Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index

Acad Pediatr. 2020 May-Jun;20(4):532-539. doi: 10.1016/j.acap.2019.12.011. Epub 2020 Jan 2.


Objectives: To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions.

Methods: A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates.

Results: Of those with biologically plausible values for height and weight (n = 30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity.

Conclusions: Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.

Keywords: health care utilization; pediatric obesity; pediatrics; public health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Body Mass Index
  • Child
  • Child, Preschool
  • Emergency Service, Hospital*
  • Humans
  • Overweight* / epidemiology
  • Primary Health Care
  • Retrospective Studies