The authors have declared that no competing interests exist.
Conceived and designed the experiments: JJN AL CM SS. Analyzed the data: JJN AL. Wrote the paper: JJN AL SS. Revised the manuscript for important intellectual content: JJN AL CM A. Mainous A. Majeed SS.
To describe the trends in hospital admissions associated with obesity as a primary diagnosis and comorbidity, and bariatric surgery procedures among children and young people in England.
National time trends study of hospital admissions data between 2000 and 2009.
Children and young people aged 5 to 19 years who were admitted to hospital with any diagnosis of obesity.
Age- and sex-specific admission rates per million children.
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. Admissions were more common in girls than boys (56.2% v 43.8%). The most common reasons for admission where obesity was a comorbid condition were sleep apnoea, asthma, and complications of pregnancy. The number of bariatric surgery procedures has risen from 1 per year in 2000 to 31 in 2009, with the majority were performed in obese girls (75.6%) aged 13–19 years.
Hospital admission rates for obesity and related comorbid conditions have increased more than four-fold over the past decade amongst children and young people. Although some of the increase is likely to be due to improved case ascertainment, conditions associated with obesity in children and young people are imposing greater challenges for health care providers in English hospitals. Most inpatient care is directed at dealing with associated conditions rather than primary assessment and management of obesity itself.
Childhood obesity has become a global epidemic and continues to be a worldwide health concern in many developing and developed countries including the U.K. and the U.S.
Several prior studies have examined the health consequences and the costs associated with obesity among adults in both the U.K. and the U.S.
The spiralling costs of treating obesity-related conditions in U.S. adolescents have been well documented.
The Hospital Episodes Statistics (HES) database
For the purposes of this study, we used HES data to examine elective or emergency obesity admissions in all children and young people aged 5 to 19 years between April 2000 and March 2010. Obesity admissions were identified using ICD-10 codes
Using a combination of primary diagnostic codes specific to obesity and surgical procedures codes, we also identified children and young people who underwent bariatric surgical procedures for the management of obesity during the study period. The procedures examined in this study were used from those reported in the National Obesity Observatory paper on bariatric surgery for obesity
We used the Agency for Healthcare Research and Quality’s Clinical Classification System (CCS) codes
We obtained mid-year population estimates for England for 2000 to 2009, stratified by 3 age groups and sex from the Office for National Statistics (ONS)
We found the majority of admissions over the entire study period of 2000 to 2009 were for obesity as a comorbidity (15,319, 73.3%), compared to 5,566 (26.7%) admissions which were for obesity itself (
Admissions for obesity, n (%) | Admissions with obesity as a comorbidity, n (%) | Total obesity-related admissions, n (%) | |
Age (median) | 13.0 years | 14.0 years | 14.0 years |
Sex | |||
Boys | 2,444 (43.9) | 6,710 (43.8) | 9154 (43.8) |
Girls | 3,120 (56.1) | 8,611 (56.2) | 11731 (56.2) |
Age group | |||
5–9 years | 1,249 (22.4) | 2,664 (17.4) | 3913 (18.7) |
10–14 years | 2,915 (52.4) | 5,446 (35.6) | 8361 (40.1) |
15–19 years | 1,402 (25.2) | 7,209 (47.0) | 8611 (41.2) |
Ethnic group | |||
White | 3,317 (59.6) | 10,197 (66.6) | 13514 (64.7) |
South Asian | 590 (10.6) | 1,121 (7.3) | 1711 (8.2) |
Black | 246 (4.4) | 512 (3.3) | 758 (3.6) |
Mixed | 141 (2.5) | 263 (1.7) | 404 (1.9) |
Other ethnicity | 115 (2.1) | 266 (1.7) | 381 (1.8) |
Not known | 1,157 (20.8) | 2,960 (19.3) | 4117 (19.8) |
Total | 5,566 | 15,319 | 20,885 |
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 (
Age (Years) | Obesity Diagnosis | Year | |||||||||
2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | ||
Boys overall number admissions | 421 | 496 | 621 | 660 | 863 | 1016 | 1095 | 1214 | 1337 | 1424 | |
5–9 | Primary | 16.6 | 11.9 | 22.1 | 33.9 | 39.5 | 42.7 | 49.6 | 46.4 | 55 | 51.2 |
Secondary | 49.1 | 53.2 | 62.6 | 60.8 | 133.4 | 160.4 | 124.7 | 135.2 | 127.1 | 148.2 | |
10–14 | Primary | 29.9 | 30.2 | 68.2 | 52.8 | 82.7 | 94.1 | 108.4 | 114.9 | 131.9 | 84.9 |
Secondary | 84.3 | 121.2 | 117.8 | 136.8 | 141.3 | 172.2 | 253.5 | 242.5 | 283.6 | 321.3 | |
15–19 | Primary | 13.7 | 16 | 19.3 | 23.6 | 32.7 | 26 | 37.2 | 65.9 | 56.1 | 66.4 |
Secondary | 69.2 | 74.4 | 90.2 | 94.9 | 101.2 | 134.2 | 110.5 | 155 | 191 | 230.5 | |
Boys OverallMid-year Population Estimates (in 1,000s) | 4,797.0 | 4,815.8 | 4,860.5 | 4,885.7 | 4,881.2 | 4,849.3 | 4,817.4 | 4,776.9 | 4,729.8 | 4,708.7 | |
Girls overall number admissions | 451 | 485 | 651 | 918 | 989 | 1107 | 1330 | 1608 | 1810 | 2382 | |
5–9 | Primary | 23.9 | 27.6 | 32.6 | 54.4 | 51.6 | 48.2 | 55.3 | 57.7 | 66.1 | 60.0 |
Secondary | 40.1 | 44.7 | 55.9 | 63.1 | 72.6 | 78.5 | 84.1 | 80.5 | 97 | 122.2 | |
10–14 | Primary | 29.5 | 33.6 | 54 | 149.8 | 100.8 | 113.1 | 127.4 | 160 | 161.6 | 135.1 |
Secondary | 67.9 | 88.6 | 106.8 | 103.6 | 145.4 | 170.7 | 202.9 | 206.4 | 214.6 | 286.5 | |
15–19 | Primary | 11.6 | 14.8 | 37.8 | 43.9 | 44.8 | 43.6 | 73.1 | 73.8 | 82.8 | 75.7 |
Secondary | 124.4 | 107.6 | 135.8 | 176.7 | 220.4 | 257.6 | 315.8 | 456.5 | 548.7 | 859.1 | |
Girls OverallMid-year Population Estimates (in 1,000s) | 4,580.0 | 4,588.0 | 4,603.5 | 4,622.9 | 4,625.5 | 4,607.0 | 4,565.2 | 4,535.6 | 4,501.5 | 4,482.7 |
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%,
The most common primary diagnoses (CCS codes) where obesity was a comorbidity were aggregated into five categories for each age group (see
We identified an almost four-fold increase in admissions for obesity, and a more than five-fold increase in hospital admissions where obesity was comorbidity amongst children and young people in England from 2000 to 2009. The largest proportionate increase was among young people aged 15 and 19 years. Three quarters of obese children and young people (72.8%,
This is, to our knowledge, the first study to report national time trends in hospital admissions with an obesity-related diagnosis in children and young people living in England. The strength of using HES data are its large nationally representative population-based sample size and standardized data collection. Although our estimates of diseases associated with obesity are likely to be conservative in absolute terms, the data from this 9-year period reflect health care providers’ unique position on having a major impact on the obesity epidemic through improved case ascertainment and treatment of obesity among children and young people living in the U.K. Over the period of this study, case ascertainment is likely to have improved due to the heightened awareness of obesity in general, as well as responses to newly implemented healthcare initiatives over the last decade and newly published guidelines for England in 2006.
As with all large clinical databases, the quality of HES data is reliant on the accuracy and consistency of coding.
Our findings of a four-fold increase in obesity related conditions to hospital are unlikely to be explained by rising trends in obesity incidence alone. National surveys and measurement programmes in children suggest the prevalence of childhood obesity continues to increase each year, although recent studies indicate a levelling off in recent years.
Additionally, we found that patients undergoing bariatric procedures were mainly girls and the number of these procedures increased substantially during our study period. The increase in bariatric surgery among adults in England has been described as exponential,
We already know that obesity is associated with a variety of health problems in later life. However, the results of this study indicate that these health consequences may be presenting earlier in the life course and are being recognized sooner by English health care providers. This represents serious ill-health for the patients involved, but also a large challenge for health systems and for the health care providers that work within them. Children who are overweight as young as four years old are likely to continue to be overweight or obese as they get older,
Our study highlights that obesity admission rates may be attributable to more case finding and active assessment and treatment as a result of greater awareness among health professionals or better coding of health service activity.”
Our findings of increasing admissions where obesity is a comorbidity among pregnant teenage girls may be related to more active case finding in the course of assessment during pregnancy or gestational obesity and warrants further investigation. This may be an area which would benefit from better data collection in the future. The U.K. has data from the National Child Measurement Programme, which was established in 2006 to increase public and professional understanding of weight related issues and it seems likely that ascertainment is likely to improve throughout the lifetime of the programme. This improved data at a national level, along with improved coding and understanding of the importance of early diagnosis among clinical staff has the potential to improve the health of both these children and the population at large.
Better ascertainment is likely to increase associated costs of treating obesity and its sequelae, at least in the short term. Our research also highlights the need for a full economic analysis of the cost of managing and treating obesity in children and young people. This will ultimately need to be ‘weighed’ against the effectiveness of whole population public health and primary care interventions. 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. Further work is also needed to investigate whether the publication of national guidelines have impacted on hospital admission patterns for obesity.
Hospital admission rates for obesity have increased more than four-fold over the past decade in children and young people, particularly amongst girls and in older age groups. NHS hospitals are using more and more resources in treating conditions associated with obesity and the majority of resources are directed at dealing with admissions where obesity is a comorbidity (such as asthma and sleep apnoea) rather than primary assessment and management of obesity itself. This study highlights the need for public health action to quantify the scale of the problem more clearly through early detection and reverse recent trends in order to reduce the number of admissions caused by obesity among children and young people in England. 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.