Children who are underweight may place just as much strain on the healthcare system as those with obesity, according to new research from the University of Oxford.
The study, published in JAMA Network Open, used electronic health records from more than 268,000 children aged 2 to 15 across England. It found that childhood weight issues, on both ends of the spectrum, cost the United Kingdom’s National Health Service (NHS) an estimated £340 million (about $430 million USD) each year.
“It’s not just obesity that drives costs,” said lead author Dr. Olu Onyimadu from Oxford’s Nuffield Department of Primary Care Health Sciences. “Underweight children may need comparable support and generate similar costs per capita to the NHS. We need to think about the full spectrum of unhealthy weight when planning services.”
Researchers tracked health care use in the year before and after each child’s weight was measured by a general practitioner. They found that medical costs rose sharply once weight issues were identified, especially for underweight children and those with severe obesity. Four- to 5-year-olds with severe obesity had the highest excess costs, at about £472 per year, while girls generally cost more to treat than boys.
Professor Stavros Petrou, co-senior author and National Institute for Health and Care Research (NIHR) Senior Investigator, said the findings provide “the evidence (commissioners) need to make the case for weight-management services.”
The study also uncovered differences by ethnicity. White children consistently showed higher health care costs when overweight or obese compared with children from other backgrounds, a finding researchers say could help target future support and reduce health inequalities.
“With 27% of children aged 2-15 living with overweight or obesity, plus those affected by underweight, we are looking at a huge opportunity for preventive care,” said Professor Mara Violato, co-senior author at Oxford Population Health.
For families, the message is clear: concerns about children being too thin can be just as important as worries about excess weight. The research shows that once a child’s weight issue is identified, health providers often respond with additional support, from nutritional advice to mental health services, when those services exist.
While this research focused on England, experts say the findings carry global relevance. Similar patterns are likely in other developed nations, where both childhood obesity and underweight rates continue to pose health and economic challenges.
The work was funded by the National Institute for Health and Care Research (NIHR) through its Applied Research Collaboration Oxford and Thames Valley program.