CHILDHOOD OBESITY AND ORTHOPEDIC PROBLEMS

Orthopedic surgeons have seen a steady increase in certain musculoskeletal problems in youth over the last couple of decades paralleling the crisis of overweight and obesity in America. Most people are aware of the increase in obesity in adults. Current estimates indicate that 65% of American adults are overweight and 30% obese. Unfortunately, this has spilled over into our youth with over 30% of children and adolescents overweight and over 15% obese now. This prevalence of obesity in boys and girls has quadrupled over the past 25 years.

Certain orthopedic problems are included in the multiple adverse health effects seen with overweight youth. Bone cartilage in a child is not strong enough to bear the extra weight. 30 to 50% of kids with certain painful hip conditions (such as slipped capital femoral epiphyses) are overweight. In younger children, excess weight can lead to bowing and overgrowth of leg bones (Blount's disease, etc). Both of these above conditions can lead to lifelong problems and often require surgery. A recent study showed that overweight children who have had ankle injuries were more likely to have persistent ankle pain seen months later. Overweight youth tend to become overweight adults and with this comes significant increased risk of osteoarthritis/degenerative joint disease in the lower extremities and particularly the knees and hips. This has led to the trend for increasing numbers of steadily younger patients requiring knee joint replacement in recent years. Overweight youth also often find it difficult to participate in normal physical activities. They have relatively poor strength to weight ratios and sometimes trouble with heat illness, social stigma, etc. Unfortunately, then, the overweight youth may try to avoid physical activities, compounding the problem.

Non-orthopedic problems, of course, include increased risk of hypertension, diabetes, sleep apnea, various psychosocial problems and multiple other medical problems.

Overweight children need to be monitored by their family medical caregiver for the various medical problems including these orthopedic problems. They should be seen for appropriate workup if they have lower extremity pain or deformity. Unusual gait or difficulty running should not be attributed to the obesity alone.

Prevention and treatment for obesity in our youth, of course, begins with weight loss and weight control. The bottom line is an energy imbalance. There is simply too much food and too little activity which results in storage of the extra calories as fat. However, the problem is multifactorial and not simple to prevent and/or treat. Intervention typically requires a combination of improvement in diet as well as an increase in activity. Typical mistakes with diet include both overly large portions and poor food choices. Activity can include simple measures such as walking or riding a bike instead of riding in a car. Time in front of the TV and video games should be limited. It is important to enlist a family physician or other primary caregiver. They may recommend formal supervised programs, particularly for more severe cases.

Overweight/obesity in youth is a growing epidemic in America. It leads to significant health problems including multiple orthopedic issues. Prevention, intervention and adoption of a better healthier lifestyle with respect to food intake and exercise can both prevent and solve the problem.

David W. Shenton, MD