Persistence Sequelae and Costs of Pediatric Overweight

Increased body fatness can occur at any age and may or may not persist. The longer a child is overweight, the more likely it is that he or she will be overweight as an adult. At any point in time the positive predictive value of early obesity increases with the age of the child but never reaches 100%. One of the most significant risks of childhood obesity is that it is a strong predictor of adult obesity and the medical complications associated with obesity in adult life, such as diabetes, hypertension, and hyperlipidemia. Early obesity is also a risk factor for later cardiovascular and metabolic morbidities. Although parental obesity is predictive of child and adolescent obesity, the contribution of parental obesity to this risk ratio diminishes in importance over time in relation to the child's own BMI (16). The tendency for excess weight in childhood and adolescence to persist into adult life has been demonstrated in a variety of studies (27-29). Thus, obesity persisting from early in life into the adult years should also be considered a risk factor for reduced lifespan, currently estimated at 4 to 9 mo of life lost but expected to increase in the future to 2 to 5 yr of potential life lost (17).

Economic and social costs of obesity are quite high. Type 2 diabetes alone may account for as much as $30 billion in direct costs and $30 billion in indirect costs per year (18). The cost of inpatient treatment for comorbid conditions associated with obesity has more than tripled over the past 20 yr. Health care-related costs for overweight and obesity in the United States exceed $90 billion per year and account for 9.1% of total US health expenditures (19). A study of direct costs for obesity and related conditions in France showed that these costs represented about 11% of the total French health care system budget, split evenly between inpatient and outpatient care (20).

The social consequences of obesity are also quite profound, affecting likelihood of employment, marriage, and educational attainment. Health-related quality-of-life scores are comparable to those of children diagnosed with cancer and worse than those of normal-weight peers or children with other chronic diseases.

A number of public health and prevention efforts are currently under way. It is important to understand the impact of policy decisions in each sector of government on access to physical activity through production, distribution, and quality. Zoning and other regulatory means may be available to increase safe opportunities for indoor and outdoor physical activity. Incentives and policy must be developed to promote the production and distribution of healthier foods. Economic tools may be used to modify institutional and organizational behaviors that directly or indirectly discourage healthier eating and physical activity. For example, regulation of food advertising during children's TV programs may be one approach to minimizing the promotion of sugared cereals and "junk foods."

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