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Childhood obesity

UK child obesity-related hospital admissions soar

Three quarters of admissions were to deal with problems complicated by obesity
Bariatric surgery procedures increased from one procedure in 2000 to 31 in 2009

The number of children admitted to hospital for problems related to obesity in England and Wales quadrupled between 2000 and 2009, according to the 'Rising Obesity-Related Hospital Admissions among Children and Young People in England: National Time Trends Study', by researchers at Imperial College London, UK.

Using the Hospital Episodes Statistics database, they reported on the number of hospital admissions for children and young people aged five to 19 where obesity was recorded in the diagnosis, between 2000 and 2009.

The study, published in the journal Plos One, states that in 2009 there were 3,806 children admitted to hospital for obesity-related conditions, compared with just 872 in 2000. Alarmingly, nearly three quarters of these admissions were to deal with problems complicated by obesity such as asthma, breathing difficulties during sleep and complications of pregnancy, rather than obesity itself being the primary reason.

"The burden of obesity is usually thought to have its serious consequences in adulthood, but we now see it manifesting earlier, in childhood," said Dr Sonia Saxena, from the School of Public Health at Imperial, who led the study. "It's clear that rising obesity levels are causing more medical problems in children, but the rise we observed probably also reflects increasing awareness among clinicians, who have become better at recognising obesity."

For this study the researchers defined total obesity admissions as comprising both primary and secondary diagnoses of obesity and reported on the number of children and young people who underwent bariatric surgical procedures for the management of obesity during the study period.

The found that between 2000 and 2009, age- and sex-specific hospital admission rates in 5–19 year olds for total obesity-related diagnoses increased more than four-fold from 93.0 (95% CI 86.0 to 100.0) per million children to 414.0 (95% CI 410.7 to 417.5) per million children, largely due to rising admissions where obesity was mentioned as a co-morbidity.

The median age of admission to hospital over the study period was 14.0 years; 5,566 (26.7%) admissions were for obesity and 15,319 (73.3%) mentioned obesity as a comorbidity (Table 1). Admissions were more common in girls than boys (56.2% v 43.8%) and the most common reasons for admission where obesity was a comorbid condition were sleep apnoea, asthma, and complications of pregnancy.

Overall admissions were more common in girls than boys (56.2% v 43.8%) and increased with age from 18.7%, 40.1% and 41.2% for age groups 5–9, 10–14 and 15–19 years respectively.

Table 1. Demographic characteristics of children and young people admitted with obesity-related diagnosis over the entire study period, by primary or secondary diagnosis, 2000 to 2009.

Hospital admission rates for obesity increased almost four-fold from 21.0 (95% CI 17.5 to 24.5) per million children in 2000 to 78.8 (95% CI 77.0 to 80.6) in 2009. Admission rates for obesity as a comorbidity increased from 70 (95% CI 65.6 to 78.4) per million children in 2000 to 335.3 (95% CI 332.3 to 338.3) per million children in 2009 (Figure 1).

Figure 1. Trends in age and sex-specific hospital admission rates per million children among children and young people ages 5 to 19 years, for obesity and where obesity was a comorbidity, 2000–2009.

Bariatric surgery

Of the 20,885 children and young people admitted to hospitals in England during the study period, 111 patients had a bariatric surgery procedure performed during 2000 and 2009 and the number increased from one procedure in 2000 to 31 in 2009. Of those 111 patients, 109 were in the 15–19 years age group and only two were in the 10–14 years age group. The majority of these procedures (75.6%, n=84) were performed in girls and the median age was 18 years (Figure 2). Laparoscopic gastric banding was the most commonly performed bariatric surgical procedure, accounting for 36% (n=34) of procedures during the study period.

Figure 2. Number of hospital admissions for bariatric surgery for children and young people ages 13 to 19 years by sex, 2000 to 2009.

“We found that patients undergoing bariatric procedures were mainly girls and the number of these procedures increased substantially during our study period,” the authors write. “While the number of these surgeries started from a very low base of one in the year 2000, and the numbers are still lower than US estimates. The increase is large and suggests that England may be moving towards the greater number of these procedures seen in the US.”

The researchers state that there needs to be a full economic analysis of the cost of managing and treating obesity in children and young people and future research should aim to identify target groups of children with higher prevalence of obesity and investigate how this compares with those treated for obesity-related conditions in hospitals in England.

In addition, they urge further researcher as to whether the publication of national guidelines have impacted on hospital admission patterns for obesity.

Conclusion

“Our findings support emerging evidence that the childhood obesity epidemic may lead to substantial problems of obesity-related disease much sooner in children and young people’s lives than previously expected,” the authors conclude. “With levels of admissions for obesity-related diagnoses rising, there is likely to be increasing demand on health services and also greater use of more radical interventions, such as pharmacological or surgical treatment, as part of efforts to address the increasing trend of obesity that threatens the lives of many children and young people in England and globally.”

The study, 'Rising Obesity-Related Hospital Admissions among Children and Young People in England: National Time Trends Study', can be accessed here

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