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Obesity counteracts bone growth in children and adolescents

By Dr. Atul N.C. Peters in Bariatric Surgery / Metabolic , Metabolic And Bariatric Surgery

Nov 16 , 2020 | 3 min read

Over the past several years, there has been an explosive increase in the number of children and adolescents who are being diagnosed as overweight and obese.

The main factor responsible for this is an overwhelming increase in the urban middle class who are more prone to fast foods and decreasing physical activity.

Beginning in the childhood, obesity can cause many health and social problems which increase throughout life few of which are type II diabetes, cardiovascular disease, pulmonary disease, metabolic syndrome, obstructive sleep apnea, low self-esteem and depression.

Increase in weight can also cause deficiencies of certain vitamins and minerals which affect bone growth and overall musculoskeletal growth leading to decrease in the quality of life.

Children and adolescents with a BMI greater than the 95th percentile are considered obese.

Obesity is the result of a combination of genetics, activity level, diet, and the environment. Overall there is more calories intake then expenditure.

The environmental factors that may contribute to excess weight in children and adolescents include:

  • Greater availability of less healthy foods and sugary drinks.
  • Advertising of less healthy foods (Burger Revolution).
  • Lack of daily, quality physical activity in schools.
  • No safe and appealing place, in many communities, to play or be active.
  • Limited access to healthy, affordable foods.
  • Increasing portion sizes.
  • Lack of breastfeeding support.
  • Greater exposure to television and media including TV, computers, video games, cell phones and movies.

Diseases and conditions that may cause, or contribute to, weight gain include hypothyroidism, Cushing's syndrome, Prader-Willi syndrome and Kleinefelter's syndrome.

Too much weight also can seriously impact the growth and health of bones, joints, and muscles.

Bones grow in size and strength during childhood. Excess weight can damage the growth plate — the area of developing cartilage tissue at the end of the body's arm, leg and other long bones. Too much weight places excess stress on the growth plate which can lead to early arthritis, a greater risk for broken bones, and other serious conditions, such as slipped capital femoral epiphysis and Blount's disease.

Slipped capital femoral epiphysis (SCFE) is an orthopaedic disorder of the adolescent hip. It occurs when the ball at the upper end (head) of the femur (thighbone) slips off in a backward direction due to weakness of the growth plate. The condition can cause weeks or months of hip or knee pain, and an intermittent limp. In severe cases, the adolescent may be unable to bear any weight on the affected leg.

Hormonal dysfunction associated with obesity may alter growth plate function in a way that can predispose a child's hip to slip. In addition, the extra weight also may increase the sheer forces across the proximal femoral growth plate contributing to the slip.

Blount's disease, or severe bowing of the legs, is another condition in which hormonal changes and increased stress on a growth plate, caused by excess weight, can lead to irregular growth and deformity. Progressive deformity, rather than knee discomfort, is the most common complaint.

Children diagnosed as obese or overweight may have a higher risk for fractures (broken bones) due to stress on the bones or because of weakened bones secondary to inactivity. In addition, these children may have more complications that can delay or alter treatment outcomes.

Children who are overweight or obese often have painful, flat feet that tire easily and prevent them from walking long distances.

Children diagnosed with obesity often have difficulties with their coordination, called developmental coordination disorder (DCD). The symptoms of DCD may include:

  • Clumsiness
  • Problems with gross motor coordination such as jumping, hopping or standing on one foot
  • Problems with visual or fine motor coordination, such as writing, using scissors, tying shoelaces or tapping one finger to another

In most children, a diet rich in calcium and other nutrients, along with regular, physical activity — at least 35 to 60 minutes a day-can help to minimize weight gain, while helping to build and maintain strong bones.