That’s the fear of a growing number of pediatricians and orthopedic surgeons, many of whom are concerned that the indirect effects of childhood obesity will develop into more direct, serious health problems – think knee and hip replacements – when those children reach young adulthood.
“What we’re seeing now is that obesity is so widespread, it affects almost every aspect of what we do,” said Dr. James McCarthy, a pediatric orthopedic surgeon and associate professor of orthopedics and rehabilitation at the University of Wisconsin (UW) School of Medicine and Public Health.
The childhood obesity epidemic in the United States has already been implicated in a long list of serious health conditions: hypertension, sleep apnea, diabetes and kidney stones are beginning to show up decades earlier than they otherwise might. Will orthopedic problems be next?
“Let’s put it this way: a child doesn’t develop serious arthritis at age six, but obesity at a younger age is likely to trigger it when that patient is 30 or 40,” says McCarthy. “A person with normal body weight might not experience it until they’re 70 or 80.”
Physicians have known for some time that being overweight sets up some children for slipped capital femoral epiphyses (SCFE), a condition in which weight displaces the ball of the hip joint, pushing it through the cartilage of the hip’s still-soft growth plate. Childhood obesity is the biggest cause of SCFE – in fact, more than 85 percent of U.S. kids with SCFE are overweight. SCFE can cause pain in the hips and knees now, and full-blown arthritis later.
Dr. Blaise Nemeth, an assistant professor of pediatrics at UW School of Medicine and Public Health, says he commonly sees overweight kids complaining of hip, back, knee and foot pain. That knee and foot pain is especially concerning, because it can create a dangerous spiral: Kids in pain cannot exercise regularly, which in turn can lead to a sedentary lifestyle and – you guessed it – more weight gain. Weight problems also make these children more susceptible to bone fractures.
“It’s a challenging issue, because, in my mind, these are not kids to whom you can just say, ‘Go out and exercise for 30-60 minutes,’ ” said Nemeth. “If it hurts them to move around and exercise, they’re not going to do it.”
Nemeth works with UW’s Pediatric Fitness Clinic, where he helps overweight youngsters manage things like pain and coordination difficulties that interfere with a regular exercise routine. Using tools like physical therapy and orthotics, as well as low-impact activities like swimming, yoga and stationary bicycling, Nemeth tries to build a fitness ethic by incorporating fun and family into the mix.
“If you can get fitness ingrained in kids as they’re developing, these can be habits that will stick with them the rest of their lives,” he says. “Being fit is not easy; it’s hard work.”
McCarthy agrees. “The seeds of these orthopedic problems are planted when they’re a child. If we don’t find a way to intervene, the fruit is going to be borne when they’re adults.”
