In a recent study published in Archive of Diseases in Childhooda group of researchers evaluated the frequency of musculoskeletal visits in children with obesity in a primary care setting.
Study: Are children living with obesity more likely to develop musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records. Image credit: New Africa/Shutterstock.com
Record
Globally, one in three adults and a similar proportion of children in the United Kingdom (UK) experience musculoskeletal problems, which cause pain and disability and affect mental health.
The increasing prevalence of obesity exacerbates these issues, as excess weight puts significant stress on the body’s joints, leading to conditions such as back pain, chronic pain, and slipped capital femoral epiphysis (SCFE).
Previous research has suggested a link between being overweight and an increased risk of musculoskeletal problems in children, but the evidence was mostly cross-sectional and of moderate to low quality.
Recent longitudinal studies also support this association, however they are few and of moderate quality, with inconsistent accounting for confounding variables. This highlights the urgent need for further research to clarify the causal relationship between obesity and musculoskeletal symptoms in children.
About the study
The present study included 123,836 (96.3%) participants from the National Child Measurement Program (NCMP) in four local authorities in north-east London, with their records linked to primary care using pseudonymous National Health Service (NHS) numbers.
The NCMP involves measuring children’s height and weight in the first and last years of primary school to monitor public health trends.
Data sharing agreements facilitated the use of NCMP data from 2013/14 to 2018/19 alongside pseudonymised primary care data from the Discovery Data Service for 285 general practitioners (GPs).
This study focused on identifying musculoskeletal consultations among these children, excluding any prior to NCMP measurement.
Musculoskeletal visits were identified through specific clinical codes, with the primary outcome being the presence or absence of at least one GP visit for a musculoskeletal problem after NCMP measurement.
Children’s body mass index (BMI) was adjusted for ethnicity and categorized into underweight, healthy weight, overweight or obese according to UK standards.
Ethnicity, derived from NCMP records or, when missing, from electronic health records, and area-level deprivation were considered confounders.
Statistical analysis included estimation of proportions and incidence rates of musculoskeletal advice, with Kaplan–Meier failure functions and Cox proportional hazards regression adjusted for confounders, including academic year of NCMP participation and local authority.
The study also investigated interactions between gender and school year of the NCMP measure. The analysis was conducted using Stata, adhering to strict data management and statistical standards to ensure the integrity of the findings.
Study results
The study looked at a sizeable population from the NCMP, which included 63,418 children in reception (50.9% boys) and 55,364 children in Year 6 (50.8% boys).
Mainly, these children came from the most deprived areas and were of black or minority ethnic origin, with a small proportion (less than 1%) excluded due to missing ethnic data.
In particular, obesity rates were higher in older children, with 19.9% of Year 6 boys and 14.4% of Year 6 girls living with obesity, compared with 8.9% of foster boys and 7 .1% of host girls.
The analysis revealed variations in musculoskeletal tests by weight status. Among younger children, girls with obesity were more likely to seek musculoskeletal visits than their healthy-weight counterparts, a trend that was not seen in boys.
Among the larger cohort, both obese girls and boys classified as underweight showed differences in counseling rates compared to their healthy weight peers.
The most common musculoskeletal problems involved knee and back pain, with a higher prevalence of back pain reported in the Year 6 cohort compared to reception children.
During the follow-up period, which ranged from two to eight years, the first musculoskeletal consultation usually occurred within two to three years after the NCMP measurements.
Incidence rates of visits differed, with girls living with obesity in both cohorts having higher rates compared to those at a healthy weight. Interestingly, underweight Year 6 boys had a lower incidence rate than their counterparts.
Cumulative incidence analysis revealed a higher likelihood of musculoskeletal visits among female foster children with obesity, although the small sample size introduced uncertainty.
The incidence was significantly lower for Year 6 boys classified as underweight, with the confidence interval not clearly overlapping with other weight categories.
The findings of the study highlight the increased risk of musculoskeletal disorders among children with obesity, especially girls, in different age groups.
Multivariate analysis, adjusted for various factors, confirmed this increased risk for overweight and obese girls in Reception and Year 6, with underweight Year 6 boys showing a reduced likelihood of visits.
