The impact of childhood obesity on musculoskeletal form

State of the art in biobehavioral approaches to the management of chronic pain in childhood

Chronic pain in childhood is prevalent, persistent and significantly impactful on most domains of life. The chronic pain experience occurs within a complex biopsychosocial framework, with particular emphasis on the social context. Currently, psychological treatments involve a cognitive-behavioral therapy treatment plan, providing some combination of psychoeducation, self-regulation training, maladaptive cognition identification, behavioral exposure and parent involvement. New treatment areas are emerging, such as group- and internet-based cognitive-behavioral therapy, motivational interviewing, comorbid obesity intervention and intensive multidisciplinary rehabilitation. Preliminary studies of emerging treatments demonstrate encouraging results; however, treatment effectiveness hinges on accurate matching of patient to treatment modality. Overall, the current direction of the field promises many innovative breakthroughs to ameliorate suffering in youth with chronic pain.

Long-term athletic development- part 1: a pathway for all youth

The concept of developing talent and athleticism in youth is the goal of many coaches and sports systems. Consequently, an increasing number of sporting organizations have adopted long-term athletic development models in an attempt to provide a structured approach to the training of youth. It is clear that maximizing sporting talent is an important goal of long-term athletic development models. However, ensuring that youth of all ages and abilities are provided with a strategic plan for the development of their health and physical fitness is also important to maximize physical activity participation rates, reduce the risk of sport- and activity-related injury, and to ensure long-term health and well-being. Critical reviews of independent models of long-term athletic development are already present within the literature; however, to the best of our knowledge, a comprehensive examination and review of the most prominent models does not exist. Additionally, considerations of modern day issues that may impact on the success of any long-term athletic development model are lacking, as are proposed solutions to address such issues. Therefore, within this 2-part commentary, Part 1 provides a critical review of existing models of practice for long-term athletic development and introduces a composite youth development model that includes the integration of talent, psychosocial and physical development across maturation. Part 2 identifies limiting factors that may restrict the success of such models and offers potential solutions.

The association between arthritis and depression is intensified by excessive body weight: Findings from a US national survey, 2005-2012

OBJECTIVE

Obesity and arthritis are leading chronic conditions, but comorbidity of these conditions and their interaction leading to depression have not been fully investigated. The purpose of this study is to determine the degree to which excess body weight effect-modifies the relationship between arthritis and depressive symptoms.

METHODS

We used the data of 8677 men and 8820 women aged 20 or older, who completed a depression screening and general medical condition interview as a part of the National Health and Nutrition Examination Survey, 2005-2012. Depression was ascertained using the Patient Health Questionnaire-9 (PHQ-9); a PHQ-9 score of 15 or higher was defined as indicative of depression.

RESULTS

Arthritis was reported in 26.5% (SE=0.9) of men and 36.9% (SE=1.4) of women. The association between depression and arthritis was not significant among healthy weight women, but significant among overweight and obese women. The prevalence ratios (PRs) of depression among arthritis-free women were 1.00 (reference) for healthy weight, 1.43 (0.85-2.42) for overweight, and 1.99 (1.23-3.23) for obese women. For women with arthritis, the PRs were 1.16 (0.63-2.12) for healthy weight, 3.80 (2.24-6.45) for overweight and 3.73 (2.30-6.05) for obese women. The intensifying effect from excessive body weight on the association between arthritis and depression was less salient among men than women.

CONCLUSIONS

The association between arthritis and depression is intensified significantly by increased body weight, in particular, among women.

The relationship between excess body weight and the risk of death from unnatural causes

OBJECTIVE

The purpose is to exam whether excess body weight is associated with an increased risk of death from unnatural causes, particularly, injury.

METHOD

We analyzed nationally representative data of 14,453 adults (19 and older) who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and were followed up with vital statuses through December 31, 2006. We used Cox proportional hazard regression to estimate the hazard ratio (HR) of death from all unnatural causes combined and specific ones. Gray's test was performed to assess the equality of cumulative incidence functions between body mass index (BMI) levels.

RESULTS

A total of 128 unnatural deaths were recorded during an 18-year follow-up with 193,019 person-years accumulated. Compared with healthy weight participants, a person with excess body weight had a low hazard of death from unnatural causes [HR=1.00 (reference), 0.58 (0.39-0.87), and 0.50 (0.30-0.82) for healthy weight, overweight and obese participants, respectively]. Injuries, including motor vehicle accidents and falls, were the major types of unnatural deaths (n=91, 71% of all unnatural deaths), and the risk of death from injuries was linearly and reversely associated with BMI. The HRs of injury were 1.00 (reference), 0.57 (0.36-0.91), and 0.36 (0.19-0.69) for healthy weight, overweight and obese participants, respectively. All these estimates were obtained after adjustment of socio-demographic variables.

DISCUSSION

Excess body weight appears to be associated with a low risk of death from unnatural causes, particularly, injuries. Additional investigations on the mechanism underlying the relationship between BMI and unnatural deaths are warranted.

Effects of weight management program on postural stability and neuromuscular function among obese children: study protocol for a randomized controlled trial

Background

Childhood obesity is one of the most critical public health problems in the world. It is associated with low neuromuscular function and postural deformities. Whether weight loss can improve postural stability and neuromuscular control, benefit daily activities, or prevent injury is unknown. Therefore, this study attempts to investigate the effect of a 6 month weight management program on postural stability and neuromuscular control among obese children.

Methods/design

We will conduct a prospective, single-blind, randomized controlled trial with 120 prepubescent obese children. Participants will be randomly assigned to a weight management group or a control group. The weight management group will participate in a dietary and exercise program. The control group will receive health education. After the intervention, participants will be followed for 6 months with no active intervention. The primary and secondary outcomes will be assessed at the baseline, and after 6 months and 12 months. Primary outcome measures will include body weight, body height, body mass index, waist circumference, hip circumference, and body fat percentage. Secondary outcome measures will include three-dimensional functional biomechanics in different tasks, proprioception tests of the knee and ankle, neuromuscular response of the leg muscles, and muscle strength tests of the knee and ankle. Furthermore, adverse events will be recorded and analyzed. An intention-to-treat analysis will be performed if any participants withdraw from the trial.

Discussion

The important features of this trial include the randomization procedures and large sample size. This study attempts to estimate the effect of weight loss intervention on outcomes, including daily life function, postural stability, and neuromuscular control in prepubescent obese children. Therefore, our results can be useful for obese children, medical staff, and healthcare decision makers.

Trial registration

Chinese Clinical Trial Registry ChiCTR-IOB-15005874.

Measurement of pain and anthropometric parameters in women with chronic pelvic pain

RATIONALE, AIMS AND OBJECTIVES

To analyse anthropometric parameters, clinical pain and experimental pain in women with chronic pelvic pain (CPP).

METHODS

Ninety-one women with a clinical diagnosis of CPP, mean age of 40.03 ± 9.97 years, submitted to anthropometric evaluation based on body mass index (BMI) and percent body fat (%BF) using bioimpedance body composition monitor; pain intensity was determined by visual analogue scale (VAS), numerical categorical scale (NCS) and McGill Pain Questionnaire; experimental pain was determined by transcutaneous electrical nerve stimulation (TENS), and anxiety and depression symptoms were determined by the Hospital Anxiety and Depression scale.

RESULTS

A total of 54.8% of the women showed %BF >32 risk of disease associated with obesity. Regarding the anthropometric data, a statistically significant difference was observed between groups for both BMI and %BF (P<0.0001). In the analysis of pain intensity by the VAS, NCS and total McGill, there was no significant difference between the groups, and experimental pain by TENS revealed significant difference only between the normal weight and overweight groups (P=0.0154). The results of anxiety symptoms were above the cut-off point in all groups, with no significant difference between them (P=0.3710). The depression symptoms were below the cut-off point in the normal weight group and above the cut-off point in the overweight and obese groups, 9.469(4.501) and 9.741(4.848), respectively, with no significant difference between them (P=0.6476).

CONCLUSION

Evaluation of anthropometric parameters and pain measurements can be applied in clinical practice, making a contribution to the diagnosis and influencing the choice of a more effective treatment for women with CPP.

Reliability of Common Lower Extremity Biomechanical Measures of Children With and Without Obesity

PURPOSE

To determine intrarater and interrater reliability of common measures of lower extremity alignment among children with obesity.

METHODS

The Craig test for femoral anteversion, tibiofemoral angle, Foot Posture Index-6, and sit-and-reach test were performed on 25 children without obesity and 25 children with obesity.

RESULTS

Intrarater reliability of all measures in both groups was high. The Craig test demonstrated greatest variability with slight interrater reliability in children who were nonobese [intraclass correlation coefficient [ICC] (95% confidence interval [CI]), 0.372 (-0.051 to 0.6420)] and moderate reliability in children who were obese [ICC (95% CI), 0.527 (0.242 to 0.717)]. Interrater reliability for the tibiofemoral angle and Foot Posture Index-6 was moderate to substantial and for the sit-and-reach test was substantial (ICC >0.99) and highly correlated. Measurement of lower extremity alignment among children with obesity was more reproducible than among children who were not obese.

CONCLUSIONS

Measures of lower extremity alignment and general flexibility in children with obesity are both reproducible and reliable.

Posture and musculoskeletal pain in eutrophic, overweighed, and obese students. A cross-sectional study

Childhood obesity increases susceptibility to musculoskeletal injuries. The purpose of this study was to describe the prevalence of overweight and obesity and to identify differences in posture and musculoskeletal pain among eutrophic, overweight, and obese students. Participants were 420 students, 252 (60%) were females and 168 males (40%), with a mean age of 11.1 (±2.3) years. The posture of all participants was qualitatively assessed; the quantitative postural evaluation was performed using the Postural Assessment Software (PAS/SAPo) for a population subsample of 99 participants. An adapted version of the Nordic Musculoskeletal Questionnaire was used for pain assessment. Data were analyzed descriptively and via statistical tests (significance level of p<0.05). The target population exhibited 22.1% of overweight individuals and 14.1% of obese. Compared to the eutrophic students, the postural evaluation showed a higher knee valgus angle, higher incidence of thoracic kyphosis, and greater prevalence of lumbar hyperlordosis in overweight and obese students (p≤0.05). No association between overweight and pain complaints was detected (p=0.994).

Alterations in the plantar pressure patterns of overweight and obese schoolchildren due to backpack carriage

BACKGROUND

Among other adverse consequences, childhood obesity is known to influence foot structure and functionality. Yet little information is available regarding how the physiologic foot-ground interaction is altered when a localized load is carried, as occurs in the case of schoolbags. We investigated plantar contact area and pressure modifications induced by backpack carriage under actual conditions. We hypothesized that a localized load acting on the body would further increase the already excessive plantar pressure that exists with overweight and obese status.

METHODS

Seventy overweight and obese schoolchildren aged 6 to 11 years underwent two 30-sec trials on a pressure platform during a regular school day, with and without a backpack. Total and subregion contact areas along with peak plantar pressures were obtained, and results were compared with those of an equal-numbered group of normal-weight schoolchildren.

RESULTS

Overweight and obese children generally had larger contact areas and higher peak plantar pressures compared with their normal-weight peers. In overweight and normal-weight participants, the backpack induced a similar generalized increase in contact area and pressures. However, the largest changes were observed in the forefoot, suggesting that load action tends to modify the physiologic pressure patterns.

CONCLUSIONS

Backpack carriage raises the already elevated peak plantar pressures in overweight children during upright stance and modifies the physiologic pressure patterns. Further investigations are needed to clarify the features of such phenomenon when dynamic activities are performed and to verify the existence of fatigue and overexertion on the foot as well as other possible negative long-term effects.

Is overweight a risk factor for sports injuries in children, adolescents, and young adults?

Physical activity and sports participation are promoted to counteract the increased prevalence of overweight and obesity in children and young adults. Both high body mass index and physical activity level have been associated with an increased risk of sports injuries. The objective is to determine the relationship between sports injuries and overweight in sports participants (4-24 years), taking physical activity into account. Data were obtained from the 2006-2011 "Injuries and Physical Activity in the Netherlands" survey. Analyses were based on a representative sample of 3846 sports participants (4-24 years). Univariate and multiple logistic regression analyses were applied to investigate the association between sports injury and weight status. Of all the sports participants, 14.7% were overweight. Compared with normal-weight sports participants, the odds of sustaining a sports injury was 0.73 [confidence interval (CI): 0.53-1.00, P = 0.050] for overweight sports participants; the odds for underweight sports participants was 0.80 (CI: 0.56-1.15, P = 0.226). There is some evidence that overweight sports participants (4-24 years) do not have an increased injury risk compared with normal-weight sports participants, even when the level of physical activity is taken into account. Additional research is recommended regarding overweight people who start to participate in a physically active lifestyle.

The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants

What is already known about this subject Samoan adults are recognized for their particularly high body mass index and prevalent obesity. While Polynesians are understudied, in other populations infancy is a critical period in the development of obesity. Breastfeeding has been shown to attenuate obesity risk. What this study adds Samoan infants show remarkably rapid gain in weight but not length in early infancy resulting in a prevalence of overweight and obesity far higher than has been previously reported elsewhere. Breastfeeding is associated with slower weight gain in infancy suggesting that its protective benefits for obesity risk are generalizable outside of European-derived populations.

BACKGROUND

Samoans are recognized for their particularly high body mass index and prevalent adult obesity but infants are understudied.

OBJECTIVE

To examine the prevalence of overweight and obesity and determine the contribution of feeding mode to obesogenic growth trajectories in American Samoan infants.

METHODS

Data were extracted from the well baby records of 795 (n = 417 male) Samoan infants aged 0-15 months. Mixed-effects growth models were used to produce individual weight and length curves. Further mixed-effects models were fitted with feeding mode (breastfed, formula- or mixed-fed) as a single observation at age 4 (±2) months. Weight and length values were converted to z-scores according to the Centers for Disease Control 2000 reference.

RESULTS

At 15 months, 23.3% of boys and 16.7% of girls were obese (weight-for-length > 95th percentile). Feeding mode had a significant effect on weight and length trajectories. Formula-fed infants gained weight and length faster than breastfed infants. Formula-fed boys were significantly more likely to be obese at 15 months (38.6%) than breastfed boys (23.4%), χ(2)  = 8.4, P < 0.01, odds ratio = 2.05, 95% confidence interval (1.04, 4.05).

CONCLUSION

Obesity in American Samoans is not confined to adults. Obesity prevention efforts should be targeted at early life and promotion of breastfeeding may be a suitable intervention target.

Effects of overweight and obese body mass on motor planning and motor skills during obstacle crossing in children

Little is known about how obesity relates to motor planning and skills during functional tasks. We collected 3-D kinematics and kinetics as normal weight (n=10) and overweight/obese (n=12) children walked on flat ground and as they crossed low, medium, and high obstacles. We investigated if motor planning and motor skill impairments were evident during obstacle crossing. Baseline conditions showed no group differences (all ps>.05). Increased toe clearance was found on low obstacles (p=.01) for the overweight/obese group and on high obstacles (p=.01) for the normal weight group. With the crossing leg, the overweight/obese group had larger hip abduction angles (p=.01) and medial ground reaction forces (p=.006) on high obstacles and high anterior ground reaction forces on low obstacles (p=.001). With the trailing leg, overweight/obese children had higher vertical ground reaction forces on high obstacles (p=.005) and higher knee angles (p=.01) and anterior acceleration in the center of mass (p=.01) on low obstacles. These findings suggest that differences in motor planning and skills in overweight/obese children may be more apparent during functional activities.

Metabolic cost, mechanical work, and efficiency during normal walking in obese and normal-weight children

PURPOSE

This study aimed to investigate the influence of childhood obesity on energetic cost during normal walking and to determine if obese children choose a walking strategy optimizing their gait pattern.

METHOD

Sixteen obese children with no functional abnormalities were matched by age and gender with 16 normal-weight children. All participants were asked to walk along a nearly circular track 30 m in length at a self-selected speed. Spatiotemporal data, kinematics, and ground reaction force were collected during walking using a three-dimensional motion analysis system. Metabolic cost was collected by a portable gas analyzer simultaneously.

RESULTS

The mechanical energy expenditure (MEE) was 72.7% higher in obese children than in normal-weight children. The net metabolic cost was 65.7% higher in obese children. No difference was found in the metabolic rate (J x kg(-1) x m(-1)), normalized MEE (J x kg(-1) x m(-1)) and mechanical efficiency between the obese and normal-weight groups. The obese children walked with a 0.15 m/s slower walking speed, 10.0% shorter cadence, and 30.9% longer double-support phase compared with normal-weight children. In addition, no differences were found in the mediolateral and vertical body center of mass displacement.

CONCLUSION

Body mass played a dominant role in the total metabolic and mechanical cost per stride. Obese children may adopt a walking strategy to avoid an increase in the metabolic cost and the mechanical work required to move their excess body mass.

Does relative body fat influence the Movement ABC-2 assessment in children with and without developmental coordination disorder?

Developmental coordination disorder (DCD) is a condition that results in an impairment of gross and/or fine motor coordination. Compromised motor coordination contributes to lower levels of physical activity, which is associated with elevated body fat. The impact of elevated body fat on motor coordination diagnostic assessments in children with DCD has not been established. The purpose of this study was to determine if relative body fat influences performance on the Movement Assessment Battery for Children, 2nd Edition (MABC-2) test items in children with and without DCD. A nested case-control, design was conducted within the Physical Health Activity Study Team longitudinal cohort study. The MABC-2 was used to assess motor coordination to categorize cases and matched controls. Relative body fat was assessed using whole body air displacement plethysmography. Relative body fat was negatively associated with the MABC-2 "balance" subcategory after adjusting for physical activity and DCD status. Relative body fat did not influence the subcategories of "manual dexterity" or "aiming and catching". Item analysis of the three balance tasks indicated that relative body fat significantly influences both "2-board balance" and "zig-zag hopping", but not "walking heel-toe backwards". Children with higher levels of relative body fat do not perform as well on the MABC-2, regardless of whether the have DCD or not. Dynamic balance test items are most negatively influenced by body fat. Health practitioners and researchers should be aware that body fat can influence results when interpreting MABC-2 test scores.

Association between childhood obesity, cognitive development, physical fitness and social-emotional wellbeing in a transitional economy

BACKGROUND

It has been suggested that obese children have lower cognitive function, demonstrate poorer physical performance and are more susceptible to social-emotional problems.

AIMS

To describe associations between human physical growth, cognitive development, physical fitness and social-emotional characteristics of obese and non-obese children and to verify the predictors of intellectual coefficient by socioeconomic status (SES).

SUBJECTS AND METHODS

A sample of 107 non-obese (N-Ob) children [-1 z-score body mass index (BMI) ≤1 z-score] and 108 obese (Ob) children [2 z-score ≤BMI ≤5 z-score] from a larger cohort was evaluated. Intellectual coefficient (IQ), social-emotional wellbeing (SEW), 6-minute walk test (6MWT) and SES (mid-low, low and very low) were assessed.

RESULTS

Ob children were taller, heavier and present more height for age and BMI than N-Ob children (p < 0.001). A significant correlation between IQ and SEW (r = 0.14), 6MWT and BMI z-score (r = -0.18) and 6MWT and SEW (r = 0.15) was found. Multiple regression analysis revealed that BMI z-score had a negative impact on IQ in the mid-low SES sub-group and that SEW had a positive effect on IQ in the very-low SES sub-group.

CONCLUSIONS

In Chilean pre-school children from low-income families cognitive ability varied according to SES.

Parents and pediatric weight management attrition: experiences and recommendations

BACKGROUND

One of the most frequently cited challenges faced by pediatric weight management programs/clinics is attrition, with many studies reporting rates greater than 50%. Few studies have evaluated parental perspectives on recommendations for weight-management treatment enhancement. The aim of this study was to elicit perspectives on areas for improvement, discussions with staff about discontinuation, and potentially modifiable aspects of attrition from parents who prematurely discontinued stage 3 pediatric weight management treatment.

METHODS

This study was performed as a semistructured interview as part of a telephone survey assessing reasons for attrition.

RESULTS

Interviews were performed with 147 parents of children who attended programs/clinics at 13 children's hospitals participating in the National Association of Children's Hospitals and Related Institutions (now Children's Hospital Association) FOCUS on a Fitter Future II collaborative. The majority of parents (65%) denied talking to staff about their decisions to stop coming. When describing what could have been done to retain families, parents most frequently discussed changing logistics (e.g., hours and locations). Parents described changes in logistics and components (i.e., nutrition education, exercise, and behavior education/support) when asked what would work best for their family for pediatric weight management.

CONCLUSIONS

Parental responses appeared to express frustration about flexibility with appointment times and treatment locations. The most frequently desired components were those traditionally offered by stage 3 pediatric weight management programs/clinics, and this may suggest a need for treatment delivery of these components to be more individualized. Additional discussion with families about their desire to discontinue treatment may provide a timely opportunity to address this need.

Musculoskeletal pain in overweight and obese children

This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain.

A comparative study of performance in simple and choice reaction time tasks between obese and healthy-weight children

This study investigated weight status related differences in executive functions and movement execution to determine whether or not childhood obesity is associated with impaired perceptual-motor function. Nineteen obese (OB) children (10 ♂ and 9 ♀, aged 6-12 years) and nineteen gender and age matched healthy-weight (HW) peers performed two computer-based reaction time tasks. For both the simple and four choice reaction time (SRT/CRT) task condition, absolute mean reaction time (RT) and movement time (MT) were determined and expressed as a percentage of total response time (RsT). During the SRT task, OB children were intrinsically slower than their HW peers as reflected by a significantly higher absolute RT, MT and RsT. In the CRT task, however, between-group differences were only present for RT and RsT, whereas absolute MT was comparable among OB and HW participants. As a result, the relative temporal structure of RsT significantly differed between BMI groups, with a greater RT percentage among the OB children. During the CRT condition, OB children probably await final decision-making with regard to the execution of their response movement, which then no longer needs to be adjusted. Our results therefore indicate the use of a more conservative strategy within the OB group, suggesting that childhood obesity is associated with impaired perceptual-motor function. Besides the widely accepted mechanical explanation, a better understanding of the mechanisms underlying OB children's motor incompetence is needed to set up appropriate interventions to tackle this deficit and indirectly address associated health-related problems.

Foot loading patterns in normal weight, overweight and obese children aged 7 to 11 years

Background

Childhood obesity is thought to predispose to structural foot changes and altered foot function. Little is currently understood about whether similar changes occur in overweight children. The aim of this study was determine foot loading characteristics in obese, overweight and normal weight children aged 7 to 11 years during level walking.

Methods

Dynamic plantar pressures were measured in 22 obese, 22 overweight and 56 normal weight children recruited from local primary and secondary schools in East London. Peak pressure, peak force, normalised peak force, pressure–time and force-time integrals were analysed at six regions of the plantar foot: lateral heel, medial heel, midfoot, 1st metatarsophalangeal joint, 2nd-5th metatarsophalangeal joint and hallux. A one-way ANOVA was used to test for significant differences in variables across the groups. Where differences existed Tukey post-hoc tests were used to ascertain the location of the difference.

Results

Children who were obese and overweight demonstrated significantly (p<0.05) higher peak pressures and peak forces as well as significantly higher force-time and pressure–time integrals under the midfoot and 2nd-5th metatarsal regions. After normalisation of peak force, similar trends existed where the obese and overweight children demonstrated significantly (p<0.05) greater loading at the midfoot and 2nd-5th metatarsals.

Conclusion

Findings from this study indicated that overweight children, as young as seven, displayed differences in foot loading during walking, when compared with normal weight children. These findings were consistent with loading patterns of children who were obese and suggest that early assessment and intervention may be required in overweight children to mitigate against the development of musculoskeletal complications associated with excessive body mass.

Implications of high-heeled shoes on body posture of adolescents

OBJECTIVE

To review studies regarding effects of high-heeled shoes on body posture of adolescents.

DATA SOURCES

The research was conducted in the Scopus, SciELO and PubMed databases between 1980 and 2011, searching for articles written in English and Portuguese with the following key-words: "posture", "center of gravity", and "high-heeled shoes". Among 55 retrieved articles, 20 were analyzed regarding posture of the spine and lower limbs, the center of gravity, and the effects of high-heeled shoes in the musculoskeletal system in adolescents.

DATA SYNTHESIS

Frequent use of high-heeled shoes leads to modification of the gravity center and body balance, which can lead to changes in the alignment of body segments. This has a negative impact on motor development of adolescents. In this phase, it is necessary to keep the posture in order to maintain the physiological growth and development of the musculoskeletal system.

CONCLUSIONS

High-heeled shoes in adolescents can lead to the development of postural disorders, among which stands out the forward head posture, lumbar hyperlordosis, pelvic anteversion, and knee valgus. The height and width of the heels are characteristics that exert most influence in the emergence of postural changes and body imbalance.

Influência do perfil nutricional e da atividade física na postura de crianças e adolescentes

O objetivo do estudo foi verificar o efeito do perfil nutricional e da atividade física na postura de crianças e adolescentes. Foram avaliados 60 indivíduos de ambos os sexos, com idade entre 5 e 14 anos. A postura foi avaliada por meio da fotogrametria. Para determinar o nível de atividade física foi utilizado o Questionário de Atividade Física para Crianças (PAQ-C). A classificação do perfil nutricional foi realizada por meio do Índice de Massa Corporal por idade e com relação ao sexo. Os resultados mostraram que a atividade física exerceu efeito sobre os ângulos assimetria do ombro (AO) e assimetria corporal (ACO) (p<0,05). O grupo ativo apresentou maior assimetria nos ângulos de AO e ACO comparado ao grupo sedentário (p<0,05). O perfil nutricional não influenciou nenhum ângulo postural (p>0,05). Também não houve efeito interativo entre os parâmetros avaliados sobre os ângulos posturais (p>0,05). É importante o desenvolvimento de ações preventivas e intervencionistas, como atividade física controlada e acompanhamento nutricional, no alinhamento postural de crianças e adolescentes em idade escolar.

Foot morphology in normal-weight, overweight, and obese schoolchildren

This study compared the foot morphology of Spanish schoolchildren based on their body mass index and age and analyzed whether body mass index affects the child's foot development at primary school. Cross-sectional study of 1,032 schoolchildren (497 boys and 535 girls), 6-12 years old. Height and weight were measured to calculate body mass index. Children were classified as obese, overweight, and normal-weight. Measurements of foot morphology were obtained with a three-dimensional feet digitizer in static standing. Significant differences were found between the feet of children with normal-weight and overweight (2.6 to 9.0 %) and among children with normal-weight and obese for all variables (3.9 to 17.3 %). Differences in width, ball height, and arch height (5.3 to 7.6 %) were only found among overweight and obese children. There were no changes in the foot morphology of children between 6 and 7 years and between 10 and 12 years. Obese children showed more gradual changes in the foot measurements. The average percentage increase by year in children with normal-weight and obese were similar (3.6 and 3.4 %, respectively); however, morphological measurements of the foot of overweight children increased at a faster rate (4.0 %).

CONCLUSION

Excess weight affects the foot structure of children. The differences between age groups seem to indicate that the feet of children with overweight and obesity follow a different growth pattern than that of normal-weight children. With these results, the shoe manufacturers can design shoes for children depending on their age and weight.

Consequences of pediatric obesity on the foot and ankle complex

BACKGROUND

Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and non-obese children.

METHODS

Twenty healthy children (ten obese and ten normal weight) were recruited for a cross-sectional research study. Anthropometric parameters were measured to evaluate active ankle dorsiflexion, arch height (arch height index, arch rigidity index ratio, and arch drop), foot alignment (resting calcaneal stance position and forefoot-rearfoot alignment in unloaded and loaded positions), and foot type (malleolar valgus index). Independent t tests determined significant differences between groups for all assessed parameters. Statistical significance was set at P < .0125.

RESULTS

Compared with non-obese participants, obese participants had significantly greater arch drop (mean ± SD: 5.10 ± 2.13 mm versus 2.90 ± 1.20 mm; P =.011) and a trend toward lower arch rigidity index ratios (mean ± SD: 0.92 ± 0.03 versus 0.95 ± 0.02; P = .013). In addition, obese participants had significantly less active ankle dorsiflexion at 90° of knee flexion versus non-obese participants (mean ± SD: 19.57 ± 5.17 versus 29.07 ± 3.06; P < .001). No significant differences existed between groups for any other anthropometric measurements.

CONCLUSIONS

The decreased active ankle dorsiflexion in the obese group can increase foot contact for a longer period of the stance phase of gait. Obese participants also presented with a more flexible foot when bearing weight.

Association between knee alignment, body mass index and physical fitness variables among students: a cross-sectional study

OBJECTIVE

To assess the association between malalignment of the knees (genu valgum) and variables of physical fitness among schoolchildren.

METHODS

We analyzed data collected between the years 2000 to 2009. The sample comprised 1,141 schoolchildren of both sexes aged 06 to 18 years. To participate in the research, the students must meet the following criteria: age between 6 and 18 years and a full assessment of physical fitness, including measurement of genu valgus in at least one of the semester assessments. Postural evaluation (valgus) was determined by the intermalleolar distance, in centimeter. Body Mass Index (BMI) determined through the growth curves of the World Health Organization. Physical fitness variables (strength of upper and lower limbs, agility, speed and flexibility), were taken according to CELAFISCS standardization.

RESULTS

Among male students it was found a prevalence of 23.2% obese, 44.4% overweight and 32.4% eutrophic. Among females, the values were: 30.9% obese, overweight 39.5% and 20.6% eutrophic. When analyzing the prevalence of valgus according to the BMI classifications it was, found a significant positive association in both sexes. Association was found between genu valgum and upper limbs strength only in crude analysis. The other variables, agility, speed and flexibility were not associated even when the analysis was adjusted.

CONCLUSION

there was a positive association between malalignment of the knees, body mass index and physical fitness among schoolchildren.

Effect of treatment for paediatric cancers on balance: what do we know? A review of the evidence

This review aims to explore the literature investigating balance outcomes in survivors of childhood cancer. A structured search of five databases resulted in 16 articles included in this review. Nearly all were classified as Level 4 evidence using the updated Oxford Centre for Evidence-Based Medicine Levels of Evidence. Balance abilities have been investigated solely in survivors of acute lymphoblastic leukaemia or central nervous system tumours. The literature tends to support the idea that survivors present with balance difficulties but the results need to be closely scrutinised. Several studies report results using the same experimental group, while other studies use balance outcome measures that have not had their psychometric properties assessed with this population. There are also few studies that evaluate dynamic balance abilities in survivors of paediatric cancers, which may be more influential on functional tasks. Furthermore, very few of the included studies investigate how the found balance deficits affect this population's daily lives, which would be necessary in order to determine if intervention should be geared towards this area. Directions for future research should also include multi-centred, clinically oriented trials to evaluate balance abilities in survivors of childhood cancers compared with healthy control subjects in order to strengthen the literature.

Body mass index and injury severity in adolescent males

Childhood obesity's relationship to injury severity has not been determined. This study examined the relationship between obesity and injury severity, differences in injury severity between weight groups, and injury predictors. The sample included 611 adolescent males treated for injury at a 10-day camping event in Virginia. Findings indicate a significant relationship between body mass index percentile and injury severity (r = .08, p = .04) and less injury severity in normal-weight adolescents, F(2, 608) = 5.27, p < .01. Predictors of injury severity were cause, place injury occurred and injury type, R(2) change = .07, F(5, 601) = 6.52, p < .01. Implications are that overweight/obese adolescents may have increased risk of serious injuries. Examining predictors may decrease incidence of injuries at future events.

The Association of Physical Fitness With Body Mass Index and Waist Circumference in Filipino Preadolescents

Aim. The objective of this study is are to examine the association of preadolescent obesity using body mass index (BMI) and waist circumference (WC) with health-related physical fitness components. Methods. Grades 4 to 6 students in 2 private schools in Manila were included in this study. Height, weight, WC, and BMI were obtained. Physical fitness field tests were sit-and-reach test, 1-minute sit-ups, standing broad jump, 40-m sprint, and 20-m shuttle run. Results. Obese subjects had poorer scores in the field tests except in the sit-and-reach test. BMI and WC were significantly negatively associated with all the physical fitness parameters, except for the 40-m sprint where positive correlation was observed, and in the sit-and-reach test where no correlation was seen. Conclusion. In the management of preadolescent overweight and obesity, exercise programs should therefore be designed toward enhancing these fitness parameters, while not sacrificing enjoyment and creativity.

Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children

The purpose of this observational study was to compare the mastery of 12 fundamental movement skills (FMS) and skill components between a treatment-seeking sample of overweight/obese children and a reference sample from the United States. Mastery of six locomotor and six object-control skills (24 components in each subdomain) were video-assessed by one assessor using the test of gross motor development-2 (TGMD-2). The 153 overweight/obese children (mean ± s.d. age = 8.3 ± 1.1 years, BMI z-score = 2.78 ± 0.69, 58% girls, 77% obese) were categorized into age groups (for the underhand roll and strike: 7-8 years and 9-10 years; all other FMS: 6-7 years and 8-10 years) and mastery prevalence rates were compared with representative US data (N = 876) using χ(2) analysis. For all 12 skills in all age groups, the prevalence of mastery was lower among overweight/obese children compared with the reference sample (all P < 0.05). This was consistent for 18 locomotor and upto 21 object-control skill components (all P < 0.05). Differences were largest for the run, slide, hop, dribble, and kick. Specific movement patterns that could be targeted for improvement include positioning of the body and feet, the control or release of an object at an optimal position, and better use of the arms to maintain effective force production during the performance of FMS. Physical activity programs designed for overweight and obese children may need to address deficiencies in FMS proficiency to foster the movement capabilities required for participation in health-enhancing physical activity.

Obesity and motor skills among 4 to 6-year-old children in the United States: nationally-representative surveys

BACKGROUND

Few population-based studies have assessed relationships between body weight and motor skills in young children. Our objective was to estimate the association between obesity and motor skills at 4 years and 5-6 years of age in the United States. We used repeated cross-sectional assessments of the national sample from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) of preschool 4-year-old children (2005-2006; n = 5 100) and 5-6-year-old kindergarteners (2006-2007; n = 4 700). Height, weight, and fine and gross motor skills were assessed objectively via direct standardized procedures. We used categorical and continuous measures of body weight status, including obesity (Body Mass Index (BMI) ≥ 95th percentile) and BMI z-scores. Multivariate logistic and linear models estimated the association between obesity and gross and fine motor skills in very young children adjusting for individual, social, and economic characteristics and parental involvement.

RESULTS

The prevalence of obesity was about 15%. The relationship between motor skills and obesity varied across types of skills. For hopping, obese boys and girls had significantly lower scores, 20% lower in obese preschoolers and 10% lower in obese kindergarteners than normal weight counterparts, p < 0.01. Obese girls could jump 1.6-1.7 inches shorter than normal weight peers (p < 0.01). Other gross motor skills and fine motor skills of young children were not consistently related to BMI z-scores and obesity.

CONCLUSIONS

Based on objective assessment of children's motor skills and body weight and a full adjustment for confounding covariates, we find no reduction in overall coordination and fine motor skills in obese young children. Motor skills are adversely associated with childhood obesity only for skills most directly related to body weight.

Does load carriage differentially alter postural sway in overweight vs. normal-weight schoolchildren?

Among a wide range of negative consequences stemming from excess mass in children, recent studies suggest an impairment of postural control, including basic capabilities such as static and dynamic balance. Such impairment may be compounded when additional tasks are performed, such as carrying localized loads as occurs among children using a backpack. To investigate this, postural control was measured among 77 overweight and obese children (6-11 years old), and an equal number of normal-weight children matched for gender, age, and height. Testing was conducted at school, in which center of pressure (COP) time series during quiet standing were obtained in the presence and absence of each student's backpack. A traditional postural control measure derived from COP (mean velocity) did not indicate significant differences between overweight and normal-weight children, regardless of backpack presence. In contrast, a complexity index (derived from multiscale entropy) suggested the existence of different postural strategies and reduced balance capabilities among overweight children, whose consequences need to be further clarified.

A pilot study to profile the lower limb musculoskeletal health in children with obesity

PURPOSE

: Evidence suggests a negative effect of obesity on musculoskeletal health in children. A pilot study was undertaken to investigate the presence of musculoskeletal impairments in children with obesity and to explore the relationships among body mass index, physical activity, and musculoskeletal measures.

METHODS

: Lower limb musculoskeletal health (pain, power, balance, flexibility, and range of motion), physical activity, and screen time were assessed using standardized methods.

RESULTS

: Seventeen children (mean age = 12.21 years) participated. Mean values for lower limb musculoskeletal measures are presented. Moderate negative correlations were found between body composition and range of motion, flexibility, and strength. Genu valgum deformity was moderately positively correlated to body mass index.

CONCLUSIONS

: The results of this pilot study suggest that children who are obese may present with musculoskeletal impairments of the lower limb. Clinicians working with children who are obese should conduct a thorough musculoskeletal assessment and consider the presence of impairments when promoting physical activity.

Body mass index and the risk of acute injury in adolescents

OBJECTIVE

To evaluate the relationship between body mass index (BMI) and acute injury in adolescents.

METHODS

An analysis of cross-sectional data from the Canadian Community Health Survey (CCHS) Cycle 3.1 collected by Statistics Canada in 2005 was conducted. The CCHS is a population-based survey that collects information pertaining to the Canadian population health status, health care use and health determinants. The CCHS Cycle 3.1 included 132,221 respondents, of whom 12,317 were 12 to 17 years of age. Multivariate logistic regression was used to estimate the odds of injury occurrence by BMI categories (obese, overweight and neither).

RESULTS

The association between overweight and obese BMI levels and injury occurrence in the bivariate model was not significant after adjusting for sex, health status, activity levels and socioeconomic status (OR=1.10 [95% CI 0.97 to 1.24] for overweight and OR=1.12 [95% CI 0.92 to 1.37] for obesity). A subanalysis of those with an injury in the past 12 months found an elevated odds of experiencing multiple injuries in the overweight group, after adjusting for age, health status and physical activity level (OR=1.43 [95% CI 1.16 to 1.77]).

CONCLUSION

An increased risk of acute injury in obese and overweight adolescents was not observed. However, the subgroup analysis suggested that multiple injuries are relatively frequent in the overweight BMI group.

Pregnancy-related pelvic pain is more frequent in women with increased body mass index

OBJECTIVE

To investigate the association between pre-pregnancy overweight/obesity and pregnancy-related pelvic pain.

DESIGN

Nested case-control study.

SETTING AND POPULATION

The Danish National Birth Cohort, a cohort of pregnant women and their children recruited 1996-2002.

METHODS

The women were interviewed twice during pregnancy and twice after childbirth. The first pregnancy interview provided information on self-reported pre-pregnancy body mass index (BMI) and possible confounders, while data on pregnancy-related pelvic pain came from an interview six months postpartum. Cases (n=2 271) were selected on the basis of self-reported pelvic pain, and controls were randomly selected among women who did not report pelvic pain (n=2 649). We used logistic regression analysis to calculate pregnancy-related pelvic pain odds ratios (OR (95% confidence intervals)) according to pre-pregnant BMI.

MAIN OUTCOME MEASURE

Self-reported pregnancy-related pelvic pain. Results. In the total cohort, 18.5% of all pregnant women reported pregnancy-related pelvic pain. In the nested case-control study, the adjusted ORs for overall pelvic pain were 0.9 (0.7-1.2) in underweight women, 1.2 (1.1-1.4) in overweight women, 1.5 (1.2-2.0) in obese women Class 1 (30≤BMI<35), and 1.9 (1.3-2.8) in obese women Class 2 + 3 (BMI≥35), all relative to normal weight women. The correspondent ORs for severe pelvic pain were 0.8 (0.6-1.2), 1.4 (1.2-1.7), 1.7 (1.3-2.2), and 2.3 (1.6-3.4). The associations were stronger among women who had not given birth before.

CONCLUSION

The risk of pregnancy-related pelvic pain increased with pre-pregnancy BMI in an exposure-response relation and potentially adds another maternal complication to obesity.

A systematic review of primary healthcare provider education and training using the Chronic Care Model for childhood obesity

The purpose of this systematic review was to examine 15 studies which evaluated interventions aimed at improving primary care providers' identification, assessment, prevention and/or management of obesity in children and adolescents. Interventions were evaluated in terms of length, components addressing nutrition, physical activity and behavioural counselling consistent with expert recommendations, and inclusion of components of the Chronic Care Model. Overall, training interventions were delivered face to face or in a combination of lecture, assigned readings, preceptorship with experienced providers, and critiqued evaluations of interactions of the provider with the patient and family. Many studies incorporated training of providers as an initial step prior to delivering an obesity intervention for children and adolescents measuring weight loss and behaviour change as outcomes. Each study was evaluated for components of the Chronic Care Model. The interventions most frequently utilized the elements of self-management support (69%), decision support (100%), delivery system support (77%) and clinical information systems (23%). Although science in this area is emerging, results suggest that intervention programmes that included more components of the Chronic Care Model were more effective.

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

Postural balance under normal and altered sensory conditions in normal-weight and overweight children

BACKGROUND

little or no research has been done in the overweight child on the relative contribution of multisensory information to maintain postural stability. Therefore, the purpose of this study was to investigate postural balance control under normal and experimentally altered sensory conditions in normal-weight versus overweight children.

METHODS

sixty children were stratified into a younger (7-9yr) and an older age group (10-12yr). Participants were also classified as normal-weight (n=22) or overweight (n=38), according to the international BMI cut-off points for children. Postural stability was assessed during quiet bilateral stance in four sensory conditions (eyes open or closed, normal or reduced plantar sensation), using a Kistler force plate to quantify COP dynamics. Coefficients of variation were calculated as well to describe intra-individual variability.

FINDINGS

removal of vision resulted in systematically higher amounts of postural sway, but no significant BMI group differences were demonstrated across sensory conditions. However, under normal conditions lower plantar cutaneous sensation was associated with higher COP velocities and maximal excursion of the COP in the medial-lateral direction for the overweight group. Regardless of condition, higher variability was shown in the overweight children within the 7-9yr old subgroup for postural sway velocity, and more specifically medial-lateral velocity.

INTERPRETATION

in spite of these subtle differences, results did not establish any clear underlying sensory organization impairments that may affect standing balance performance in overweight children compared to normal-weight peers. Consequently, it is believed that other factors account for overweight children's functional balance deficiencies.

Relação entre aptidão cardiorrespiratória e indicadores de adiposidade corporal em adolescentes

OBJETIVO: Analisar a relação entre aptidão cardiorrespiratória e indicadores de adiposidade corporal em adolescentes de ambos os sexos. MÉTODOS: 78 sujeitos (45 rapazes e 33 moças) foram avaliados quanto à massa corporal, estatura e dobras cutâneas tricipital e subescapular. O índice de massa corpórea e a somatória das duas dobras cutâneas foram calculados. A aptidão cardiorrespiratória foi analisada pelo teste de vai-e-vem de 20 metros de vários estágios e a estimativa do consumo máximo de oxigênio foi analisada por uma equação específica. Para a comparação entre os grupos, foi empregado o teste de Mann-Whitney e, para verificar a relação entre a aptidão cardiorrespiratória e os indicadores de adiposidade corporal, utilizou-se o coeficiente de correlação de Spearman. RESULTADOS: Os adolescentes com alta aptidão cardiorrespiratória apresentaram sistematicamente valores mais baixos de gordura corporal em relação a seus pares com baixa aptidão cardiorrespiratória (p<0,05), com diferenças variando entre 36 e 42% para os rapazes e entre 14 e 33% para as moças. Correlações negativas, moderadas e estatisticamente significativas foram verificadas entre os indicadores de aptidão cardiorrespiratória e de adiposidade corporal para ambos os sexos, com exceção do índice de massa corpórea. CONCLUSÕES: Os resultados sugerem que o aumento da adiposidade corporal pode influenciar negativamente a aptidão cardiorrespiratória em adolescentes de ambos os sexos.