Bone Up on
Childhood Obesity
As a parent, you know how important it is to promote a healthy weight for your children. Children who are obese can have a host of issues to deal with, including high blood pressure and cholesterol, increased risk of developing diabetes, breathing problems such as sleep apnea or asthma and a host of social and psychological problems.

But obesity can also negatively affect their
bone health too
Children continue to build bone mass until about the age of 20. Growth plates, located in the body’s long bones, continue to grow until girls are 12-14 years old, and boys are 15-16 years old. Up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, which makes youth the best time for you to make an impact on your child’s bone health.

Obesity and Bone
Risk Factors
Being obese is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Obesity is connected to an increased risk of a number of musculoskeletal issues.
  • Blount’s Disease. This severe bowing of the legs is due to hormonal changes brought on by obesity and the stress that is placed on the growth plates. That stress can lead to irregular bone growth and deformity. Blount’s Disease is a condition that develops over time and does not have pain associated with it. The treatment for Blount’s Disease is surgical. A wedge of bone is removed from the shinbone (tibia). When the wedge is closed, it straightens the leg. If a child remains obese, the condition can reoccur and additional surgery would be needed.
  • Developmental Condition Disorder (DCD). This is essentially impaired physical ability. An obese child will seem clumsy, have a hard time with gross motor skills such as jumping rope or standing on one foot, and fine motor skills such as using scissors or tying shoes. The corrective action for this, other than losing weight, is physical or occupational therapy.
  • Flat Feet. It is not uncommon for pregnant women to increase their shoe size by one-half size with each pregnancy. This is due to the hormonal changes which impact the bones, and the increased weight load being carried. Children suffer something similar when they are obese and their bones are still growing. The excess weight on growing bones can result in the development of flat feet, which is a lifelong condition, making it painful to walk long distances. The corrective action is orthotics (special shoes) and stretching exercises focused on the Achilles tendon (heel cord).
  • Fractures and Complications. Obese children are at an increased risk of breaking their bones. When the bones are broken, there is also a risk of complications. For example, when a bone breaks, a pin or screw may be needed to stabilize the bone as it heals. Crutches may be more difficult to use for a child who is significantly overweight and surgery to repair broken bones is more common. Healing of broken bones often takes longer too.
  • Increased Risk of Osteoporosis. Perhaps you know older adults who have osteoporosis. A “dowager’s hump” is one obvious indication of this condition. Osteoporosis causes bones to become weak and brittle. Children who are obese are more likely to develop osteoporosis and at a much younger age. Your child could feel (in his or her bones) as though they are 50 or 60 when they are only 30. Osteoporosis has been called a “childhood disease with geriatric consequences.”
  • Slipped Capital Femoral Epiphysis. Obesity can alter growth plate function in a way that can make it possible for a child’s hip to slip out of the socket. The signs that this is happening can be knee pain or hip pain, or perhaps a limp. In severe cases a child may be unable to place any weight on one leg. The medical correction for this condition is surgery to stabilize the growth plate with a screw to prevent further slippage.




Skeleton Key

You may know that a skeleton key is a magical key that will successfully unlock anything. Or you can think of it as the key to good health when you’re really, really old – like 30.

Being overweight now can make you feel prematurely old later on in life. As a teenager, it may be cool to look 18 when you’re 15, or 21 when you’re 18. As an adult, it may NOT be cool to feel 40 when you’re 30, or feel 70 when you’re 50. Make no bones about it – your skeleton is an important key to your health.

How Bones Work

You may not have studied how bones work – so here are the basics.

A bone begins as cartilage when you are a tiny fetus in your mother’s womb. Fetus cartilage becomes bone, except in the ears and nose. Cartilage keeps growing, which is why old people seem to have huge ears and long noses. The bone-making process is called ossification and it is run primarily by types of cells called osteoclasts and osteoblasts.

Osteoclasts harden the cartilage and take bone out of the middle, leaving room for the blood vessels and bone marrow to form, while osteoblasts build the bone. They work together in a process called remodeling. When you’re young, there are more osteoblasts (builders) than osteoclasts (removers). When you’re old, the balance is reversed and there are more osteoclasts than osteoblasts.

Like breathing, this bone remodeling process occurs for our entire lifetime.

Why Bone Matters

Healthy bones matter for a lifetime, and being overweight now can impact your bones now and later. Here’s why:
  • Obesity can damage growth plates. Bones grow in size and strength during childhood. If you’re carrying extra weight as a child, it can damage the growth plate which is the growing part located at each end of the bone. Growth plates are in the long bones of the body – which is why some teens get “growing pains” in their legs. Growth plate damage can lead to early arthritis, a greater risk for broken bones and other serious joint conditions and bone disease.
  • Obesity increases risk of breaking bones. You’re building bone mass until you’re about 20. If you are a healthy weight, with a good diet, your bones are also strong. If you are obese as a teen, you don’t build the same bone strength. As a result, you are at increased risk of breaking bones due to stress on the bones or because of weakened bones combined with a lack of physical activity.
  • Obesity hinders bone repair. When a bone breaks, your body makes a blood clot. Your osteoclasts begin removing the temporary blood clot and cartilage bridge (trabecular bone) and the osteoblasts then replace it with compact bone. If you break an arm or a leg after falling down, and you’re obese, you are a risk for complications. For example, if it is a bad break and you need metal implants, those implants might not be strong enough to repair the broken or misaligned bones. Crutches might be harder to use, and a cast might not be enough to stabilize the bone break. As a result, surgery, in addition to a cast, is often required.
  • Earlier onset of osteoporosis. When you’re old, because there are more osteoclasts (removers) than osteoblasts (builders) the bones get brittle and weak. This is osteoporosis. When someone has osteoporosis, they can break a bone by sneezing; simply falling down can be fatal. If you’re obese, you could begin to feel the effects of osteoporosis when you’re 50 instead of 70.
Bone health is also affected by diet (getting enough calcium) and weight bearing exercises such as running.
Corrective Actions

The good news is that you can help your child either lose weight or maintain a healthy weight and thereby prevent the musculoskeletal issues associated with childhood obesity.
  • Activity. Find something physical you can do together with your children. Bike riding is a great example, and you can all walk together any time of the year. Also, set a firm time limit on couch potato activities such as TV, computers, social media and video games to keep them more active.
  • Be a role model. If you drink milk with your meals, and don’t smoke, you’re setting a good example for bone health. Eat calcium-rich snacks and make sure weight-bearing exercise is part of your weekly routine. Don’t forget to include vitamin D (the sunshine vitamin) and lean protein as part of your healthy diet.
  • No soda. Limit access to soft drinks (or other sugary snacks) by not keeping them in the house. If healthy foods and drinks are all that are available, your children are more likely to eat and drink the smarter stuff.

Provide calcium-rich foods

Think of snack time as a mini-mealtime. Serve fat-free or low-fat milk. Keep calcium-rich snacks on hand such as string cheese, single-serving puddings, yogurt or frozen yogurt, almonds and calcium-fortified orange juice. Make it easy for them to grab leafy greens, which have calcium, vitamin K, potassium and other minerals needed for healthy bone growth. During your child’s annual checkup, talk to the pediatrician about bone health. Ask the doctor if there is any medical condition that may interfere with your child’s bone mass development. Your doctor should know the answer.

Healthy bone growth is a once-in-a-lifetime opportunity. Make sure obesity doesn’t interfere with your child’s full potential to enjoy a healthy life with strong, healthy bones.
How to Build Strong Bones

Here are four simple steps:
  • Eat dark leafy greens. They have the calcium, vitamin K, potassium and other minerals and nutrients you need to build bone. A salad is an obvious choice, but a smoothie can work as well.
  • Take in vitamins C and D. Vitamin C (calcium) is in milk and milk products and in “calcium-enriched” foods such as cereal. You can get vitamin D by spending 20 minutes a day outside (no more) without sunblock, or you can take a multivitamin that includes vitamin D.
  • Eat protein. Mix it up -- beans, fish, chicken. You can choose protein from the school menu, and encourage mom and dad to offer healthy proteins at home.
  • Do weight-bearing exercise. Use your body to its full advantage. Aerobic exercise that keeps you on your toes (and feet) help build your bones – whether it’s walking, tennis, running, volleyball, hiking, ice hockey, dancing, skiing, soccer, skateboarding, gymnastics, in-line skating, basketball, lifting weights or jumping rope. These exercises improve the amount of calcium moving into the upper body and upper thighs, two areas most at risk for fractures.
When you’re 16 it may be hard to imagine having joint pain when you’re 40. But it could happen. There are many good reasons to maintain a healthy weight when you’re growing up. Bone health is just one of them.
 
Good luck with the four simple steps – or as they say in theater: (don’t) break a leg!


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