Published online January 14, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. e269-e277 (doi:10.1542/peds.2007-0874)
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ARTICLE

Health Status and Health Care Expenditures in a Nationally Representative Sample: How Do Overweight and Healthy-Weight Children Compare?

Asheley Cockrell Skinner, PhDa,b, Michelle L. Mayer, PhD, MPHa,b, Kori Flower, MD, MS, MPHc and Morris Weinberger, PhDa,d

a Department of Health Policy and Administration
b Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
c Charles Drew Community Health Center, Piedmont Health Services, Burlington, North Carolina
d Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina

OBJECTIVE. Childhood overweight is epidemic in the United States. Although limited, previous studies suggest that overweight children have chronic health problems. A more complete understanding of the effect of overweight on children's health requires a nationally representative, population-based sample. Our objective was to examine whether overweight children have (1) more chronic conditions, (2) poorer health, and (3) greater health care expenditures than healthy-weight children.

PATIENTS AND METHODS. This was a cross-sectional study of children aged 6 to 17 years participating in 1 of 2 nationally representative surveys of civilian, noninstitutionalized Americans, the 2001–2002 National Health and Nutrition Examination Survey and 2002 Medical Expenditure Panel Survey. The main outcome measures were prevalence of dyslipidemia, hyperglycemia, and hypertension; self-reported health status; and health care expenditures.

RESULTS. Overweight children, compared with healthy-weight children, have significantly increased risk for high total cholesterol levels (15.7% vs 7.2%), high low-density lipoprotein (11.4% vs 7.7%) or borderline low-density lipoprotein cholesterol levels (20.2% vs 12.5%), low high-density lipoprotein cholesterol levels (15.5% vs 3.0%), high triglyceride levels (6.7% vs 2.1%), high fasting glucose levels (2.9% vs 0.0%), high glycohemoglobin levels (3.7% vs 0.5%), and high systolic blood pressure (9.0% vs 1.6%). Overweight children, compared with healthy-weight children, demonstrate significantly lower prevalence of excellent health (National Health and Nutrition Examination Survey: 36.5% vs 53.3%; Medical Expenditure Panel Survey: 42.8% vs 55.6%). These differences persist in multiple regression models that control for potential confounders. In adjusted analyses, expenditures were comparable between overweight and healthy-weight children.

CONCLUSIONS. Our data demonstrate that overweight children have more chronic conditions and poorer health but have health care expenditures that are no greater than those for healthy-weight children. Addressing the health care needs of overweight children may prevent the development of chronic conditions and improve health status. These findings demonstrate the need to more thoroughly consider whether (1) overweight children have appropriate access to care, (2) physicians fully recognize the impact of overweight, and (3) physicians have resources to address overweight.

Key Words: childhood obesity • chronic conditions • health care costs • health status • access to care

Abbreviations: NHANES—National Health and Nutrition Examination Survey • MEPS—Medical Expenditure Panel Survey • OR—odds ratio • aOR—adjusted odds ratio • LDL—low-density lipoprotein • HDL—high-density lipoprotein • CSHCN—children with special health care needs

Accepted Jul 16, 2007.