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Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Juvenile obesity and its association with utilisation and costs of pharmaceuticals - results from the KiGGS study

Authors: Christina M Wenig, Hildtraud Knopf, Petra Menn

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

According to a national reference, 15% of German children and adolescents are overweight (including obese) and 6.3% are obese. An earlier study analysed the impact of childhood overweight and obesity on different components of direct medical costs (physician, hospital and therapists). To complement the existing literature for Germany, this study aims to explore the association of body mass index (BMI) with utilisation of pharmaceuticals and related costs in German children and adolescents.

Methods

Based on data from 14, 836 respondents aged 3-17 years in the German Interview and Examination Survey for Children and Adolescents (KiGGS), drug intake and associated costs were estimated using a bottom-up approach. To investigate the association of BMI with utilisation and costs, univariate analyses and multivariate generalised mixed models were conducted.

Results

There was no significant difference between BMI groups regarding the probability of drug utilisation. However, the number of pharmaceuticals used was significantly higher (14%) for obese children than for normal weight children. Furthermore, there was a trend for more physician-prescribed medication in obese children and adolescents. Among children with pharmaceutical intake, estimated costs were 24% higher for obese children compared with the normal weight group.

Conclusions

This is the first study to estimate excess drug costs for obesity based on a representative cross-sectional sample of the child and adolescent population in Germany. The results suggest that obese children should be classified as a priority group for prevention. This study complements the existing literature and provides important information concerning the relevance of childhood obesity as a health problem.
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Literature
1.
go back to reference WHO: Prevalence of overweight and obesity in children and adolescents. Fact Sheet 23. 2009, Geneva: World Health Organization, 7. WHO: Prevalence of overweight and obesity in children and adolescents. Fact Sheet 23. 2009, Geneva: World Health Organization, 7.
2.
go back to reference Kurth BM, Schaffrath Rosario A: The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 736-743. 10.1007/s00103-007-0235-5.CrossRefPubMed Kurth BM, Schaffrath Rosario A: The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 736-743. 10.1007/s00103-007-0235-5.CrossRefPubMed
3.
go back to reference Prugger C, Keil U: Development of obesity in Germany - prevalence, determinants and perspectives [in German]. Deutsche Medizinische Wochenschrift. 2007, 132 (16): 892-897. 10.1055/s-2007-973636.CrossRefPubMed Prugger C, Keil U: Development of obesity in Germany - prevalence, determinants and perspectives [in German]. Deutsche Medizinische Wochenschrift. 2007, 132 (16): 892-897. 10.1055/s-2007-973636.CrossRefPubMed
4.
go back to reference Lee YS: Consequences of childhood obesity. Ann Acad Med Singapore. 2009, 38 (1): 75-77.PubMed Lee YS: Consequences of childhood obesity. Ann Acad Med Singapore. 2009, 38 (1): 75-77.PubMed
5.
go back to reference Nejat EJ, Polotsky AJ, Pal L: Predictors of chronic disease at midlife and beyond - the health risks of obesity. Maturitas. 2010, 65 (2): 106-111. 10.1016/j.maturitas.2009.09.006.CrossRefPubMed Nejat EJ, Polotsky AJ, Pal L: Predictors of chronic disease at midlife and beyond - the health risks of obesity. Maturitas. 2010, 65 (2): 106-111. 10.1016/j.maturitas.2009.09.006.CrossRefPubMed
6.
go back to reference Magarey AM, Daniels LA, Boulton TJ, Cockington RA: Predicting obesity in early adulthood from childhood and parental obesity. Int J Obes Relat Metab Disord. 2003, 27 (4): 505-513. 10.1038/sj.ijo.0802251.CrossRefPubMed Magarey AM, Daniels LA, Boulton TJ, Cockington RA: Predicting obesity in early adulthood from childhood and parental obesity. Int J Obes Relat Metab Disord. 2003, 27 (4): 505-513. 10.1038/sj.ijo.0802251.CrossRefPubMed
7.
go back to reference Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ: Indirect costs of obesity: a review of the current literature. Obesity Reviews. 2008, 9 (5): 489-500. 10.1111/j.1467-789X.2008.00472.x.CrossRefPubMed Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ: Indirect costs of obesity: a review of the current literature. Obesity Reviews. 2008, 9 (5): 489-500. 10.1111/j.1467-789X.2008.00472.x.CrossRefPubMed
8.
go back to reference von Lengerke T, Happich M, Reitmeir P, John J: Utilization of out- and inpatient health services by obese adults: a population-based study in the Augsburg region, Germany. Gesundheitswesen. 2005, 67 (Suppl 1): S150-157.CrossRefPubMed von Lengerke T, Happich M, Reitmeir P, John J: Utilization of out- and inpatient health services by obese adults: a population-based study in the Augsburg region, Germany. Gesundheitswesen. 2005, 67 (Suppl 1): S150-157.CrossRefPubMed
9.
go back to reference von Lengerke T, Reitmeir P, John J: Direct medical costs of (severe) obesity: a bottom-up assessment of over- vs. normal-weight adults in the KORA-study region (Augsburg, Germany) [in German]. Gesundheitswesen. 2006, 68 (2): 110-115. 10.1055/s-2005-858994.CrossRefPubMed von Lengerke T, Reitmeir P, John J: Direct medical costs of (severe) obesity: a bottom-up assessment of over- vs. normal-weight adults in the KORA-study region (Augsburg, Germany) [in German]. Gesundheitswesen. 2006, 68 (2): 110-115. 10.1055/s-2005-858994.CrossRefPubMed
10.
go back to reference Muller-Riemenschneider F, Reinhold T, Berghofer A, Willich SN: Health-economic burden of obesity in Europe. European Journal of Epidemiology. 2008, 23 (8): 499-509. 10.1007/s10654-008-9239-1.CrossRefPubMed Muller-Riemenschneider F, Reinhold T, Berghofer A, Willich SN: Health-economic burden of obesity in Europe. European Journal of Epidemiology. 2008, 23 (8): 499-509. 10.1007/s10654-008-9239-1.CrossRefPubMed
11.
go back to reference John J, Wenig CM, Wolfenstetter SB: Recent economic findings on childhood obesity: cost-of-illness and cost-effectiveness of interventions. Current Opinion in Clinical Nutrition & Metabolic Care. 2010, 13 (3): 305-313. 10.1097/MCO.0b013e328337fe18.CrossRef John J, Wenig CM, Wolfenstetter SB: Recent economic findings on childhood obesity: cost-of-illness and cost-effectiveness of interventions. Current Opinion in Clinical Nutrition & Metabolic Care. 2010, 13 (3): 305-313. 10.1097/MCO.0b013e328337fe18.CrossRef
12.
go back to reference Johnson E, McInnes M, Shinogle J: What is the economic cost of overweight children?. Eastern Economic Journal. 2006, 32 (1): 171-188. Johnson E, McInnes M, Shinogle J: What is the economic cost of overweight children?. Eastern Economic Journal. 2006, 32 (1): 171-188.
13.
go back to reference Skinner AC, Mayer ML, Flower K, Weinberger M: Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare?. Pediatrics. 2008, 121 (2): e269-277. 10.1542/peds.2007-0874.CrossRefPubMed Skinner AC, Mayer ML, Flower K, Weinberger M: Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare?. Pediatrics. 2008, 121 (2): e269-277. 10.1542/peds.2007-0874.CrossRefPubMed
14.
go back to reference Hampl SE, Carroll CA, Simon SD, Sharma V: Resource utilization and expenditures for overweight and obese children. Arch Pediatr Adolesc Med. 2007, 161 (1): 11-14. 10.1001/archpedi.161.1.11.CrossRefPubMed Hampl SE, Carroll CA, Simon SD, Sharma V: Resource utilization and expenditures for overweight and obese children. Arch Pediatr Adolesc Med. 2007, 161 (1): 11-14. 10.1001/archpedi.161.1.11.CrossRefPubMed
15.
go back to reference Buescher PA, Whitmire JT, Plescia M: Relationship between body mass index and medical care expenditures for North Carolina adolescents enrolled in Medicaid in 2004. Preventing chronic disease. 2008, 5 (1): A04.PubMed Buescher PA, Whitmire JT, Plescia M: Relationship between body mass index and medical care expenditures for North Carolina adolescents enrolled in Medicaid in 2004. Preventing chronic disease. 2008, 5 (1): A04.PubMed
16.
go back to reference Estabrooks PA, Shetterly S: The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med. 2007, 161 (3): 222-227. 10.1001/archpedi.161.3.222.CrossRefPubMed Estabrooks PA, Shetterly S: The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med. 2007, 161 (3): 222-227. 10.1001/archpedi.161.3.222.CrossRefPubMed
17.
go back to reference Finkelstein EA, Trogdon JG: Public health interventions for addressing childhood overweight: analysis of the business case. Am J Public Health. 2008, 98 (3): 411-415. 10.2105/AJPH.2007.114991.CrossRefPubMedPubMedCentral Finkelstein EA, Trogdon JG: Public health interventions for addressing childhood overweight: analysis of the business case. Am J Public Health. 2008, 98 (3): 411-415. 10.2105/AJPH.2007.114991.CrossRefPubMedPubMedCentral
18.
go back to reference Monheit AC, Vistnes JP, Rogowski JA: Overweight in adolescents: implications for health expenditures. Economics and Human Biology. 2009, 7 (1): 55-63. 10.1016/j.ehb.2008.07.007.CrossRefPubMed Monheit AC, Vistnes JP, Rogowski JA: Overweight in adolescents: implications for health expenditures. Economics and Human Biology. 2009, 7 (1): 55-63. 10.1016/j.ehb.2008.07.007.CrossRefPubMed
19.
go back to reference Wenig CM: The impact of BMI on direct costs in Children and Adolescents: empirical findings for the German Healthcare System based on the KiGGS-study. Eur J Health Econ. Epub 2010 Wenig CM: The impact of BMI on direct costs in Children and Adolescents: empirical findings for the German Healthcare System based on the KiGGS-study. Eur J Health Econ. Epub 2010
20.
go back to reference Robert Koch-Institute: Public Use File KiGGS, Kinder- und Jugendgesundheitssurvey 2003-2006. 2008, Berlin Robert Koch-Institute: Public Use File KiGGS, Kinder- und Jugendgesundheitssurvey 2003-2006. 2008, Berlin
21.
go back to reference Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H, Knopf H, Lange M, Mensink GB, et al: The challenge of comprehensively mapping children's health in a nation-wide health survey: design of the German KiGGS-Study. BMC Public Health. 2008, 8: 196-10.1186/1471-2458-8-196.CrossRefPubMedPubMedCentral Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H, Knopf H, Lange M, Mensink GB, et al: The challenge of comprehensively mapping children's health in a nation-wide health survey: design of the German KiGGS-Study. BMC Public Health. 2008, 8: 196-10.1186/1471-2458-8-196.CrossRefPubMedPubMedCentral
22.
go back to reference Hölling H, Kamtsiuris P, Lange M, Thierfelder W, Schlack R, Tamm M: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Study management and conduct of fieldwork [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 557-566. 10.1007/s00103-007-0216-8.CrossRefPubMed Hölling H, Kamtsiuris P, Lange M, Thierfelder W, Schlack R, Tamm M: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Study management and conduct of fieldwork [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 557-566. 10.1007/s00103-007-0216-8.CrossRefPubMed
23.
go back to reference Kamtsiuris P, Lange M, Schaffrath Rosario A: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Sample design, response and nonresponse analysis [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 547-556. 10.1007/s00103-007-0215-9.CrossRefPubMed Kamtsiuris P, Lange M, Schaffrath Rosario A: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Sample design, response and nonresponse analysis [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 547-556. 10.1007/s00103-007-0215-9.CrossRefPubMed
24.
go back to reference Kurth BM: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): an overview of its planning, implementation and results taking into account aspects of quality management [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 533-546. 10.1007/s00103-007-0214-x.CrossRefPubMed Kurth BM: The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): an overview of its planning, implementation and results taking into account aspects of quality management [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 533-546. 10.1007/s00103-007-0214-x.CrossRefPubMed
25.
go back to reference Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß H, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, et al: Percentiles of body mass index in children and adolescents evaluated from different regional German studies [in German]. Monatsschrift Kinderheilkunde. 2001, 149: 807-818. 10.1007/s001120170107.CrossRef Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß H, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, et al: Percentiles of body mass index in children and adolescents evaluated from different regional German studies [in German]. Monatsschrift Kinderheilkunde. 2001, 149: 807-818. 10.1007/s001120170107.CrossRef
26.
go back to reference Knopf H: Medicine use in children and adolescents [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 863-870. 10.1007/s00103-007-0249-z.CrossRefPubMed Knopf H: Medicine use in children and adolescents [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50: 863-870. 10.1007/s00103-007-0249-z.CrossRefPubMed
27.
go back to reference Kleiser C, Schaffrath Rosario A, Mensink GB, Prinz-Langenohl R, Kurth BM: Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS Study. BMC Public Health. 2009, 9: 46-10.1186/1471-2458-9-46.CrossRefPubMedPubMedCentral Kleiser C, Schaffrath Rosario A, Mensink GB, Prinz-Langenohl R, Kurth BM: Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS Study. BMC Public Health. 2009, 9: 46-10.1186/1471-2458-9-46.CrossRefPubMedPubMedCentral
29.
go back to reference Winkler J, Stolzenberg H: Social Status Scaling in the German National Health Interview and Examination Survey [in German]. Gesundheitswesen. 1999, 61 (Sonderheft 2): 178-183. Winkler J, Stolzenberg H: Social Status Scaling in the German National Health Interview and Examination Survey [in German]. Gesundheitswesen. 1999, 61 (Sonderheft 2): 178-183.
30.
go back to reference Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T: Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 578-589. 10.1007/s00103-007-0219-5.CrossRefPubMed Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T: Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 578-589. 10.1007/s00103-007-0219-5.CrossRefPubMed
31.
go back to reference Winkler J: Die Messung des sozialen Status mit Hilfe eines Index in den Gesundheitssurveys der DHP. Messung soziodemographischer Merkmale in der Epidemiologie, Schriften des Robert Koch-Institut 1/98. Edited by: Ahrens W, Bellach B, Jöckel K. 1998, München, 69-74. Winkler J: Die Messung des sozialen Status mit Hilfe eines Index in den Gesundheitssurveys der DHP. Messung soziodemographischer Merkmale in der Epidemiologie, Schriften des Robert Koch-Institut 1/98. Edited by: Ahrens W, Bellach B, Jöckel K. 1998, München, 69-74.
32.
go back to reference Ravens-Sieberer U: Der Kindl-R Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen -Revidierte Form. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Edited by: Schumacher J, Klaiberg A, Brähler E. Göttingen. 2003, Hogrefe, 184-188. Ravens-Sieberer U: Der Kindl-R Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen -Revidierte Form. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Edited by: Schumacher J, Klaiberg A, Brähler E. Göttingen. 2003, Hogrefe, 184-188.
33.
go back to reference Ravens-Sieberer U, Bullinger M: Assessing health related quality of life in chronically ill children with the german KINDL: first psychomertric and content analytical results. Qual Life Res. 1998, 7 (5): 399-407.CrossRefPubMed Ravens-Sieberer U, Bullinger M: Assessing health related quality of life in chronically ill children with the german KINDL: first psychomertric and content analytical results. Qual Life Res. 1998, 7 (5): 399-407.CrossRefPubMed
34.
go back to reference Schenk L, Ellert U, Neuhauser H: Children and adolescents in Germany with a migration background. Methodical aspects in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 590-599. 10.1007/s00103-007-0220-z.CrossRefPubMed Schenk L, Ellert U, Neuhauser H: Children and adolescents in Germany with a migration background. Methodical aspects in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) [in German]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007, 50 (5-6): 590-599. 10.1007/s00103-007-0220-z.CrossRefPubMed
35.
go back to reference Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B: Empirische Bewertungssätze in der gesundheitsökonomischen Evaluation - ein Vorschlag der AG Methoden der gesundheitsökonomischen Evaluation (AG MEG). Gesundheitswesen. 2005, 67 (10): 736-746. 10.1055/s-2005-858698.CrossRefPubMed Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B: Empirische Bewertungssätze in der gesundheitsökonomischen Evaluation - ein Vorschlag der AG Methoden der gesundheitsökonomischen Evaluation (AG MEG). Gesundheitswesen. 2005, 67 (10): 736-746. 10.1055/s-2005-858698.CrossRefPubMed
36.
go back to reference Braun S, Prenzler A, Mittendorf T, von der Schulenburg JM: Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance [in German]. Gesundheitswesen. 2009, 71 (1): 19-23. 10.1055/s-0028-1102930.CrossRefPubMed Braun S, Prenzler A, Mittendorf T, von der Schulenburg JM: Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance [in German]. Gesundheitswesen. 2009, 71 (1): 19-23. 10.1055/s-0028-1102930.CrossRefPubMed
37.
go back to reference Rote Liste Service GmbH: Rote Liste (official price list). 2007, Editio Cantor Verlag Rote Liste Service GmbH: Rote Liste (official price list). 2007, Editio Cantor Verlag
38.
go back to reference Efron B, Tibshirani RJ: An Introduction to the Bootstrap. 1993, New York: Chapman & HallCrossRef Efron B, Tibshirani RJ: An Introduction to the Bootstrap. 1993, New York: Chapman & HallCrossRef
39.
go back to reference Kilian R, Matschinger H, Loeffler W, Roick C, Angermeyer MC: A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment. J Ment Health Policy. 2002, 5 (1): 21-31. Kilian R, Matschinger H, Loeffler W, Roick C, Angermeyer MC: A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment. J Ment Health Policy. 2002, 5 (1): 21-31.
40.
go back to reference Barber J, Thompson S: Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy. 2004, 9 (4): 197-204. 10.1258/1355819042250249.CrossRefPubMed Barber J, Thompson S: Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy. 2004, 9 (4): 197-204. 10.1258/1355819042250249.CrossRefPubMed
41.
go back to reference Manning WG, Basu A, Mullahy J: Generalized modeling approaches to risk adjustment of skewed outcomes data. Journal of Health Economics. 2005, 24 (3): 465-488. 10.1016/j.jhealeco.2004.09.011.CrossRefPubMed Manning WG, Basu A, Mullahy J: Generalized modeling approaches to risk adjustment of skewed outcomes data. Journal of Health Economics. 2005, 24 (3): 465-488. 10.1016/j.jhealeco.2004.09.011.CrossRefPubMed
42.
go back to reference Wolfram G: Adipositas, Magersucht, Störungen des Essverhaltens. Die innere Medizin: Referenzwerk für den Facharzt. Volume 11. Edited by: Gerok W, Huber C, Meinertz T, Zeidler H. 2007, Stuttgart: Schattauer, 1212-1214. Wolfram G: Adipositas, Magersucht, Störungen des Essverhaltens. Die innere Medizin: Referenzwerk für den Facharzt. Volume 11. Edited by: Gerok W, Huber C, Meinertz T, Zeidler H. 2007, Stuttgart: Schattauer, 1212-1214.
43.
go back to reference Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. Journal of Health and Social Behavior. 1995, 36 (1): 1-10. 10.2307/2137284.CrossRefPubMed Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. Journal of Health and Social Behavior. 1995, 36 (1): 1-10. 10.2307/2137284.CrossRefPubMed
44.
go back to reference Smith TG, Stoddard C, Barnes MG: Why the Poor Get Fat: Weight Gain and Economic Insecurity. Forum for Health Economics & Policy. 2009, 12 (2): Art. 5 Smith TG, Stoddard C, Barnes MG: Why the Poor Get Fat: Weight Gain and Economic Insecurity. Forum for Health Economics & Policy. 2009, 12 (2): Art. 5
45.
go back to reference Sobal J, Stunkard AJ: Socioeconomic status and obesity: a review of the literature. Psychological Bulletin. 1989, 105 (2): 260-275.CrossRefPubMed Sobal J, Stunkard AJ: Socioeconomic status and obesity: a review of the literature. Psychological Bulletin. 1989, 105 (2): 260-275.CrossRefPubMed
46.
go back to reference Finkelstein EA, Ruhm CJ, Kosa KM: Economic causes and consequences of obesity. Annual Review of Public Health. 2005, 26: 239-257. 10.1146/annurev.publhealth.26.021304.144628.CrossRefPubMed Finkelstein EA, Ruhm CJ, Kosa KM: Economic causes and consequences of obesity. Annual Review of Public Health. 2005, 26: 239-257. 10.1146/annurev.publhealth.26.021304.144628.CrossRefPubMed
47.
go back to reference Burkhauser RV, Cawley J: Beyond BMI: the value of more accurate measures of fatness and obesity in social science research. J Health Econ. 2008, 27 (2): 519-529. 10.1016/j.jhealeco.2007.05.005.CrossRefPubMed Burkhauser RV, Cawley J: Beyond BMI: the value of more accurate measures of fatness and obesity in social science research. J Health Econ. 2008, 27 (2): 519-529. 10.1016/j.jhealeco.2007.05.005.CrossRefPubMed
48.
go back to reference Eto C, Komiya S, Nakao T, Kikkawa K: Validity of the body mass index and fat mass index as an indicator of obesity in children aged 3-5 year. Journal of physiological anthropology and applied human science. 2004, 23 (1): 25-30. 10.2114/jpa.23.25.CrossRefPubMed Eto C, Komiya S, Nakao T, Kikkawa K: Validity of the body mass index and fat mass index as an indicator of obesity in children aged 3-5 year. Journal of physiological anthropology and applied human science. 2004, 23 (1): 25-30. 10.2114/jpa.23.25.CrossRefPubMed
49.
go back to reference Dencker M, Thorsson O, Linden C, Wollmer P, Andersen LB, Karlsson MK: BMI and objectively measured body fat and body fat distribution in prepubertal children. Clinical physiology and functional imaging. 2007, 27 (1): 12-16. 10.1111/j.1475-097X.2007.00709.x.CrossRefPubMed Dencker M, Thorsson O, Linden C, Wollmer P, Andersen LB, Karlsson MK: BMI and objectively measured body fat and body fat distribution in prepubertal children. Clinical physiology and functional imaging. 2007, 27 (1): 12-16. 10.1111/j.1475-097X.2007.00709.x.CrossRefPubMed
Metadata
Title
Juvenile obesity and its association with utilisation and costs of pharmaceuticals - results from the KiGGS study
Authors
Christina M Wenig
Hildtraud Knopf
Petra Menn
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-340

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