Overweight and obesity isn’t simply a number on a scale or a point on a growth curve. It also consists of changes in body chemistry, metabolism, physics (pressure and gravity), and anatomy. Yesterday, we glanced at a new report in Pediatrics which highlights physical exam abnormalities pediatricians look for when we recognize that a child’s BMI is too high. One thing to notice is the effect excess weight has on growing bones and muscle:

  • “Waddling Gait” — Gravity applies pressure on weight-bearing joints and bones. Chronic pain in the joints of the lower extremities (hips, knees, feet) and back are common complaints among obese individuals.
  • Hyperlordosis — Another cause of chronic low back pain, lordosis is the excessive inward curvature of the spine which gets exaggerated from abdominal fat mass.
  • Hip pathology — Slipped Capital Femoral Epiphysis (SCFE) is the most common hip disorder of adolescence and is more common in overweight and obese teenagers. This very serious condition presents with chronic hip, thigh, or knee pain and a significant limp in a young teenager. Surgical procedures done on an urgent basis are necessary to fix the damage and prevent destruction of the hip bones and joints.
  • “Knock-knee” (Genu Valgum) — Excessive weight upon weight-bearing joints of the lower extremites causes this acquired deformity, which can bring long-term pain and disability.

Genu valgum increases stress on the lateral knee, increasing risk for osteoarthritis. Adolescent females with obesity are at risk for a rapidly progressive form of genu valgum.

  • “Flatfoot” (Pes Planus) — Another common cause of chronic ankle and foot pain in children, the prevalence of pes planus increases with body weight.

 

Children who are overweight or obese often have skin changes that indicate serious morbidity from their excess body weight:

  • Acanthosis negricans (AN) — Thickening and darkening of the skin of the nape of the neck, underarms, eyelids, and skin folds is the hallmark of AN and usually indicates insulin resistance — the precursor of type 2 diabetes.
  • Striae (“Stretch marks”) — Rapid body growth (height and weight) can actually injure the skin and cause linear bands that start out red, then turn purple before eventually becoming silvery-white. Overweight and obese children often develop striae right before the onset of puberty on the thighs, arms, and abdomen.
  • Intertrigo — Irritation, maceration, and inflammation of skin subjected to friction leads to this uncomfortable rash that causes itching and burning, and sometimes leads to secondary fungal (candidiasis) and bacterial infections (impetigo).
  • Hirsuitism (abnormal hair growth) and Acne — These two findings in an obese adolescent female represents polycystic ovarian syndrome (PCOS) until proven otherwise. The odds of developing PCOS increases with increasing BMI, and PCOS increases the risk of insulin resistance and type 2 diabetes.

 

Pediatric Alliance providers screen all preteens, teenagers, and young adults for symptoms of depression. Physical signs of depression in obese children can be hard to see unless one asks:

  • Flat Affect — Depression is common in overweight and obese children and teenagers and an apathetic attitude can be an initial sign:

Adolescent girls with obesity are at increased risk for depression… Adolescents who experience weight-related teasing are twice as likely to report depressive symptoms than those who were not teased. The association is bidirectional; adolescents with depression are also more likely to have obesity. Depression in childhood is associated with obesity in adulthood.

 

Read the entire report, Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review, in Pediatrics here.

 

(Google Images)