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Cost of hospital care for obese children has doubled

Americans, and specifically taxpayers, paid nearly double in costs of hospitalizing obese children between 1999 and 2005, with almost twice as many such children requiring hospital care, according to a new report in the journal Health Affairs.

The authors don’t know exactly why, since the prevalence of childhood obesity did not change. However, they speculate that physicians may be more frequently listing obesity as a primary or secondary reason for admission. Another possible reason is that children are becoming even more obese and for longer periods of time, giving disease processes much more time to cause damage. Hospitalizations increased even for children as young as 6.

The report evaluated hospitalizations whose primary or secondary diagnosis was listed as mental illness, pregnancy-related conditions, asthma, diabetes, appendicitis, pneumonia, skin and subcutaneous infections, biliary tract disease, and other bone diseases in children and adolescents aged 2–19. All told, their care cost the healthcare system $237.6 million in 2005, up from $125.9 million in 2001, measured in 2005 dollars.

Seen in 2008 dollars, the numbers are 20% higher.

This is despite evidence from federal reports that the prevalence of obesity in children and adolescents did not go up in that period, the authors wrote.

“This is an unfortunate finding,” said Leonardo Trasande, MD, assistant professor of community and preventive medicine at Mount Sinai School of Medicine in New York. Even if it’s true that doctors are now more likely to list obesity as a contributing comorbidity, “it means the cost burden is more reflective of reality, and people will need to refine their perspective of how much obesity is immediately contributing to children’s health problems,” Trasande said.

Obesity-related hospitalizations increased 8.8% per year among children aged 2–5, 10.4% per year among children aged 6–11, and 11.4% per year among adolescents aged 12–19 between 1999 and 2005.

Trasande and coauthors noted that it is likely the numbers are much worse, because there is evidence that physicians may not list obesity as a condition in the patient’s chart.

“If obesity prevalence among children with asthma is roughly equal to that for all American children, then one would expect about 20% of children hospitalized with asthma to be obese, yet we found less than 2% of asthma hospitalization with obesity listed as a comorbidity,” the authors wrote.

The study used patient discharge statistics from the National Inpatient Sample, which reflects costs from government and private insurance payers at sampled hospitals across the United States.

There is caution in the report, the authors wrote. “Diagnosis is a product of clinical judgment and reimbursement by hospital payers and is subject to inaccuracy,” they said.

In addition, CMS “officially recognized obesity as an illness in late 2004, and a diagnosis of obesity does not routinely result in additional reimbursement or risk adjustment. Obesity is unlikely to be included to justify an adverse outcome that might have occurred, because coding is unlikely to protect from litigation or otherwise exaggerate the impact of obesity on lengths-of-stay charges or costs,” the authors wrote.

Obesity likely influenced the reason for admission in a variety of ways. For example, obesity during pregnancy is a risk factor for perinatal complications and sleep apnea, and it also can affect skin function. Obesity is associated with postoperative complications for appendicitis, and children who are obese may be likely to suffer from mental disorders.

Medicaid bears a large share of the cost of hospitalizations in children with a secondary diagnosis of obesity, with a cost of about $118 million in 2005, up from $53.6 million in 2001. “Increasing obesity among children appears to be driving increases in Medicaid spending,” the authors wrote. “Given the increasing burden of obesity-associated hospitalizations, our findings suggest that additional federal support of prevention programs could reduce obesity treatment costs borne by federal and state governments.”

John Baker, MD, president of the American Society for Metabolic and Bariatric Surgery, said the study points to the need for more aggressive interventions, because clearly the higher costs associated with these hospitalizations justify spending more money to prevent them.

“We need to start with our children and adolescents as well as our young adults to treat obesity at all levels,” says Baker, who practices in Little Rock, AR. “And there needs to be a core benefit added to our national health reform agenda.”