Applied Health Economics and Health Policy

, Volume 12, Issue 2, pp 139–150 | Cite as

The Impact of Overweight and Obesity on Pediatric Medical Expenditures

  • Davene R. Wright
  • Lisa A. Prosser
Original Research Article



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.


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


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.


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.


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.


Ordinary Little Square Medical Expenditure Medical Expenditure Panel Survey Metropolitan Statistical Area Ordinary Little Square Model 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author contributions

DRW and LAP were responsible for the study concept and design. DRW was responsible for the analysis and interpretation of data and drafted the manuscript. DRW and LAP reviewed the manuscript for intellectual content and approved the final manuscript. DRW is the guarantor for the overall content of the manuscript.

Supplementary material

40258_2014_88_MOESM1_ESM.docx (218 kb)
Supplementary material 1 (DOCX 218 kb)


  1. 1.
    Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303(3):242–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891–8.CrossRefGoogle Scholar
  3. 3.
    Buescher PA, Whitmire JT, Plescia M. Relationship between body mass index and medical care expenditures for North Carolina adolescents enrolled in Medicaid in 2004. Prev Chronic Dis. 2008;5(1):A04.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Estabrooks PA, Shetterly S. The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med. 2007;161(3):222–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Hampl SE, Carroll CA, Simon SD, Sharma V. Resource utilization and expenditures for overweight and obese children. Arch Pediatr Adolesc Med. 2007;161(1):11–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Janicke DM, Harman JS, Jamoom EW, Simon SL, Zhang J, Dumont-Driscoll M. The relationship among child weight status, psychosocial functioning, and pediatric health care expenditures in a medicaid population. J Pediatr Psychol. 2010;35(8):883–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Bell JF, Zimmerman FJ, Arterburn DE, Maciejewski ML. Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort. Obesity (Silver Spring). 2011;19(1):228–32.CrossRefGoogle Scholar
  8. 8.
    Monheit AC, Vistnes JP, Rogowski JA. Overweight in adolescents: implications for health expenditures. Econ Hum Biol. 2009;7(1):55–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Trasande L, Chatterjee S. The impact of obesity on health service utilization and costs in childhood. Obesity (Silver Spring). 2009;17(9):1749–54.CrossRefGoogle Scholar
  10. 10.
    Johnson E, McInnes MM, Shinogle JA. What is the economic cost of overweight children? Eastern Econ J. 2006;32(1):171–87.Google Scholar
  11. 11.
    Skinner AC, Mayer ML, Flower K, Weinberger M. Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare? Pediatrics. 2008;121(2):e269–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Turer CB, Lin H, Flores G. Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents. Acad Pediatr. 2013;13(3):251–8.Google Scholar
  13. 13.
    Finkelstein EA, Trogdon JG. Public health interventions for addressing childhood overweight: analysis of the business case. Am J Public Health. 2008;98(3):411–5.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    BLS, Bureau of Labor Statistics. Consumer Price Index. 2012 (cited 2013 September 1).
  15. 15.
    Medical Expenditure Panel Survey. In: AHRQ AfHRaQ, editor. Rockville: AHRQ; 2010.Google Scholar
  16. 16.
    Fryar CD, Ogden CL. Prevalence of underweight among children and adolescents: United States, 2003–2006: Centers for Disease Control and Prevention; 2012.Google Scholar
  17. 17.
    Centers for Disease Control and Prevention National Center for Health Statistics. CDC growth charts: United States. 2000 (cited September 30, 2010).
  18. 18.
    Centers for Disease Control and Prevention. About BMI for children and teens. 2009 January 27 (cited 2009 September 29).
  19. 19.
    Akinbami LJ, Ogden CL. Childhood overweight prevalence in the United States: the impact of parent-reported height and weight. Obesity (Silver Spring). 2009;17(8):1574–80.CrossRefGoogle Scholar
  20. 20.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA. 2012;307(5):483–90.PubMedCrossRefGoogle Scholar
  21. 21.
    AAP, American Academy of Pediatrics. Pediatric medical cost model. 2009 (cited 2011 April 3).Google Scholar
  22. 22.
    Haddix AC, Teutsch S, Corso PS. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. 2nd ed. New York: Oxford University Press; 2003.Google Scholar
  23. 23.
    Perrin JM, Bloom SR, Gortmaker SL. The increase of childhood chronic conditions in the United States. JAMA. 2007;297(24):2755–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20(4):461–94.PubMedCrossRefGoogle Scholar
  25. 25.
    Lipscomb J, Ancukiewicz M, Parmigiani G, Hasselblad V, Samsa G, Matchar DB. Predicting the cost of illness: a comparison of alternative models applied to stroke. Med Decis Making. 1998;18(2 Suppl):S39–56.Google Scholar
  26. 26.
    Buntin MB, Zaslavsky AM. Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ. 2004;23(3):525–42.PubMedCrossRefGoogle Scholar
  27. 27.
    StataCorp. Stata Statistical Software: Release 12. College Station: Statacorp LP; 2011.Google Scholar
  28. 28.
    Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc. 1983;78:605–10.CrossRefGoogle Scholar
  29. 29.
    Homer CJ, Fowler FJ, Gallagher PM, Shaul J, Uyeda M, Zaslavsky A, et al. The Consumer Assessment of Health Plan Study (CAHPS) survey of children’s health care. Jt Comm J Qual Improv. 1999;25(7):369–77.PubMedGoogle Scholar
  30. 30.
    Lin Y. Association of Body Mass Index and Prescription Drug Use in Children from the Medical Expenditures Panel Survey, 2003–2006. Seattle: University of Washington; 2010.Google Scholar
  31. 31.
    Patient Protection and Affordable Care Act. 111–148. United States; 2010.Google Scholar
  32. 32.
    Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, et al. Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health. 2009;12(4):409–18.PubMedCrossRefGoogle Scholar
  33. 33.
    Archer K, Lemeshow S, Hosmer D. Goodness-of-fit tests for logistic regression models when data are collected using a complex sampling design. Comput Stat Data Anal. 2007;51(9):4450–64.CrossRefGoogle Scholar
  34. 34.
    Wenig CM. The impact of BMI on direct costs in children and adolescents: empirical findings for the German Healthcare System based on the KiGGS-study. Eur J Health Econ. 2012;13(1):39–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Janssen I, Lam M, Katzmarzyk PT. Influence of overweight and obesity on physician costs in adolescents and adults in Ontario. Canada. Obes Rev. 2009;10(1):51–7.CrossRefGoogle Scholar
  36. 36.
    Kuhle S, Kirk S, Ohinmaa A, Yasui Y, Allen AC, Veugelers PJ. Use and cost of health services among overweight and obese Canadian children. Int J Pediatr Obes. 2011;6(2):142–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Au N. The health care cost implications of overweight and obesity during childhood. Health Serv Res. 2012;47(2):655–76.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Vellinga A, O’Donovan D, De La Harpe D. Length of stay and associated costs of obesity related hospital admissions in Ireland. BMC Health Serv Res. 2008;8:88.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Woolford SJ, Gebremariam A, Clark SJ, Davis MM. Incremental hospital charges associated with obesity as a secondary diagnosis in children. Obesity (Silver Spring). 2007;15(7):1895–901.CrossRefGoogle Scholar
  40. 40.
    Kuhle S, Kirk SF, Ohinmaa A, Veugelers PJ. Comparison of ICD code-based diagnosis of obesity with measured obesity in children and the implications for health care cost estimates. BMC Med Res Methodol. 2011;11:173.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Trasande L, Liu Y, Fryer G, Weitzman M. Effects of childhood obesity on hospital care and costs, 1999–2005. Health Aff (Millwood). 2009;28(4):w751–60.Google Scholar
  42. 42.
    Weden MM, Brownell PB, Rendall MS, Lau C, Fernandes M, Nazarov Z. Parent-reported height and weight as sources of bias in survey estimates of childhood obesity. Am J Epidemiol. 2013.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of WashingtonSeattleUSA
  2. 2.Child Health Evaluation and Research Unit, Division of General PediatricsUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Center for Child Health, Behavior and DevelopmentSeattle Children’s Research InstituteSeattleUSA

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