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Burden of child and adolescent obesity on health services in England
  1. Russell M Viner1,
  2. Sanjay Kinra2,
  3. Dasha Nicholls1,
  4. Tim Cole1,
  5. Anthony Kessel3,
  6. Deborah Christie4,
  7. Billy White1,
  8. Helen Croker4,
  9. Ian C K Wong5,
  10. Sonia Saxena6
  1. 1 UCL Great Ormond St. Institute of Child Health, London, UK
  2. 2 London School of Hygiene & Tropical Medicine, England, UK
  3. 3 Public Health England, London, UK
  4. 4 UCL Institute of Epidemiology & Health Care, London, UK
  5. 5 UCL School of Pharmacy, London, UK
  6. 6 Imperial College London, London, UK
  1. Correspondence to Professor Russell M Viner, UCL Great Ormond St. Institute of Child Health, 30 Guilford St. London, WC1N 1EH, UK; r.viner{at}


Objective To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.

Design Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.

Setting Data on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.

Main outcome measures Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).

Results 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.

Conclusions There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.

  • Obesity
  • Epidemiology
  • Burden of disease
  • Health services research
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  • Contributors RV and SS conceptualised the study. RV undertook the analyses and led writing of the paper. SK, DN, TC, AK, DC, BW, HK and IW contributed to interpretation of results and writing of the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The original Health Survey for England data we used are publicly available from the UK Data Service.

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