Lower Extremity Pain Is Associated With Reduced Function and Psychosocial Health in Obese Children
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Childhood obesity is associated with reduced quality of life, physical fitness, and a higher prevalence of lower extremity (LE) pain; however, it is unclear whether and how these factors are related.
For this study we asked if obese children with LE pain (LE+) had higher BMI-Z scores, lower physical function and psychosocial health, and lower physical fitness compared with obese children without LE pain (LE−). We determined the association of BMI-Z score with physical function, psychosocial health, or physical fitness in obese children.
Medical charts of 183 obese children were reviewed. Recorded data included anthropometrics, demographics, reports of musculoskeletal pain, Pediatric Quality of Life (PedsQL)-Physical Function score, PedsQL-Psychosocial Health score, and physical fitness levels. Data from 175 individuals were included in the analysis, with 51 in the LE+ group and 124 in the LE− group. Statistical analysis included Mann-Whitney U tests and Spearman’s rank order correlations.
Between the LE+ and LE− groups, BMI-Z and physical fitness scores were not different. The LE+ group scored worse on the PedsQL-Physical Function scale (LE+: 72.4 [17.1], LE−: 79.5 [15.0]) and PedsQL-Psychosocial Health scale (LE+: 70.0 [16.1], LE−: 75.8 [16.3]). BMI-Z scores negatively correlated with PedsQL-Physical Function scores, PedsQL-Psychosocial Health scores, and physical fitness scores.
Our findings indicate that LE pain should be considered in the evaluation and management of children who are obese.
Level of Evidence
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Baskin ML, Ard J, Franklin F, Allison DB. Prevalence of obesity in the United States. Obes Rev. 2005;6:5–7. CrossRef
- Beets MW, Pitetti KH, Cardinal BJ. Progressive aerobic cardiovascular endurance run and body mass index among an ethnically diverse sample of 10-15-year-olds. Res Q Exerc Sport. 2005;76:389–397. CrossRef
- Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr. 2010;91:1499S–1505S. CrossRef
- Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007;56:1204–1211. CrossRef
- Cameron A, Magliano D, Dunstan D, Zimmet P, Hesketh K, Peeters A, Shaw J. A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. Int J Obes. 2012;36:295–303. CrossRef
- Carrel AL, Bowser J, White D, Moberg DP, Weaver B, Hisgen J, Eickhoff J, Allen DB. Standardized childhood fitness percentiles derived from school-based testing. J Pediatr. 2012;161:120–124. CrossRef
- Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord. 2001;25:622–627. CrossRef
- Cole TJ, Faith MS, Pietrobelli A, Heo M. What is the best measure of adiposity change in growing children: BMI, BMI%, BMI z-score or BMI centile? Eur J Clin Nutr. 2005;59:419–425. CrossRef
- Connelly M, Rapoff MA. Assessing health-related quality of life in children with recurrent headache: reliability and validity of the PedsQLTM 4.0 in a pediatric headache sample. J Pediatr Psychol. 2006;31:698–702. CrossRef
- D’Hondt E, Deforche B, Vaeyens R, Vandorpe B, Vandendriessche J, Pion J, Philippaerts R, de Bourdeaudhuij I, Lenoir M. Gross motor coordination in relation to weight status and age in 5- to 12-year-old boys and girls: a cross-sectional study. Int J Pediatr Obes. 2011;6:e556–564. CrossRef
- Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122:198–208. CrossRef
- De Los Reyes A, Kazdin AE. Measuring informant discrepancies in clinical child research. Psychol Assess. 2004;16:330–334.
- de Sa Pinto AL, de Barros Holanda PM, Radu AS, Villares SM, Lima FR. Musculoskeletal findings in obese children. J Paediatr Child Health. 2006;42:341–344.
- Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med. 1999;107:542–548. CrossRef
- Graf C, Koch B, Kretschmann-Kandel E, Falkowski G, Christ H, Coburger S, Lehmacher W, Bjarnason-Wehrens B, Platen P, Tokarski W, Predel HG, Dordel S. Correlation between BMI, leisure habits and motor abilities in childhood (CHILT-project). Int J Obes Relat Metab Disord. 2004;28:22–26. CrossRef
- Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR. Obesity and quality of life: mediating effects of pain and comorbidities. Obes Res. 2003;11:209–216. CrossRef
- Janke EA, Collins A, Kozak AT. Overview of the relationship between pain and obesity: what do we know? Where do we go next? J Rehabil Res Dev. 2007;44:245–262. CrossRef
- Jia H, Lubetkin EI. The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf). 2005;27:156–164. CrossRef
- Jinks C, Jordan K, Croft P. Disabling knee pain—another consequence of obesity: results from a prospective cohort study. BMC Public Health. 2006;6:258. CrossRef
- Joshi P, Bryan C, Howat H. Relationship of body mass index and fitness levels among schoolchildren. J Strength Cond Res. 2012;26:1006–1014. CrossRef
- Kemp C, Pienaar AE. Physical activity levels and energy expenditure of 9-year-old–12-year-old overweight and obese children. Health SA Gesondheid. 2011;16:1–6. CrossRef
- Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7:352–356. CrossRef
- Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11. 2002:1–190.
- Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology. 2012;20:53–58. CrossRef
- LeResche L, Mancl LA, Drangsholt MT, Saunders K, Korff MV. Relationship of pain and symptoms to pubertal development in adolescents. Pain. 2005;118:201–209. CrossRef
- Lohmander LS, de Verdier MG, Rollof J, Nilsson PM, Engström G. Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis. 2009;68:490–496. CrossRef
- McGill HC Jr, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, Strong JP. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation. 2002;105:2712–2718. CrossRef
- McGraw B, McClenaghan BA, Williams HG, Dickerson J, Ward DS. Gait and postural stability in obese and nonobese prepubertal boys. Arch Phys Med Rehabil. 2000;81:484–489. CrossRef
- McMillan AG, Phillips KA, Collier DN, Blaise Williams DS. Frontal and sagittal plane biomechanics during drop jump landing in boys who are obese. Pediatr Phys Ther. 2010;22:34–41. CrossRef
- McMillan AG, Pulver AM, Collier DN, Williams DS. Sagittal and frontal plane joint mechanics throughout the stance phase of walking in adolescents who are obese. Gait Posture. 2010;32:263–268. CrossRef
- Meredith M, Welk G. FITNESSGRAM & ACTIVITYGRAM: Test Administration Manual. 4th ed. Champaign, IL, USA: Human Kinetics; 2010.
- Mills PM, Wang Y, Cicuttini FM, Stoffel K, Stachowiak GW, Podsiadlo P, Lloyd DG. Tibio-femoral cartilage defects 3-5 years following arthroscopic partial medial meniscectomy. Osteoarthritis Cartilage. 2008;16:1526–1531. CrossRef
- Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology. 2007;132:2087–2102. CrossRef
- Panepinto JA, Pajewski NM, Foerster LM, Hoffmann RG. The performance of the PedsQL generic core scales in children with sickle cell disease. J Pediatr Hematol Oncol. 2008;30:666–673. CrossRef
- Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18:189–193. CrossRef
- Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, van der Wouden JC. Pain in children and adolescents: a common experience. Pain. 2000;87:51–58. CrossRef
- Pinhas-Hamiel O, Singer S, Pilpel N, Fradkin A, Modan D, Reichman B. Health-related quality of life among children and adolescents: associations with obesity. Int J Obes. 2005;30:267–272. CrossRef
- Pinhas-Hamiel O, Singer S, Pilpel N, Fradkin A, Modan D, Reichman B. Health-related quality of life among children and adolescents: associations with obesity. Int J Obes (Lond). 2006;30:267–272. CrossRef
- Prentice-Dunn H, Prentice-Dunn S. Physical activity, sedentary behavior, and childhood obesity: a review of cross-sectional studies. Psychol Health Med. 2012;17:255–273. CrossRef
- Quaresma A, Palmeira AL, Martins SS, Veloso S, Fonseca H, de Matos MG. Fitness versus fatness and quality of life: analysis of the influence of the cardiorespiratory fitness on the weight related quality of life of adolescents. Fitness Performance. 2009;8:254–263. CrossRef
- Riazi A, Shakoor S, Dundas I, Eiser C, McKenzie SA. Health-related quality of life in a clinical sample of obese children and adolescents. Health Qual Life Outcomes. 2010;8:134. CrossRef
- Riddiford-Harland DL, Steele JR, Baur LA. Upper and lower limb functionality: are these compromised in obese children? Int J Pediatr Obes. 2006;1:42–49. CrossRef
- Ringold S, Wallace CA, Rivara FP. Health-related quality of life, physical function, fatigue, and disease activity in children with established polyarticular juvenile idiopathic arthritis. J Rheumatol. 2009;36:1330–1336. CrossRef
- Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics. 2005;115:e152–e162. CrossRef
- Salsich GB, Perman WH. Tibiofemoral and patellofemoral mechanics are altered at small knee flexion angles in people with patellofemoral pain. J Sci Med Sport. 2012 May 10 [Epub ahead of print].
- Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813–1819. CrossRef
- Sharma L, Lou C, Cahue S, Dunlop DD. The mechanism of the effect of obesity in knee osteoarthritis: the mediating role of malalignment. Arthritis Rheum. 2000;43:568–575. CrossRef
- Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286:188–195. CrossRef
- Soric M, Misigoj-Durakovic M. Physical activity levels and estimated energy expenditure in overweight and normal-weight 11-year-old children. Acta Paediatr. 2010;99:244–250.
- Sorof J, Daniels S. Obesity hypertension in children. Hypertension. 2002;40:441–447. CrossRef
- Stovitz SD, Pardee PE, Vazquez G, Duval S, Schwimmer JB. Musculoskeletal pain in obese children and adolescents. Acta Paediatr. 2008;97:489–493. CrossRef
- Strutzenberger G, Richter A, Schneider M, Mundermann A, Schwameder H. Effects of obesity on the biomechanics of stair-walking in children. Gait Posture. 2011;34:119–125. CrossRef
- Taylor ED, Theim KR, Mirch MC, Ghorbani S, Tanofsky-Kraff M, Adler-Wailes DC, Brady S, Reynolds JC, Calis KA, Yanovski JA. Orthopedic complications of overweight in children and adolescents. Pediatrics. 2006;117:2167–2174. CrossRef
- US Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD, USA: US Department of Health and Human Services, Office of the Surgeon General; 2010.
- Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL. The PedsQL in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and type 1 Diabetes Module. Diabetes Care. 2003;26:631–637. CrossRef
- Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3:329–341. CrossRef
- Varni JW, Limbers CA, Burwinkle TM. How young can children reliably and validly self-report their health-related quality of life? An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes. 2007;5:1.
- Varni JW, Seid M, Knight TS, Uzark K, Szer IS. The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. J Behav Med. 2002;25:175–193. CrossRef
- Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–812. CrossRef
- Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care. 1999;37:126–139. CrossRef
- Varni JW, Seid M, Smith Knight T, Burwinkle T, Brown J, Szer IS. The PedsQL in pediatric rheumatology: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory Generic Core Scales and Rheumatology Module. Arthritis Rheum. 2002;46:714–725. CrossRef
- Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002;110:903–910. CrossRef
- Williams J, Wake M, Hesketh K, Maher E, Waters E. Health-related quality of life of overweight and obese children. JAMA. 2005;293:70–76. CrossRef
- Willson JD, Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech (Bristol, Avon). 2008;23:203–211.
- Witchel S, Finegold D. Endocrinology. In: Zitelli B, Davis H, eds. Atlas of Pediatric Physical Diagnosis. 5th ed. St. Louis, MO, USA: Mosby; 2002:315–338.
- World Health Organization EC. Physical Status, the Use and Interpretation of Anthropometry. Geneva, Switzerland: World Health Organization; 1995:263–311.
- Zeller MH, Modi AC. Predictors of health-related quality of life in obese youth. Obesity (Silver Spring). 2006;14:122–130. CrossRef
- Zorba E, Cengiz T, Karacabey K. Exercise training improves body composition, blood lipid profile and serum insulin levels in obese children. J Sports Med Phys Fitness. 2011;51:664–669.
- Lower Extremity Pain Is Associated With Reduced Function and Psychosocial Health in Obese Children
Clinical Orthopaedics and Related Research®
Volume 471, Issue 4 , pp 1236-1244
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Rheumatology, Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA
- 2. Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- 3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 4. Health and Rehabilitation Sciences PhD Program, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- 5. Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- 6. Sports Health and Performance Institute, OSU Sports Medicine, Ohio State’s Wexner Medical Center, Columbus, OH, USA