Children with unhealthy weight status cost England's National Health Service significantly more than their healthy-weight peers, with severe obesity and underweight driving the highest excess healthcare expenditures, according to a comprehensive analysis of nearly 270,000 children's medical records.
The study, published in JAMA Network Open, found that severe obesity generated the highest mean annual excess costs in the year after BMI measurement at £190 ($274), followed by underweight at £164 ($236), compared with children at healthy weight. When extrapolated nationally, childhood overweight and obesity account for an estimated £273 million ($393 million) in annual healthcare costs across England.
Researchers analyzed electronic health records from 268,231 unique children aged 2 to 15 years (mean 6.82 years; 55% male) between 2014 and 2020, making this the first national estimate of excess healthcare costs attributable to unhealthy childhood weight derived from English electronic health records.
The research team examined healthcare costs for one year before and one year after body mass index (BMI) measurement, using Clinical Practice Research Datalink data linked with Hospital Episode Statistics. Costs were adjusted for sex, age, ethnicity, socioeconomic status, and geographic region.
After BMI measurement, excess costs were £67 ($97) for overweight, £141 ($203) for obesity, and £190 ($274) for severe obesity compared with healthy-weight children. Children with underweight showed significantly higher costs only after BMI measurement.
Gender differences emerged in the analysis. Girls incurred lower overall costs than boys, with cost differences of £79 ($114) before BMI measurement and £76 ($110) after. However, girls with severe obesity showed greater excess costs at £253 ($364) compared with their healthy-weight peers.
Age-related patterns also surfaced. Children aged 4 to 5 years with severe obesity incurred significantly higher costs before BMI measurement at £347 ($500). After measurement, severe obesity was associated with significantly higher costs exclusively in this same age group at £472 ($680).
White children exhibited significantly higher costs in overweight, obesity, and severe obesity categories compared with healthy-weight peers both before and after BMI measurement. Conversely, Indian children with overweight had significantly lower costs than their healthy-weight peers in the year before measurement only.
The study addresses a critical public health challenge in England, where 27% of children aged 2 to 15 years had overweight or obesity in 2022. The UK ranks among the top 10 countries in Europe and the Organisation for Economic Co-operation and Development for childhood obesity prevalence.
"In the short term, children with excess weight are at increased risk of mental health disorders, type 2 diabetes, asthma, and poorer educational outcomes," wrote lead author Olu Onyimadu, DPhil, of the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and colleagues. " Long-term, childhood excess weight significantly raises the risk of adult obesity and associated chronic conditions.
The researchers concluded that their findings "support the economic case for preventive and therapeutic interventions targeting unhealthy childhood weight" and provide cost estimates for use in future cost-effectiveness analyses of intervention programs.
The authors acknowledged several limitations, including that BMI is not routinely recorded in primary care in England, which may introduce selection bias. The sample size for children aged 14 to 15 years was also relatively small. Additionally, not all children with excess weight seek care for weight-related issues, potentially leading to underrepresentation.
The authors reported no conflicts of interest. The research was funded by the National Institute for Health and Care Research and conducted at the University of Oxford's Nuffield Department of Primary Care Health Sciences.
Source: JAMA Network Open
