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      An Analysis of the Medical Costs of Obesity for Fifth Graders in California and Texas

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          Abstract

          The prevalence of childhood obesity in the United States increased more than three-fold from 1976 – 1980 to 2007 – 2008. The Presidential Youth Fitness Program’s FitnessGram® is the current method recommended by the President’s Council on Fitness, Sports & Nutrition for assessing health-related fitness factors, including body composition. FitnessGram® data from California and Texas, the two most populous states, over a three-year time span indicate that more than one-third of fifth grade students, typically ten-year-olds, are obese. Previous studies report that an obese ten-year-old child who remains obese into adulthood will incur elevated direct medical costs beyond his or her normal-weight peers over a lifetime. The recommended elevated cost estimates are approximately $12,660 when comparing against a normal-weight child who gains weight as an adult and approximately $19,000 compared to a child who remains at normal weight as an adult. By applying these figures to FitnessGram® results from California and Texas, each group of fifth grade students in each of the two states will incur between $1.4 and $3.0 billion in direct medical costs over a lifetime. When the percentage of obese fifth graders is extrapolated to the rest of the United States’ 4 million ten-year-olds, this results in more than $17 billion (accounting for adulthood weight gain) or $25 billion (not accounting for adulthood weight gain) in added direct lifetime medical costs attributable to obesity for this single-year age cohort. This information should be used to influence spending decisions and resource allocation to obesity reduction and prevention efforts.

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          Most cited references21

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          Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis.

          The ideal means of identifying obesity in children and adolescents has not been determined although body mass index (BMI) is the most widely used screening tool.
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            The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.

            Although overweight and obesity in childhood are related to dyslipidemia, hyperinsulinemia, and hypertension, most studies have examined levels of these risk factors individually or have used internal cutpoints (eg, quintiles) to classify overweight and risk factors. We used cutpoints derived from several national studies to examine the relation of overweight (Quetelet index, >95th percentile) to adverse risk factor levels and risk factor clustering. The sample consisted of 9167 5- to 17-year-olds examined in seven cross-sectional studies conducted by the Bogalusa Heart Study between 1973 and 1994. About 11% of examined schoolchildren were considered overweight. Although adverse lipid, insulin, and blood pressure levels did not vary substantially with the Quetelet index at levels <85th percentile, risk factor prevalences increased greatly at higher levels of the Quetelet index. Overweight schoolchildren were 2.4 times as likely as children with a Quetelet index <85th percentile to have an elevated level of total cholesterol. Odds ratios for other associations were 2.4 (diastolic blood pressure), 3.0 (low-density lipoprotein cholesterol), 3.4 (high-density lipoprotein cholesterol), 4.5 (systolic blood pressure), 7.1 (triglycerides), and 12.6 (fasting insulin). Several of these associations differed between whites and blacks, and by age. Of the 813 overweight schoolchildren, 475 (58%) were found to have at least one risk factor. Furthermore, the use of overweight as a screening tool could identify 50% of schoolchildren who had two or more risk factors. Because overweight is associated with various risk factors even among young children, it is possible that the successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease.
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              Lifetime health and economic consequences of obesity.

              Obesity is an established risk factor for several chronic diseases. The lifetime health and economic consequences of obesity for individual patients have not been documented. To estimate the lifetime health and economic consequences of obesity. We developed a dynamic model of the relationship between body mass index and the risks and associated costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes mellitus, coronary heart disease, and stroke. The model was estimated using data from the Third National Health and Nutrition Examination Survey, the Framingham Heart Study, and other secondary sources. We used this model to estimate (1) risks of hypertension, hypercholesterolemia, and type 2 diabetes mellitus at future ages; (2) lifetime risks of coronary heart disease and stroke; (3) life expectancy; and (4) expected lifetime medical care costs of these 5 diseases for men and women aged 35 to 64 years with body mass indexes of 22.5, 27.5, 32.5, and 37.5 kg/m2 (nonobese and mildly, moderately, and severely obese, respectively). Disease risks and costs increase substantially with increased body mass index. The risk of hypertension for moderately obese 45- to 54-year-old men, for example, is roughly 2-fold higher than for their nonobese peers (38.1% vs 17.7%), whereas the risk of type 2 diabetes mellitus is almost 3-fold higher (8.1% vs 3.0%). Lifetime risks of coronary heart disease and stroke are similarly elevated (41.8% vs 34.9% and 16.2% vs 13.9%, respectively), whereas life expectancy is reduced by 1 year (26.5 vs 27.5 years). Total discounted lifetime medical care costs for the treatment of these 5 diseases are estimated to differ by $10,000 ($29,600 vs $19,600). Similar results were obtained for women. The lifetime health and economic consequences of obesity are substantial and suggest that efforts to prevent or reduce this problem might yield significant benefits.
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                Author and article information

                Journal
                Int J Exerc Sci
                Int J Exerc Sci
                International Journal of Exercise Science
                Berkeley Electronic Press
                1939-795X
                2016
                15 January 2016
                : 9
                : 1
                : 26-33
                Affiliations
                Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
                Author notes
                [†]

                Denotes graduate student author

                [‡]

                Denotes professional author

                Article
                ijes-9-1-26
                4882466
                27293504
                21eb60de-2c74-4d85-82cf-e9a8bd429a35
                Copyright @ 2016
                History
                Categories
                Original Research

                childhood,fitnessgram,obese
                childhood, fitnessgram, obese

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