Childhood obesity-related hospital visits quadruple

"Generation XXL" is the headline on the front page of Metro, as the results of a new study show that hospital admissions related to obesity in children have soared in recent years.

The study looked at English hospital admissions over a 10-year period for obese children and teenagers. It found that hospital admission rates for obesity and obesity-related health problems among children and young people have risen more than fourfold in the last decade, particularly among girls and teenagers.

Most admissions were not for obesity itself but for complications of obesity, including asthma, sleep apnoea (disturbed breathing during sleep), and pregnancy complications. The number of children having weight loss surgery has also risen sharply, with most operations being performed in teenage girls. However, the figures have remained low. There was just one admission in 2000 and 31 in 2009.

As the authors point out, some of this increase could be attributed to greater awareness and improved diagnosis of obesity-related conditions. Nevertheless, this reliable study makes disturbing reading and highlights the possibility that the "obesity epidemic" in children may be leading to health problems far earlier than previously expected.

Where did the story come from?

The study was carried out by researchers from Imperial College London, UK and the University of South Carolina, US. It was published in the peer-reviewed open access journal PLOS ONE. Its authors are funded by a number of public institutions, including the UK National Institute for Health Research.

The research was covered fairly in the media, with several reports including comments from independent experts. Somewhat surprisingly, none of the papers' coverage chose to denigrate the main group identified – obese teenage mums-to-be. The coverage may have been guided by a press release from Imperial College London that sensibly and accurately outlined the research.

What kind of research was this?

This study looked at national trends in hospital admissions associated with obesity and weight loss surgery among children and young people in England between 2000 and 2009.

The authors point out that although the recent steep rise in childhood obesity appears to be levelling off, national surveys suggest that about three in 10 children between the ages of two and 15 are overweight, and 14-20% are obese.

Obese children are at increased risk of conditions such as type 2 diabetes, asthma and sleep apnoea, while emerging evidence suggests they may also be at risk of cardiovascular disease.

The health consequences of childhood obesity could translate into large increases in demand for healthcare services, placing already stretched services under increased financial pressure.

What did the research involve?

The researchers used information from a national database which records all single episodes of NHS hospital admissions in England, including NHS-funded treatment performed in private hospitals. The database is called Hospital Episode Statistics and is freely available for everyone to look at.

For every admission, the database gives the main reason for admission (the primary diagnosis) and other health conditions that may contribute to the condition (the secondary diagnosis) using international disease codes. It also includes information such as gender and the age of the patient, as well as any procedures performed.

The researchers used data on planned or emergency obesity admissions in all children aged 5-19 between 2000 and 2010. The data included admissions for the management of obesity where obesity was the primary diagnosis and admissions for other health problems where obesity was thought to be a contributory factor (secondary diagnosis). They also identified children and young people who underwent weight loss (bariatric) surgery.

Three age bands – 5-9, 10-14 and 15-19 – were created to reflect key stages of childhood development, with children under the age of five excluded. They obtained population estimates for these three age groups for 2000-09 in England, stratified by sex. They then calculated the age- and sex-specific admission rates per million children for all years.

What were the basic results?

Between 2000 and 2009, researchers found that hospital admission rates in 5-19 year olds for total obesity-related diagnoses increased more than fourfold from 93 (95% confidence interval [CI] 86-100) per million children, to 414 (95% CI 410.7-417.5) per million children.

They say the increase was largely due to rising admissions in which obesity was mentioned as a secondary diagnosis. In just over a quarter (26.7%) of admissions, obesity was the main reason for admission (primary diagnosis), while for the remaining three-quarters (73.3%) obesity was a secondary diagnosis (contributing to the condition they were admitted for).

The researchers also found that:

• the average age of admission to hospital over the study period was 14 years
• admissions were more common in girls than boys (56.2% v 43.8%)
• the most common reasons for admission where obesity was a secondary diagnosis were sleep apnoea, asthma and complications of pregnancy
• the number of bariatric surgery procedures rose from one per year in 2000 to 31 in 2009, with the majority performed in obese girls (75.6%) aged 13-19 years

How did the researchers interpret the results?

The researchers point out that hospital admissions for obesity in children and young people have increased more than fourfold in the last decade, with more and more NHS resources being used to treat conditions associated with obesity.

They say public health action is needed both to quantify the scale of the problem more clearly and reverse the "obesity epidemic", thereby reducing the number of admissions caused by obesity.

Conclusion

This study is useful for monitoring national trends in the number of child hospital admissions for obesity and obesity-related conditions over the past decade.

However – as the authors point out – the study has some limitations. The quality of the data used relies on the accuracy of disease coding, and it is possible that obesity as a secondary diagnosis may sometimes be omitted. But this would lead to an underestimate of children admitted for obesity-related conditions, rather than the reverse.

Also, the big increase in obesity-related admissions may partly reflect increased awareness and improved diagnosis, rather than rising incidence of obesity.

The authors also point out that compared with admission rates for other common childhood diseases, admission rates for obesity are still small. Nevertheless, the results of this study make disturbing reading, and indicate that some of the health consequences of obesity may be felt in childhood as well as adulthood.

If you are worried that your child is obese, you need to take action now. If you don't, it is highly likely that your child's obesity will persist into adulthood, which can cause a range of serious complications.

Your GP or practice nurse can assess your child's weight and provide further advice on lifestyle changes. They may also be able to refer you to a local weight management programme for children, such as those run by the Weight Management Centre, MEND and Carnegie Weight Management.

These programmes are often free to attend through your local health authority, and typically involve a series of weekly group workshop sessions with other parents and their children. These workshops will teach you more about the diet and lifestyle changes that will help your child achieve a healthy weight.