Obese kids visit the ED more often

A study that followed more than 19,500 children aged from 2 to 18 years for about 8 years found that those who were overweight or obese made more hospital emergency department (ED) and outpatient clinic visits than children of normal weight.

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Investigators obtained electronic height, weight, and utilization data for participants-all residents of a single county in Minnesota-and calculated baseline body mass index (BMI). They categorized BMIs as underweight/healthy (<85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). At baseline, 14.5% of children were overweight and 11.7% were obese. The retrospective analysis of participants’ medical records adjusted for potential confounding factors: age, sex, race, chronic medical conditions, and socioeconomic status. More than 5% of participants had chronic medical conditions, including upper respiratory disorders, skin disorders, osteoarthritis and joint conditions, anxiety/depression/bipolar, attention-deficit/behavior disorders, asthma, chronic neurologic problems, developmental disorders, headaches/migraines, back problems, diabetes, or dyslipidemia. The percentage of children with 3 or more chronic medical conditions rose with increasing BMI category.

Compared with children whose BMI was below the 85th percentile, those who were overweight and obese had more ED visits, even after adjustment for confounding factors. Of the total study population, 62% had a least 1 ED visit during the study period, with 4 indications accounting for 68% of all ED visits: accident/injury (34.2%), acute respiratory disease (16.8%), acute gastrointestinal (10.4%), and psychiatric/substance abuse (6.4%). As obesity status increased, so did frequency of ED visits for the 2 most common indications, accidents/injuries and acute respiratory problems. A higher BMI also was associated with moderately increased risk of outpatient clinic visits, but baseline BMI category did not affect the risk of hospitalizations (Lynch BA, et al. Acad Pediatr. 2015;15[6]:644-650).

Commentary: This is an interesting observation in need of an explanation. Perhaps the answer to why overweight and obese children are seen more often in the ED is in the diagnoses treated. In this case, most often accidents/injuries and acute respiratory problems. Severity of asthma has been previously linked to increasing BMI for incompletely understood reasons, although potential explanations have included sleep-disordered breathing. Perhaps disordered sleep and resulting fatigue also can explain the increased risk of accidents and injuries. I think we’ll see more about this topic in the future. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.