Obesity in children with medical complexity

Children with medical complexity (CMC) are much more likely to be obese or overweight than those without medical complexity, according to a recent study.

CMC are children with underlying chronic health conditions, significant functional status limitations, and increased hospitalization risk. About 1% to 11% of children in the United States are CMC and make up more than 30% of total pediatric health care costs.

Obesity, defined as a preventable public health problem, affects more than 1 in 3 US children, and has been linked to impaired life quality, decreased lifespan, and health inequities.

For CMC, obesity could be a cause of comorbidities such as delays to life-saving medical procedures, limitations to functional status, and increased risk of infection and chronic conditions. However, the prevalence of obesity among CMC has not been recorded.

To determine the prevalence of obesity among CMC, investigators conducted a retrospective cohort study. The study period occurred from January 1, 2019, to December 31, 2019, in a single health system.

Participants included children aged 2 to 18 years, with patient specific data gathered from the Stanford Medicine Research Data Repository. Children were excluded from the study if they did not have a valid weight and height recorded for at least 1 clinical encounter.

The primary outcome of the study was childhood overweight or obesity, using the definition provided by the Centers for Disease Control and Prevention. Independent variables included sociodemographic characteristics linked to obesity risk, medical characteristics linked with illness severity, and potential mediators and moderators.

There were 12 non-mutually exclusive CMC subgroups: gastrointestinal conditions, respiratory conditions, neurologic and neuromuscular conditions, congenital and genetic conditions, cardiovascular conditions, renal and urologic conditions, malignancy conditions, metabolic conditions, hematologic and immunologic conditions, neonatal and prematurity conditions, technology dependance, and transplant recipients.

The risk of overweight was 14.5% in CMC and 11% in non-CMC, compared to 17.4% in CMC and 7.3% in non-CMC for obesity. CMC were at greater risk if they were Hispanic or Black, had public insurance, and had parents whose preferred language was Spanish.

About 8% of CMC had obesogenic medical conditions. CMC with metabolic conditions, gastrointestinal conditions, and malignancies saw the greatest risks of obesity and overweight, while enteral feeds and being female saw reduced risks.

After adjustments, investigators found that CMC were 27% more likely to be overweight or obese compared to non-CMC. This study indicated that system-level interventions could be designed to reduce obesity among CMC.

Reference

PeinadoFabregat MI, Saynina O, Sanders LM. Obesity and overweight among children with medical complexity. Pediatrics. 2022;151(1). doi:10.1542/peds.2022-058687