Pediatric Obesity Can Lead to Adult Orthopedic Problems

MADISON — Overweight child today, orthopedic patient in twenty years.

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 things - like knee and hip replacements - when those children reach adulthood.

"What we're seeing now is that obesity is so widespread, it affects almost every aspect of what we do," says James McCarthy, MD, a UW Health pediatric orthopedic surgeon.

The pediatric obesity epidemic in the United States has already been implicated in a long list of serious health conditions - diseases like hypertension, sleep apnea, diabetes and kidney stones are beginning to show up decades earlier than they otherwise might. Now orthopedic issues could be the latest addition.

"Let's put it this way: a child doesn't develop serious arthritis at age 6, but obesity at a younger age is likely to trigger it when that patient is 30 or 40," says Dr. 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.

Pediatric 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.

Blaise Nemeth, MD, a pediatric orthopedist who works with UW Health's Pediatric Fitness Clinic, 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 can't exercise regularly, which in turn can lead to a sedentary lifestyle and more weight gain. Weight issues also make these children more susceptible to bone breaks and 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,'" says Dr. Nemeth. "If it hurts them to move around and exercise, they're not going to do it."

In the Pediatric Fitness Clinic, Dr. Nemeth helps kids who are battling weight problems 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, Dr. Nemeth, who also sees patients at American Family Children's Hospital, 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."

Dr. McCarthy agrees. "The seeds of these orthopedic problems are planted when they are children. If we don't find a way to intervene, the fruit is going to be borne when they're adults."