Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination

Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s article highlights the often-overlooked impact of obesity on neuromusculoskeletal health in children. It advocates for incorporating functional assessments—such as strength, balance, and gait screening—into routine pediatric obesity care to identify and address physical limitations that can hinder long-term health and quality of life.

Article Summary

This article highlights how obesity in children can impair strength, balance, gait, and joint health and it advocates for routine neuromusculoskeletal screening to personalize obesity care and improve quality of life in pediatric patients.

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Article Review

As the prevalence of pediatric obesity continues to climb, its systemic impact on musculoskeletal health is increasingly evident in clinical practice. In the article “Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination”, O’Malley and colleagues deliver a much-needed synthesis of the neuromusculoskeletal impairments associated with obesity in children. This review highlights key findings on how excess adiposity influences movement, physical function, pain, and quality of life—and importantly, provides guidance on integrating these considerations into clinical assessment.

The authors begin by addressing a gap in pediatric obesity care: while much focus has been placed on metabolic and psychosocial complications, the neuromusculoskeletal sequelae often remain under-recognized. They emphasize that motor difficulties are not just secondary effects but core components of the obesity disease process in children. The article discusses how alterations in gait, posture, and balance are common, and may lead to a vicious cycle of physical inactivity, further weight gain, and physical deconditioning.

One strength of this review is its organization around functional domains: postural control, strength, pain, gait, motor coordination, and physical activity tolerance. The authors provide evidence from multiple studies linking pediatric obesity with altered biomechanics—such as flat-footedness, joint misalignment, reduced ankle dorsiflexion, and impaired dynamic balance. These structural changes may contribute to discomfort and injury risk and reduce a child’s confidence or willingness to engage in physical activity, which is crucial to long-term obesity treatment.

Pain, particularly in the lower limbs, is another underappreciated consequence discussed in the review. Musculoskeletal pain in children with obesity is often mistakenly attributed to poor fitness alone, rather than considered an active barrier that warrants direct intervention. The authors argue convincingly for the routine screening of pain in clinical obesity evaluations, and suggest tools like the Pediatric Pain Questionnaire or Visual Analog Scales to quantify discomfort.

One of the most clinically useful contributions of this paper is the proposed approach to neuromusculoskeletal examination. O’Malley et al. advocate for a practical set of assessments that can be performed in a busy clinic, such as evaluating single-leg stance, heel-to-toe walking, and sit-to-stand performance. They also highlight the importance of observing general movement patterns and gait during routine office transitions—subtle clues that may reveal major limitations in function.

Importantly, the authors move beyond problem identification and into the realm of solution-building. They emphasize the need for interdisciplinary care, where physical therapists, exercise physiologists, and occupational therapists collaborate with pediatricians and obesity medicine providers. Early referrals for neuromuscular evaluation may prevent long-term disability, and tailored interventions (e.g., strength training, motor coordination programs) can improve both physical and emotional well-being.

This article also indirectly supports a strength-based approach to obesity care. Rather than focusing solely on weight or BMI reduction, functional outcomes—such as increased endurance, improved coordination, or reduced pain—can be valuable and motivating goals for patients and families. This aligns with the broader shift in obesity medicine toward holistic and patient-centered care.

There are, however, a few limitations to consider. As a narrative review, the article summarizes existing literature but does not conduct a systematic meta-analysis. Some of the studies cited are small or observational in design, and many lack standardized assessments of musculoskeletal function in children. Additionally, while the review includes some international perspectives, most referenced data come from high-income countries, potentially limiting generalizability.

Despite these limitations, this article is highly relevant to pediatric obesity providers and should prompt changes in clinical routines. At a minimum, it makes the case for incorporating basic neuromusculoskeletal screening into all pediatric obesity evaluations. Recognizing and addressing functional impairments early can enhance physical literacy, reduce injury risk, and empower children to re-engage with movement in positive ways.

For clinicians, the key takeaway is clear: a thorough physical assessment should include more than weight, height, and blood pressure. Posture, balance, movement quality, and pain perception all provide critical insight into a child's health status and lived experience with obesity. By identifying these issues, we can offer more personalized, compassionate, and effective interventions—especially for children who may be silently struggling with discomfort or physical limitations.

In sum, O’Malley et al. provide an excellent foundation for integrating musculoskeletal considerations into pediatric obesity care. Their work is a timely reminder that obesity affects the whole child—including their ability to move, play, and participate fully in life. As obesity medicine providers, it is our responsibility to see, assess, and support every dimension of that experience.