Conference Proceedings
Childhood Obesity Case Statement

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Objective

The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications.

Methods

Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines. This case statement was then reviewed by the members of the pediatric specialty group of the US Bone and Joint Initiative, which represents an extensive number of organizations dealing with musculoskeletal health.

Results

Multiple musculoskeletal disorders are clearly caused by or worsened by childhood obesity. The review of the literature clearly demonstrates the increased frequency and severity of many childhood musculoskeletal disorders. Concerns about the long-term implications of these childhood onset disorders such as pain and degenerative changes into adulthood are clearly recognized by all the member organizations of the US Bone and Joint Initiative.

Conclusions

It is imperative to recognize the long-term implications of musculoskeletal disorders caused by or worsened by childhood obesity. It is also important to recognize that the ability to exercise comfortably is a key factor to developing a healthy lifestyle and maintaining a healthy body weight. Efforts to develop reasonable and acceptable programs to increase physical activity by all facets of society should be supported. Further research into the long-term implications of childhood musculoskeletal disorders related to childhood obesity is necessary.

Section snippets

International scope of the problem

Obesity is now recognized as a worldwide problem. Wang in 2006 demonstrated that with the exception of Russia and Poland in the 1990s, the prevalence of overweight and obesity has increased in almost all the countries studied. This finding is most profound in economically developed countries and in urbanized populations [9]. Kosli also showed significant prevalence of obesity not only in the US but also in the European Union and throughout the world [10].

No area of the world is immune to this

Scope of the problem: Pain

Obesity in adults has long been linked to musculoskeletal pain and post operative complications. Somewhat surprisingly, there is a lack of evidence to prove a relationship between obesity and back pain in adults, at least in one large epidemiologic study [14]. Obesity has more recently also been reported to be associated with pain in children. The most common sites of discomfort in one study of obese children (obesity defined as having a body mass index [BMI] in the 95th percentile for age- and

Alignment/gait abnormalities

Concern over the long-term impact on joints of altered gait, secondary to obesity has led to recommendation for further study [20]. There is no significant information as to the long-term effect this alteration will have as these children become adults. It is of great concern that obese children and adolescents are already presenting with significant pain and malalignments at a very young age and that this may be a precursor to early degenerative arthritis as an adult [21]. Further research

Slipped capital femoral epiphysis

The etiology of slipped capital femoral epiphysis is thought to be multifactorial. The association of this diagnosis with overweight conditions has been found in several countries, including the United States [28]. Manoff in 2005 evaluated the correlation between BMI and the incidence of SCFE, utilizing the Center for Disease Control and Prevention BMI for age percentile growth charts. For those with slipped capital femoral epiphysis, 81.1% of the individuals had a BMI above the 95th percentile

Fractures

There have been reports of an increasing incidence of distal radial fractures and forearm fractures in children over the past few decades. This increase has occurred at the same time as the increase in obesity and could be related to changing patterns of physical activity, decreased bone acquisition due to poor calcium and vitamin D intake, or other factors [38]. Complications of treating fractures, at least of the femur, have been reported to be higher in children with obesity. However, these

Vitamin D and mineral supplementation

The role of vitamin D and mineral supplementation in a healthy diet to maximize bone health is also not clear in children, as it requires further areas of emphasis and research, and is beyond the scope of this review. This obviously has long-termimplications not only for musculoskeletal health, but also for many other potential medical conditions. For example, very low levels of vitamin D increased the likelihood of Blount disease 7.33 times, but did not increase the likelihood of slipped

Summary and conclusions

The impact of obesity (typically defined as a body mass index over the 95th percentile matched for age and sex) in children, as it relates to metabolic diseases such as diabetes and heart disease, cannot be emphasized enough. Unfortunately, limited literature exists examining the associated musculoskeletal problems. However, clinicians are recognizing that obese children and adolescents are presenting with significant musculoskeletal abnormalities, especially pain and developmental issues of

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