Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents

Objective: To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents. Methods: Secondary analysis of 2005 to 2009 Medical Expenditure Panel Survey data (n = 17,224). Outcome measures included suboptimal health, emotional/behavioral problems, health care utilization, and expenditures. Results: Overweight and obese children and adolescents had greater risk of suboptimal health (adjusted risk ratio [ARR], 1.4 and 1.7; P <.01), use of prescriptions (ARR, both 1.1; P =.01), and emergency department visits (ARR, 1.2 and 1.1; P =.01); overweight children/adolescents had lower mean out-of-pocket expenditures (∼$100, P <.01); and obese children/adolescents had greater risk of emotional/behavioral problems (ARR, 1.2; P <.01) and specialist visits (ARR, 1.1; P =.01). The most common specialty referral among obese children/adolescents was psychiatry. Overweight and obesity were not associated with office visits or total expenditures. A greater proportions of children and adolescents with suboptimal health and emotional/behavioral problems had health care expenditures, and those with suboptimal health were more likely to have out-of-pocket expenditures. Conclusions: Pediatric overweight and obesity affect child and adolescent health status, emotional/behavioral problems, and specific domains of health care utilization, but do not appear to be associated with total health care expenditures. Out-of-pocket expenditures are lower among overweight children and adolescents. These findings highlight the need for early intervention in overweight children/adolescents, when health care expenditures may not be greater, and suggest that it may prove useful to pay special attention to the health status and emotional/behavioral problems of overweight and obese children/adolescents in weight-management interventions.