

CONCLUSION

The results suggest that obesity as well as BMI-gain are strong predictors of future drug utilisation and associated expenditures in adults, and thus highlight the necessity of timely and effective intervention and prevention programmes. This study complements the existing literature and provides important information on the relevance of obesity as a health problem.

Combating pediatric obesity in Germany: the role of economic findings in informing policy

As in most countries, overweight and obesity among children and adolescents have dramatically increased in Germany over the last two decades. This serious public-health challenge has stimulated many efforts to curb the pediatric obesity epidemic. In this article, the authors briefly describe these efforts and examine the role of health economics in informing German health policies and evaluating the outcomes of interventions aimed at reducing pediatric obesity. The findings indicate that the tools of health-economic analysis have rarely been used to guide the development of strategies to prevent pediatric obesity and to support decision-making on the use of the scarce resources available for preventive actions. The authors give some reasons why health economics has not been an important policy tool so far and make some recommendations for how this could be changed. Reasons impeding health economics playing a more important role in this area are the existence of many unsolved issues in the methods of health economic evaluation and large gaps in the knowledge base on the effectiveness of interventions. Nevertheless, these methods should be considered to be indispensible tools of health policy development. However, taking into account the broad range of political and societal concerns related to pediatric obesity, decision-making in this area will ultimately rest on a process of deliberate thinking integrating different perspectives among, which health economics will be one.

Is central obesity associated with poorer health and health-related quality of life in primary school children? Cross-sectional results from the Baden-Württemberg Study

BACKGROUND

Childhood obesity and its consequences are a growing threat to national economies and health services. The aim of this study was to determine associations between waist-to-height ratio (WHtR) as a measure of central obesity, and health-related quality of life (HRQoL) and absenteeism of primary school children in the state of Baden-Württemberg, Germany.

METHODS

Cross-sectional data from 1888 first and second grade children (7.1±0.6 years) participating in the baseline measurements of the Baden-Württemberg Study were analyzed. Parents completed questionnaires including a rating of their children's HRQoL using KINDLR and EQ5D-Y VAS. Days of absence because of illness, and number of visits to a physician during the last year of school/kindergarten were asked, as well as the number of days parents took off work to care for their sick child. Anthropometric measurements were taken by trained staff. The Mann-Whitney-U test was used for statistical analysis of differences between WHtR groups. Logistic regression models were used to identify factors associated with sick days.

RESULTS

A total of 158 (8.4%) children were centrally obese (WHtR ≥0.5). These children had significantly more sick days (9.05 vs. 6.84, p < 0.001) and visits to a physician (3.58 vs. 2.91, p < 0.05), but not days of parental absence than other children. According to regression analysis, sick days were also associated with age, migration status, physical activity pattern, maternal health awareness and family education level. Parent-rated HRQoL was significantly lower in centrally obese children for the EQ5D-Y VAS (88.1 vs. 91.6, p < 0.001), and the KINDLR subscales 'school' (79.9 vs. 82.5, p < 0.05) and 'friends' (75.4 vs. 78.3, p < 0.05), but not for the total score.

CONCLUSIONS

Cross-sectional results show higher rates of absence, more visits to a physician and lower HRQoL in children with central obesity. Each missed day at school implies a hazard to academic achievement and each additional visit to a physician is related to higher health care costs. Thus, the negative impact of central obesity is already measurable in primary school children, which emphasizes the urgent need for early delivery of health promotion and targeted prevention.

The economic burden placed on healthcare systems by childhood obesity

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.

An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions

OBJECTIVE

This review aims to put an economic perspective on childhood and adolescent obesity by providing an overview on the latest literature on obesity-related costs and the cost effectiveness of interventions to prevent or manage the problem.

METHODS

The review is based on a comprehensive PubMed/Medline search performed in October 2011.

RESULTS

Findings on the economic burden of childhood obesity are inconclusive. Considering the different cost components and age groups, most but not all studies found excess health care costs for obese compared with normal-weight peers. The main limitations relate to short study periods and the strong focus on health care costs, neglecting other components of the economic burden of childhood obesity. The results of the economic evaluations of childhood and adolescent obesity programs support the expectation that preventive and management interventions with acceptable cost effectiveness do exist. Some interventions may even be cost saving. However, owing to the differences in various methodologic aspects, it is difficult to compare preventive and treatment approaches in their cost effectiveness or to determine the most cost-effective timing of preventive interventions during infancy and adolescence.

CONCLUSION

To design effective public policies against the obesity epidemic, a better understanding and a more precise assessment of the health care costs and the broader economic burden are necessary but, critically, depend on the collection of additional longitudinal data. The economic evaluation of childhood obesity interventions poses various methodologic challenges, which should be addressed in future research to fully use the potential of economic evaluation as an aid to decision making.

Juvenile obesity and its association with utilisation and costs of pharmaceuticals--results from the KiGGS study

Background

According to a national reference, 15% of German children and adolescents are overweight (including obese) and 6.3% are obese. An earlier study analysed the impact of childhood overweight and obesity on different components of direct medical costs (physician, hospital and therapists). To complement the existing literature for Germany, this study aims to explore the association of body mass index (BMI) with utilisation of pharmaceuticals and related costs in German children and adolescents.

Methods

Based on data from 14, 836 respondents aged 3-17 years in the German Interview and Examination Survey for Children and Adolescents (KiGGS), drug intake and associated costs were estimated using a bottom-up approach. To investigate the association of BMI with utilisation and costs, univariate analyses and multivariate generalised mixed models were conducted.

Results

There was no significant difference between BMI groups regarding the probability of drug utilisation. However, the number of pharmaceuticals used was significantly higher (14%) for obese children than for normal weight children. Furthermore, there was a trend for more physician-prescribed medication in obese children and adolescents. Among children with pharmaceutical intake, estimated costs were 24% higher for obese children compared with the normal weight group.

Conclusions

This is the first study to estimate excess drug costs for obesity based on a representative cross-sectional sample of the child and adolescent population in Germany. The results suggest that obese children should be classified as a priority group for prevention. This study complements the existing literature and provides important information concerning the relevance of childhood obesity as a health problem.