Bones, Joints, and Pediatric Obesity

We’ve recently discussed Slipped Capital Femoral Epiphysis, or SCFE, which is highly correlated with high Body Mass Index, or BMI. The concept was clearly described by Reuters journalist Lisa Rapaport:

Children and teens are considered obese when their body mass index (BMI) is higher than 95 percent of other youth their same age and sex. They’re considered severely obese when their BMI is higher than 99 percent of other kids.

Many obesity-related health problems don’t show up for a while. They develop in sinister anonymity until the affected person graduates from childhood or even becomes an adult. SCFE, however, is not like that. It shows up in progressively younger kids, and, really it isn’t very mysterious. As Dr. Pretlow says, it’s “simply excessive weight on growing bones.”

But a simple cause can bring on devastating results, like big-time surgery with all the concomitant suffering and risks (plus expense), and maybe even intractable disability throughout the remainder of a person’s life.

The science of treating SCFE is described as “emergent,” which means that nobody quite knows what they are doing. What they want to do is stabilize the epiphysis. The current preferred treatments are described by a study guide for doctors:

The gold standard treatment of SCFE remains in situ screw fixation (especially for mild to moderate slips), although some centers have adopted more aggressive approaches (closed manipulation or mini-open reduction before fixation or the modified Dunn procedure) that improve capital alignment so as to minimize potential damage to the articular cartilage and labrum due to a non-concentric joint.

There is also pinning, a preventative measure that is appropriate in some cases. A person can wind up with legs of different lengths, which only exacerbates any other bone and joint problems. Often, the grim specter of a total hip replacement enters the picture.

All these invasive procedures might be superseded by something fancy, like stem cell therapy. But the new thing will be even more un-obtainably expensive, so most kids will still be stuck with surgery as their only hope. Obesity very much seems to be an addictive process — whether the addictor is the food itself, or the process of feeding — and the need to end it becomes more urgently apparent every day.

Journalist Christina Hall Nettles captured a quotation from Dr. Wendy Pomerantz, whose specialty is pediatric emergency medicine:

The most common lower body injuries were sprains. Because obese patients have an increased body mass and force, they are more likely to twist or roll on a lower extremity and cause injury than non-obese children… In addition, obese people may have poor balance, which may result in more injuries.

Overweight kids sustain more bone and joint injuries in the lower body than the upper body. That is a definite clue suggesting that the total weight impacting on a bone or joint has something to do with the likelihood of injury. Nettles also quotes podiatrist Robert A. Weil, whose expertise is in sports medicine:

Underlying the complex medical and mechanical diagnoses in overweight children is the simple truth that the extra weight in obesity aggravates every joint… Any running or jumping activities will have negative biomechanical effects on all foot, ankle, and knee areas—compounded by excess weight.

And it gets worse, as Nettles explains, based on a study that spotlighted the link between increased BMI and long-term morbidity resulting from ankle injuries:

Six weeks after an ankle injury obese children […] demonstrated more persistent pain, swelling, or weakness and had a higher risk of re-injury… Six months post-injury 46% of the obese children had persistent symptoms, compared with 29% of children with lower BMI.

As we know, exercise is essential for weight loss and for about 50 other reasons. So there’s that, and there are a bunch of morbidly obese kids with body parts that could be further damaged by exercise. Those two conditions seem irreconcilable. But maybe not.

Swimming is good or, for people who can’t manage even that much, water exercise sessions. Dr. Weil recommends pull-ups:

If we can encourage children to develop their upper body strength with a goal of doing a single pull up, their fitness and their confidence will soar as “wear and tear” and stress on their feet, legs, and back decrease.

Your responses and feedback are welcome!

Source: “SCFE (Slipped Capital Femoral Epiphysis),” POSNA.org, 08/06/18
Source: “Pediatric obesity weighs on growing bones, joints,” LerMagazine.com, July 2012
Image by https://visualhunt.com/f2/photo/4433001334/1869640682/
Photo credit: Mark Doliner via Flickr

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

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:

Presentations

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.

Food & Health Resources