Original Investigation
Nutrition, Obesity, and Exercise
Child Body Mass Index and Health Care Costs in England
Olu Onyimadu, Alison Hayes, Patrick Fahr, et al
JAMA Netw Open 2025;8;(10):e2537560. doi:10.1001/jamanetworkopen.2025.37560
Question What is the health care cost burden attributable to unhealthy weight status among children in England?
Findings In this cross-sectional study of 268 231 children accessing health care in England, underweight, overweight, obesity, and severe obesity were associated with higher health care costs compared with healthy weight 1 year after body mass index assessment. For underweight and severe obesity, these excess annual costs were £164 (US $236) and £190 (US $274), respectively.
Meaning Cost estimates generated from this research can potentially inform clinical and budgetary service planning and serve as parameter inputs for studies evaluating the cost-effectiveness of interventions targeting childhood unhealthy weight.
Abstract
Importance In England, 27% of children aged 2 to 15 years live with overweight or obesity. However, national estimates of excess health care costs attributable to unhealthy weight status are lacking.
Objective To estimate health care costs associated with childhood weight status, stratified by sex, age, and ethnicity, in England.
Design, Setting, and Participants This retrospective cross-sectional study used 2014 to 2020 Clinical Practice Research Datalink Aurum data linked with Hospital Episode Statistics at general practices in England. Children aged 2 to 15 years with at least 1 body mass index (BMI) measurement recorded during a general practice visit between January 1, 2015, and March 30, 2019, for whom primary care and linked Hospital Episode Statistics data were available were studied. The analysis was conducted from December 11, 2023, to March 17, 2025.
Exposure BMI-derived weight status categories.
Main Outcomes and Measures Total health care costs were analyzed for the 1-year period before and after BMI measurement. Attributable health care costs were estimated using 2-part generalized linear models, adjusted for sex, age, ethnicity, socioeconomic status, and geographic region.
Results The study included the health care records of 268 231 unique children (mean [SD] age, 6.82 [2.66] years; 148 230 [55%] male; 4554 [2%] Bangladeshi, 16 708 [6%] Black, 7778 [3%] Chinese or other Asian, 7665 [3%] Indian, 10 875 [4%] Pakistani, 169 299 [63%] White, 10 886 [4%] multiracial, and 40 466 [15%] other or unknown). Before BMI measurement, health care costs were higher for children with overweight, obesity, and severe obesity but lower for children with underweight compared with children with healthy weight. After BMI measurement, costs were higher in children with underweight, overweight, obesity, and severe obesity compared with children with healthy weight. Severe obesity had the highest mean annual excess costs at £190 (95% CI, £77-£302) (US $274 [95% CI, US $111-US $435]) followed by underweight at £164 (95% CI, £69-£260) (US $236 [95% CI, US $99-US $374]). Health care costs varied by sex, age group, and ethnicity, although interactions were limited to specific BMI categories and covariate levels. The excess annual national health care cost attributable to overweight and obesity was £0.27 billion (95% CI, £0.12 billion to £0.43 billion) (US $0.39 billion [95% CI, US $0.17 billion to US $0.62 billion]).
Conclusions and Relevance In this cross-sectional study of children, health care costs were higher for nearly all unhealthy weight categories compared with healthy weight BMI measurement. These findings support the economic case for preventive and therapeutic interventions targeting unhealthy childhood weight and offer cost estimates for use in cost-effectiveness analyses.
