Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings.

Article Summary

This article examines the incidence of slipped capital femoral epiphysis (SCFE) trends due to rising obesity rates. SCFE is one of the common hip conditions that tends to occur during the pre-teen to teenage years during growth spurts. The femoral head moves (slips) with regard to the rest of the femur that causes damage to the growth plate which causes pain, instability, and rigidity to the affected hip. The exact cause is unknown. The disorder is more common in boys than girls. This distinct disorder requires immediate referral to a pediatric orthopedic for immediate surgical intervention to prevent possible osteonecrosis, chondrolysis, femoroacetabular impingement, and early onset of osteoarthritis. The goal of surgery is to place a screw in the femoral head to prevent any more slipping which could cause additional damage. The prognosis regarding this disorder depends primarily on early detection, quick referral, surgical intervention, and afterwards weight loss to prevent the development of degenerative joint disease. Healthcare providers need to monitor those pediatric patients that has the disease of obesity which is a compelling risk factor for developing SCFE along with hypothyroidism, osteodystrophy, or genetic predisposition.

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Article Review

The authors used a decade long (2011-2020) retrospective cohort study analysis to evaluate incidence trends of SCFE. Given that obesity is a known risk factor, the study focused on patients younger than 18 years with a primary diagnosis of SCFE. There were different variables collected which included diagnosis, age, demographic, sex, and race. During this decade long study the incidence of SCFE surged from 2.46 to 5.96 per 10,000 children which according to the authors had a mirroring increase with childhood obesity trends. The groups most affected by SCFE were Black and Hispanic ethnicities which are known to be affected by obesity. Furthermore, children identified in the lower socioeconomic status (SES) was also predominantly affected with SCFE. These findings reflect the rise in childhood obesity in the United States, where 1 in 5 children and adolescents have been affected over the past decades. The surprising data was the geographical area which had the highest incidence of SCFE which was residency in the West. According to obesity facts, the majority of the obesity cases exist primarily in the South. This necessitates close monitoring of SCFE, a condition missed due to its varying presentation compared to other pediatric hip disorders.. The authors analysis showed a similar concurrent rise of SCFE and obesity trends, however, they emphasized not trying to imply causality.

Pediatric obesity is affecting millions of children and adolescents making it one of the most common chronic diseases. We have learned about the multifactorial, chronic, relapsing, and complexity of dealing with obesity in children. The American Academy of Pediatrics addressed childhood and adolescent obesity in the release of clinical practice guidelines (CPG) which provided evidence-based interventions to assist in the treatment of childhood and adolescent obesity. Some of the risk factors which were listed in the CPG that cause obesity included low socioeconomic status (SES), food deserts, marketing of unhealthy foods, and government policies. In addition, the Obesity Medicine Association suggested pillars for formulating weight management intervention including dietary management, physical activity management, behavioral modifications, and medical intervention. The authors briefly discussed the relationship that low SES and poor nutrition in association with the development of SCFE along with obesity.

Obesity is a major risk factor for developing SCFE in the pediatric population, which often presents with hip abnormalities.. The marked increase in SCFE during the same decade as the rise in obesity may indicate correlation between the two trends. The authors emphasized that while the trends in SCFE and obesity mirrored each other, this does not imply a causative relationship. The observation however did highlight one of the risk factors being obesity which could increase one’s risk of developing SCFE.