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Health & Exercise Forum

Childhood Obesity Damaging to Bones & Joints

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Sep 10, 2012


Dr. Mackarey's Health & Exercise ForumGuest Columnist: Janet Caputo, PT, DPT, OCS

September is National Childhood Obesity Awareness Month!

As a child, I was a “chubby” and I still struggle with my weight.  I preferred playing indoors with Barbie dolls while my “skinny” cousins played softball and rode their bikes.  My parents, remembering many nights when they went to bed without supper during the Great Depression, did not want me to experience the pain of hunger.  My Nona, remembering how skinny her children were, fed me bread, butter, and sugar.  Also, considering my Italian heritage, everything was about food! Food helped no matter how you felt: happy, sad, or mad!

According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years.  Fast foods, processed foods, and computerized games have contributed to our children consuming too many calories and expending very little energy.  It is well known that childhood obesity not only contributes to low self-esteem and depression, but also damages the cardiovascular system (pre-mature development of diabetes, high blood pressure, and high cholesterol). However, recent studies show that damage to the bones and joints of overweight children can lead to arthritis and joint deformities.

A study published in Pediatrics in 2010 found that leg injuries were significantly higher in obese children compared to their normal weight counterparts.  Common musculoskeletal injuries in obese children include sprains and broken bones.  Increased joint and bone forces, excessive body weight, and poor balance collectively contribute to the higher incidence of leg injuries.   Obese children typically suffer more traumatic injuries requiring surgical intervention.

Childhood Obesity Affects Bones & Joints

Childhood obesity may contribute to flat feet, mal-alignment of the knees, osteoarthritis, deformities of the hip and bowed lower legs.  Excess body weight increases foot pressure and puts developing feet at risk for pain and dysfunction.  Many obese children present with a flat foot and complain of ankle/foot pain with running and jumping.  Typically, practitioners recommend custom shoe inserts to improve alignment in the flat foot but obesity impairs the child’s response to this intervention.  Overweight and obese children often develop knocked knees.  Abnormal joint movements from flat feet and knocked knees coupled with excessive joint forces from increased body weight may interfere with joint integrity over time, possibly resulting in the pre-mature development of arthritis.  Clinicians report an increase in the frequency of hip deformities, typical of overweight and obese, adolescent bones. Obese children develop these hip, knee, ankle, and foot problems, because the excess weight interferes with the structure and function of developing bones and joints, resulting in pain and deformity.

Childhood Obesity Affects Mobility

Obesity can also affect a child’s neuromuscular system resulting in abnormal changes in walking patterns and problems with balance and stability.  Walking pattern typically changes with age as individuals develop arthritis, leg weakness, and loss of balance.  Elderly people tend to walk more slowly without swinging their arms and without lifting their feet.  Shockingly, clinicians have noticed similar changes in obese children.  Obese children report greater exertion with walking which may be the result of the decreased hip, knee and ankle movement as well as the decreased walking speed demonstrated in this population. Also, obese children tend to walk with a rigid posture and spend more time with both feet on the ground.  Researchers believe that these differences in walking style may be the child’s attempt to compensate for poor stability, decreased balance, and reduced joint position sense.

Provide Healthy Options to Prevent Childhood Obesity

Greater risk of injury, difficulty walking, and more complaints of musculoskeletal pain should not be used as excuses to avoid being physically active.  To help an obese child become more physically active you must first consider what the child enjoys doing.  The “exercise” must be fun!  Second, ensure the child safety with supportive footwear and the appropriate protective equipment.  Next, explore activities that challenge the cardiopulmonary system without stressing the musculoskeletal system such as swimming and cycling.

There are many fun and effective options available. For example, Wii Fit by NintendoR offers many fun low impact sports and fitness programs. Also, Airobics (trampoline based aerobic exercise) or a modified martial arts program are low impact and address stability and balance.  A Pilates-for-kids program or stability ball exercises will target muscle strengthening and body. Some fitness centers have programs specifically designed for children. SubwayR Restaurant has a special program called “Random Acts of Fitness for Kids” to promote healthy lifestyles in youngsters. Also, offers a website for that teaches children about the body and how it works regarding health and fitness. You can even get a fitness trainer specifically for kids ( However, my personal preference to insure a comprehensive and safe program for the individual needs of your child is to discuss the problem with your family physician or pediatrician and get a referral to see an orthopedic physical therapist that specializes in bone and joint problems. Remember, helping your child “get in shape” may also rub off on you! Good luck and have fun!

Visit your doctor regularly and listen to your body.

CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.