Orthopaedic surgeons must take a leadership role

Americans’ waistlines have been increasing over the past several decades. This increase in obesity is particularly concerning because it is also occurring in the pediatric population, with the most recent reports from the Centers for Disease Prevention and Control showing that 18 percent of American children are obese.

Obesity is associated with a variety of comorbidities, including pediatric orthopaedic complications that have a significant impact on patient care and health costs. As orthopaedic surgeons, we must not only recognize the impact of obesity on our pediatric patients, we also have an obligation to help in battling this epidemic.

Obesity and SCFE
Orthopaedic diseases commonly seen in obese children include Blount’s disease and slipped capital femoral epiphysis (SCFE). SCFE is the most common hip disorder of adolescents and has been strongly associated with obesity in several studies. Furthermore, studies have demonstrated that as the rates of childhood obesity have risen, so has the incidence of SCFE. Thus, evaluating the local incidence of SCFE can help identify trends of pediatric obesity.

The Vanderbilt Medical Center conducted such a review, examining patients with a diagnosis of SCFE who were seen over a 10-year period. Not surprisingly, of the nearly 200 patients treated, 92.6 percent were considered either at risk for obesity (between the 85th and 95th percentile of weight for age) or obese (95th percentile or higher). As demonstrated in Figures 1 and 2, the increase in the number of SCFE cases at Vanderbilt mirrored the increase in the overall incidence of childhood obesity nationwide.

The growing problem of childhood obesity has not gone unrecognized by the orthopaedic community. The AAOS has taken a leadership role in combating childhood obesity, including recently partnering with the American Academy of Pediatrics (AAP) to increase awareness of childhood obesity.

In a public service announcement, AAOS Past President E. Anthony Rankin, MD, stated that “incorporating physical activity and a healthy diet into a child’s daily routine certainly creates a strong musculoskeletal frame, which is a step in the right direction.” Dr. Rankin also noted that by educating both children and adults about changing their exercise and eating habits, children can live “stronger and healthier lives.”

The U.S. Bone and Joint Initiative has also taken a leadership role in advocating for healthier children by addressing the issue of childhood obesity and its impact on musculoskeletal health during its annual Bone and Joint National Action Week. Finally, the Pediatric Orthopaedic Society of North America (POSNA) has joined with the AAP to fight childhood obesity with a series of public awareness announcements and initiatives that advocate for activity and weightbearing exercises for children.

The orthopaedist’s role
Although national leadership is a vital component in reducing and preventing pediatric obesity, it is also critical that individual physicians participate in the battle against childhood obesity. Obesity is a multifactorial issue compounded by genetics, socioeconomic status, and limited access to healthy food options. Therefore, according to Benjamin Alman, MD, who spoke at the 2011 POSNA annual meeting, a multidisciplinary approach in treating obese patients must be taken. This includes helping patients and their parents find the appropriate dietary and activity programs that will facilitate weight loss. During clinic visits, orthopaedic surgeons must encourage both the patient and his or her parents to adopt healthier lifestyle habits.

Several excellent resources with information on childhood obesity are available. The AAP has an informative website for physicians and parents regarding prevention and treatment of childhood obesity (www.aap.org/obesity/index.html). The White House has also recognized the importance of fighting the childhood obesity epidemic. Its “Let’s Move” initiative (www.letsmove.gov) educates and informs parents, children, and community leaders about the problem and possible solutions. Individual physicians may find these resources helpful in curbing the obesity epidemic.

Without adequate intervention now, childhood obesity will become more of a burden on our healthcare system. Patient education from primary care pediatricians is not sufficient to curb this trend. Orthopaedic surgeons who treat these patients have a responsibility to help combat childhood obesity by both educating patients and advocating for services that will fight the obesity epidemic, address related healthcare costs, and improve patient care.

If we as orthopaedic surgeons take an active role now to combat childhood obesity, we can help stop this epidemic and ensure a healthier, fitter future for America.

For more information on issues surrounding the provision of orthopaedic care to obese children, see the roundtable discussion.

D. Jake McClure, BS; Tyler J. Armstrong, BS; Manish K. Sethi, MD; Gregory A Mencio, MD; William T. Obremskey, MD, MPH; Mallory Powell, BA; and A. Alex Jahangir, MD, are affiliated with the Vanderbilt University Center for Health Policy.