The impact of childhood obesity on bone, joint, and muscle health
This concludes the article by Dr Agbeko Ocloo. The first part was published last Friday.
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Slipped Capital Femoral Epiphysis
Slipped capital femoral epiphysis (SCFE) is an orthopaedic disorder of the adolescent hip. It occurs when the ball at the upper end (head) of the femur (thighbone) slips off in a backward direction due to weakness of the growth plate. The condition can cause weeks or months of hip or knee pain, and an intermittent limp. In severe cases, the adolescent may be unable to bear any weight on the affected leg.
(Courtesy of John Killian, MD, Birmingham, Alabama)
The condition is not rare, and often develops during periods of accelerated growth or shortly after the onset of puberty. Hormonal dysfunction associated with obesity may alter growth plate function in a way that can predispose a child's hip to slip. In addition, the extra weight also may increase the sheer forces across the proximal femoral growth plate contributing to the slip.
Treatment of SCFE usually begins within 24 to 48 hours of diagnosis and consists of stabilising the "slipped" growth plate with a screw to prevent further slippage.
In children diagnosed with obesity, it can be more challenging to appropriately position and secure the ball of the femur bone without complications.
Blount's Disease
An adolescent with Blount's disease. (Courtesy of Texas Scottish Rite Hospital for Children)
Blount's disease, or severe bowing of the legs, is another condition in which hormonal changes and increased stress on a growth plate, caused by excess weight, can lead to irregular growth and deformity. Progressive deformity, rather than knee discomfort, is the most common complaint.
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In younger children and less severe cases, a leg brace or orthotic may correct the problem. However, surgery, consisting of a tibial osteotomy, may be needed. In this procedure, a wedge of bone is removed from the outside of the tibia (shinbone) under the healthy side of the knee. When the surgeon closes the wedge, it straightens the leg.
Children diagnosed as overweight or obese have a higher risk of complications related to this procedure, including infection, delayed bone healing, failure of fixation, and recurrence of Blount's disease.
Fractures and Related Complications
Children diagnosed as obese or overweight may have a higher risk for fractures (broken bones) due to stress on the bones or because of weakened bones secondary to inactivity. In addition, these children may have more complications that can delay or alter treatment outcomes.
For example, traditional metal implants may not be sufficiently strong to repair broken or misaligned bones. In addition, crutches may be difficult to use for children who are obese or overweight, and cast immobilization may not sufficiently stabilize broken bones. As a result, surgery, in addition to casting, is often required.
Flat Feet
Children who are overweight or obese often have painful, flat feet that tire easily and prevent them from walking long distances. Many children with flat feet are treated with orthotics and stretching exercises focused on the Achilles tendon (heel cord).
Because weight loss is often enough to ease the pain of flat feet, low impact weight reduction exercises, such as swimming, may be recommended.
Impaired Mobility
Children diagnosed with obesity often have difficulties with their coordination, called developmental coordination disorder (DCD). The symptoms of DCD may include:
Clumsiness
Problems with gross motor coordination such as jumping, hopping or standing on one foot. Problems with visual or fine motor coordination, such as writing, using scissors, tying shoelaces or tapping one finger to another
Developmental coordination disorder may impair or limit a child's ability to exercise, potentially resulting in more weight gain. Physical and occupational therapy may improve DCD.
Anesthesia and Other Surgical/Treatment Complications
Children with obesity have a higher rate of anesthetic complications than normal-weight children. In addition, children diagnosed as overweight or obese are more likely to have diabetes, hypertension, sleep apnea, and other endocrine abnormalities that may affect surgical and other treatment, and ultimately, delay or impair bone healing and a return to normal function.
Preventing and treating weightgain in children and adolescents
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In a very small number of children with extremely high BMIs — 40 or above — bariatric surgery may be recommended to reduce weight and avoid long-term musculoskeletal and other related conditions and complications.
In most children, a diet rich in calcium and other nutrients, along with regular, physical activity — at least 35 to 60 minutes a day-can help to minimise weight gain, while helping to build and maintain strong bones.