Orthopedic Complications of Overweight in Children and Adolescents

Abstract

OBJECTIVE-Few studies have quantified the prevalence of weight-related orthopedic conditions in otherwise healthy overweight children. The goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large pediatric cohort of children that included severely overweight children.METHODS-Medical charts from 227 overweight and 128 nonoverweight children and adolescents who were enrolled in pediatric clinical studies at the National Institutes of Health from 1996 to 2004 were reviewed to record pertinent orthopedic medical history and musculoskeletal complaints. Questionnaire data from 183 enrollees (146 overweight) documented difficulties with mobility. In 250, lower extremity alignment was determined by bilateral metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements made from whole-body dual-energy x-ray absorptiometry scans. RESULTS-Comparedwith nonoverweight children, overweight children reported a greater prevalence of fractures and musculoskeletal discomfort. The most common self-reported joint complaint among those who were questioned directly was knee pain (21.4% overweight vs 16.7% nonoverweight). Overweight children reported greater impairment in mobility than did nonoverweight children (mobility score: 17.0 ± 6.8 vs 11.6 ± 2.8). Both metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements showed greater malalignment in overweight compared with nonoverweight children.CONCLUSIONS-Reported fractures, musculoskeletal discomfort, impaired mobility, and lower extremity malalignment are more prevalent in overweight than nonoverweight children and adolescents. Because they affect the likelihood that children will engage in physical activity, orthopedic difficulties may be part of the cycle that perpetuates the accumulation of excess weight in children. Orthopedic complications of excess weight in adults include progression of degenerative osteoarthritis and articular cartilage breakdown, 4,5 a decline in physical functioning, 6 and poorer outcomes after orthopedic surgery for obesity-related disorders. 7,8 Some orthopedic disorders that are unique to childhood also have been suggested to be weight related. For example, retrospective analyses of children and adolescents with slipped capital femoral epiphysis and adolescent tibia vara (Blount's disease) reveal overrepresentation of overweight individuals. 9-11 However, few prospective data that quantify the prevalence and manifestations of potentially weight-related orthopedic conditions in overweight children and adolescents who are not referred for orthopedic concerns are available. Furthermore, the impact of such conditions on mobility in overweight children has not previously been examined. KeywordsThe goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large cohort of children who ranged in BMI from normal to severely overweight. We hypothesized that, compared with nonoverweight children and adolescents, those who were...

Childhood Obesity Is Associated With Increased Risk of Most Lower Extremity Fractures

“…Landin [21], in fact, demonstrated that between the ages of 10 and 15 years, the incidence of sports-related injuries doubles in girls and more than triples in boys. At the same time, multiple articles have demonstrated that obese children participate in sports much less and have substantially more difficulty with physical activities than their nonobese counterparts [3,13,33,36]. Thus, the effective exposure of obese adolescents to one of the most common causes of injuries-sports, and especially competitive sports-is much lower, thus possibly lowering their risk of fracture.…”

Lower Extremity Pain Is Associated With Reduced Function and Psychosocial Health in Obese Children

“…Musculoskeletal comorbidities have become a recent focus of research in obese children. Obese children report more frequent and severe joint pain [13,51,53] and lower extremity malalignment is more prevalent in overweight and obese children [28][29][30]52]. Like with obese adults, obese children report lower function and healthrelated quality of life compared with their healthy peers [38,41,53,63], but less is known about factors in obese children that may contribute to poor function and quality of life.…”

“…Overweight and obese children have a higher prevalence of musculoskeletal pain [13,53], particularly in the lower extremity (LE) [13,51,53]. A cross-sectional study in 2459 children showed that overweight and obese children more frequently report LE pain and problems and more frequently visit their family physician for pain and problems in the LE compared with healthy-weight children [22].…”

The Association of Overweight and Ankle Injuries in Children

“…A crosssectional survey of 9 to 17 year old children based on self-report showed an association between obesity and the occurrence of injuries, 9 and a chart review of the records of children and adolescents found an association between overweight orthopedic difficulties, including musculoskeletal discomfort and impaired mobility. 10 The combination of increased body mass and previous ankle sprain is associated with a higher risk of subsequent sprains in high school athletes. 11 Both adults and children who sustain an ankle injury and are obese are likely to have greater long-term ankle morbidity than their normal weight counterparts.…”