A Claims-Based Analysis of Weight Management in Pediatric Populations Covered By Commercial or Medicaid Insurance


Brady B1, Palmer L2
1Merative, Laurel, MD, USA, 2Merative, Ann Arbor, MI, USA

OBJECTIVES: There has been increased focus on management of childhood obesity with the continued global rise in pediatric obesity rates. Recently the American Association of Pediatrics included bariatric surgery as a treatment option for children and adolescents with severe obesity in 2023. This study utilized commercial and Medicaid administrative claims data to investigate weight-related diagnosis reporting management from 2016 to 2022.

METHODS: Annual cohorts of pediatric patients with continuous eligibility and ≥1 office visit were identified in the Merative MarketScan Commercial or Multi-state Medicaid Databases in the 2016, 2018, 2020, and 2022 calendar years. Overall reporting of pediatric weight class based on BMI-related diagnosis codes, along with the proportion of patients in each weight class and use of nutritional counseling, was assessed within the annual samples.

RESULTS: Each annual cohort included approximately 2-4 million patients. The proportion of patients with ≥1 pediatric BMI code increased from 13.3%-29.2% in the commercial sample and 18.7%-30.6% in the Medicaid sample over the study period. Medicaid patients consistently showed increased percentages of patients with pediatric BMI codes reported, as well as higher rates of obesity (24.3%-26.4%) compared to commercial patients (14.2%-15.4%) among patients with ≥1 BMI code. Medicaid patients also had increased proportions of patients in each weight class receiving nutritional counseling compared to commercial patients; however, in both cases the proportion of patients receiving nutritional counseling did not dramatically differ across weight classes.

CONCLUSIONS: Utilization of diagnosis codes reporting pediatric weight-related metrics is increasing coincident with increasing rates of childhood obesity. Among patients with a code, children covered by Medicaid are more likely to be obese a compared to their peers covered by commercial insurance suggesting income-related health disparities. Given the potential long-term implications of childhood obesity, further investigation of methods to help children manage their weight are warranted.

Conference/Value in Health Info

2024-05, ISPOR 2024, Atlanta, GA, USA

Value in Health, Volume 27, Issue 6, S1 (June 2024)




Clinical Outcomes, Epidemiology & Public Health, Study Approaches

Topic Subcategory

Clinical Outcomes Assessment, Disease Classification & Coding


Diabetes/Endocrine/Metabolic Disorders (including obesity), Pediatrics

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