It’s no secret that American children have gotten fatter in recent decades.
Now a new study joins earlier research showing the consequences: A sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.
Claims for Type 2 diabetes — formerly known as “adult-onset” diabetes — among young people aged 0 to 22 years old more than doubled between 2011 and 2015, according to an analysis of a large national database of claims paid by about 60 insurers.
At the same time, claims for prediabetes among children and youth rose 110 percent, while high blood pressure claims rose 67 percent. Sleep apnea, a condition where a patient temporarily stops breathing while sleeping, rose 161 percent.
The findings “not only raise quality-of-life questions for children, but also the … kind of resources that will be necessary to address this emerging situation,” said Robin Gelburd, president of the nonprofit Fair Health, a national clearing house for claims data that offers free medical cost comparison tools to consumers and sells data to insurers and health systems.This KHN story also ran on NPR. It can be republished for free (details).
To be sure, the analysis is certainly not the first to note a rise in obesity or Type 2 diabetes in this age group; nor does it explore the possible reasons behind the apparent increase in claims. One factor in the rise could simply be increased awareness and testing for the problem, while variations between states could reflect differences in patient ethnicities, how doctors practice, insurance rules or all of those factors.
“We try to give a big picture and welcome others to look under there hood for details,” acknowledged Gelburd.
But the analysis is different than some earlier research because it uses a database of actual claims for about 150 million people, all of whom have private insurance. The study focused on a subset of youth: Those who had a diagnosis of obesity or Type 2 diabetes. Researchers analyzed claims data tied to those patients to determine what other conditions they experienced and the medical services provided to them.
Claims data is considered a good research tool because it reflects services actually provided. But, conversely, the Fair Health analysis is also limited because it does not include claims submitted by Medicaid or other government programs, so it doesn’t represent a true cross section of the population.
Even with those limitations, the findings “are frightening,” said Stephen Pont, a pediatrician and medical director of the childhood obesity center at Dell Children’s Medical Center in Austin, Texas, who did not work on the analysis.
“The vast majority of kids should never have high blood pressure or diabetes or sleep apnea. Now we’re seeing those consequences in kids,” he said. “That will result in shorter lives and lower quality of life.”
The solution, he added, cannot be found solely in the doctor’s office, but many insurers hamstring efforts to help children by limiting medical coverage of efforts to combat obesity. Most don’t cover related costs such as those for weight management programs until a complication such as high blood pressure is developed, he said.
To keep the Fair Health statistics in perspective, it’s important to note that Type 2 diabetes only affects a small number of children. The Centers for Disease Control and Prevention estimates that only 0.25 percent of all children suffer from the condition. But when it does hit, patients must go on medication, often for life, and can suffer serious health problems, including blindness and kidney failure.
The Fair Health analysis found that during the four years that were analyzed, the number of claims tied to an obesity diagnosis among youth aged 0 to 22 also rose, jumping 94 percent in infants and toddlers to as much as 154 percent among 19 to 22-year-olds.
That contrasts with CDC findings that the prevalence of obesity among children and youth aged 2 to 19 years old remained relatively stable from 2011 to 2014. Fair Health researchers suggested a possible reason for the difference is that its dataset does not include Medicaid, the state-federal health program for low-income residents. (Diabetes disproportionately affects low-income populations.)
Geographically, the study found a range of claims among the states, which also surprised some outside researchers. States with a high prevalence of claims for Type 2 diabetes included Ohio, Pennsylvania, North Dakota, Utah and South Dakota.
Some states on the lower end of the scale didn’t seem to reflect their overall health statistics. Louisiana and Alabama, for example, appeared to have a lower number of claims for Type 2 than many other states, despite generally appearing at the bottom of state rankings across a variety of health measures.
“How does one interpret the difference between a low claim state like Louisiana and a high claim state like Ohio? Something is happening here,” said Dennis Bier, professor of pediatrics in Houston at Baylor College of Medicine, who also did not work on the study. “Does that mean doctors in Louisiana are not making enough claims for diabetes?”
Gelburd said the Fair Health data was adjusted for each state, but the analysis did not have access to ethnicity or socioeconomic data, so those variables were not factored in.
How demographic and other variables impact the findings is worth exploring, said Bier. Has there been a sudden change in the development of Type 2 diabetes? Or, conversely, does the uptick in the Fair Health data reflect a change in medical practice or awareness of the condition? Perhaps there are state insurance rules in one state that require more medical coverage for obesity than others, driving the differences.
But no matter the underlying causes of the increase noted in the analysis, Bier said it is well known that the longer children remain obese, the more likely they are to get diabetes.
Chiefly, the country needs to find more effective ways to prevent obesity from occurring in children in the first place, which he said is difficult: “We’re pretty poor at getting people to change their behavior.”
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