Obesity in Pediatric Orthopaedics
Obesity in Pediatric Orthopaedics
The rates of childhood obesity have risen sharply over the past several decades. A variety of factors have contributed to this, including increased caloric intake, decreased activity levels, and possibly genetic contributions. Current trends as well as stateby- state report cards are reported on the child health data website. Health consequences previously uncommonly seen in children are becoming increasingly prevalent, including hypertension, hyperlipidemia, diabetes, metabolic syndrome, and obstructive sleep apnea. Additionally, obese children and adolescents are likely to have poorer health status as adults. A small ray of hope has appeared in that the CDC has reported a 1% decline in early childhood obesity in 19 states (http://www.cdc.gov/vitalsigns/ChildhoodObesity/index.html).
With respect to general musculoskeletal function, obese children and adolescents report more frequent and more severe musculoskeletal pain. Perhaps surprisingly, in a cohort study of children who had been followed since the prenatal care provided to their mothers, obesity also was associated with an increase in joint hypermobility (using the Beighton score). Hypermobility was found to increase the risk of musculoskeletal pain, particularly in the knee and shoulder. The causes for increasedmusculoskeletal pain are not clear, but obesity has been demonstrated to alter gait patterns and mechanics, and certainly increased weight increases joint reactive forces. Obese patients take wider, slower steps and tend to select slower walking speeds. They have increased trunk sway with postural testing. Differences become more pronounced when tasks are complicated by adding load. Some of these gait alterations may be resolved by weight loss. In an interesting study of gait parameters in adults before and after weight loss from bariatric surgery, decreases in hip and knee moments and step width were seen after weight loss. This represents a reversal of some of the findings of the ''fat thigh'' gait pattern. Another adult study demonstrated decrease in reported joint pain, improvement in Short Form (SF)-36 physical function, and improvement in gait speed 3mo after bariatric surgery. Bariatric surgery rates have been increasing in adolescent patients, and improvement in health-related quality of life by SF-36 has been reported. No data on changes in gait parameters in obese children or adolescents with extensive weight loss were found. It is reasonable to speculate, however, that adolescents may experience similar improvements in gait parameters after dramatic weight loss.
Obesity Rates and Health Status
The rates of childhood obesity have risen sharply over the past several decades. A variety of factors have contributed to this, including increased caloric intake, decreased activity levels, and possibly genetic contributions. Current trends as well as stateby- state report cards are reported on the child health data website. Health consequences previously uncommonly seen in children are becoming increasingly prevalent, including hypertension, hyperlipidemia, diabetes, metabolic syndrome, and obstructive sleep apnea. Additionally, obese children and adolescents are likely to have poorer health status as adults. A small ray of hope has appeared in that the CDC has reported a 1% decline in early childhood obesity in 19 states (http://www.cdc.gov/vitalsigns/ChildhoodObesity/index.html).
With respect to general musculoskeletal function, obese children and adolescents report more frequent and more severe musculoskeletal pain. Perhaps surprisingly, in a cohort study of children who had been followed since the prenatal care provided to their mothers, obesity also was associated with an increase in joint hypermobility (using the Beighton score). Hypermobility was found to increase the risk of musculoskeletal pain, particularly in the knee and shoulder. The causes for increasedmusculoskeletal pain are not clear, but obesity has been demonstrated to alter gait patterns and mechanics, and certainly increased weight increases joint reactive forces. Obese patients take wider, slower steps and tend to select slower walking speeds. They have increased trunk sway with postural testing. Differences become more pronounced when tasks are complicated by adding load. Some of these gait alterations may be resolved by weight loss. In an interesting study of gait parameters in adults before and after weight loss from bariatric surgery, decreases in hip and knee moments and step width were seen after weight loss. This represents a reversal of some of the findings of the ''fat thigh'' gait pattern. Another adult study demonstrated decrease in reported joint pain, improvement in Short Form (SF)-36 physical function, and improvement in gait speed 3mo after bariatric surgery. Bariatric surgery rates have been increasing in adolescent patients, and improvement in health-related quality of life by SF-36 has been reported. No data on changes in gait parameters in obese children or adolescents with extensive weight loss were found. It is reasonable to speculate, however, that adolescents may experience similar improvements in gait parameters after dramatic weight loss.