Advice about SCFE: Don’t Get It

In the realm of scientific studies, 600,000 is quite a large number for a cohort, or bunch of people with something in common; or as today’s entrepreneurs prefer to call such a group, a demographic. Thanks to Scotland’s routine collection of Body Mass Index measurements, via health screenings in schools, researchers have the opportunity to look at the medical records of more than half a million children. Given that kind of scrutiny, there is no telling what ugly trends might show up.

Not surprisingly, the study confirmed that kids who become obese tend to stay that way, which is an argument being used everywhere for the necessity of checking early and often for encroaching obesity. The children who qualified as obese at five years of age had a 75% chance of still being so at 12.

The study yielded all kinds of interesting statistics and correlations. For instance, it indicated, rather shockingly, that Slipped Capital Femoral Epiphysis (SCFE) affects one in every 1,300 individuals in their childhood or teen years — quite an impressive toll for a disease that practically no one has ever heard of.

So, what is SCFE?

The physis is the bone’s growth plate, and when it is messed up, it changes the shape of the hip and causes bone impingement. The round end at the top of the thighbone can slip backward. Two biological explanations are advanced for the disease, of which one or both may be in play. Obesity apparently lowers the age of puberty and advances skeletal maturation, which could be a factor; and, more obviously, mechanical load has a role too. Obesity has long been the prime suspect, but this study is said to bring the first substantial proof.

Socioeconomic deprivation has been suggested as a risk factor for SCFE, but poverty and obesity are so closely intertwined that causality is easily confused with coexistence. We do know, now, that SCFE is being diagnosed at younger ages — as the report says, “The reduced age at onset in children with obesity is a novel finding.”

Historically, figuring out what is going on has been difficult. When the hip is damaged, the pain caused there is often referred to the thigh or knee, which makes the clinician’s job harder. Obviously, earlier diagnosis is a desirable goal.

A non-trivial situation

Even better is avoidance, because this is something of which a person does not want even a mild case. A description of “Childhood Obesity and Slipped Capital Femoral Epiphysis” (published by Pediatrics) includes an attention-getting quotation:

While children with SCFE identified early typically only need relatively simple surgery, the authors said, SCFE is one of the most common reasons for hip replacement in young adults, and sometimes even children.

They seem to imply that, once this condition is diagnosed, surgery is the immediate go-to solution. Not nutrition, or exercise, or antibiotics, or acupuncture, or any of a thousand other healing arts. Straight to the scalpel.

The worst-case scenario is complete collapse of a hip, along with the strong probability of lifelong disability, and yes, it hurts a lot. The report says:

Most crucially, children with severe obesity at 5 years old, had almost 20 times the subsequent risk of developing SCFE than a lower weight child… The temporal relationship, dose response, and magnitude of the association build on the existing biological plausibility and findings in previous lower-quality studies to offer the strongest possible support for a causal relationship between childhood obesity and SCFE.

Two things are clear: Although normal-weight kids can come down with this condition, it is much more likely to occur in the overweight and obese. It appears that if a child can make it past six years with BMI scores in the lowest range, the lifetime risk of SCFE is “almost negligible.”

Your responses and feedback are welcome!

Source: “Study Shows Childhood Obesity the Major Risk Factor for Serious Hip Disease,”, 10/22/18
Source: “Childhood Obesity and Slipped Capital Femoral Epiphysis,”, October 2018
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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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