Overweight primary school girls more likely to seek doctor's help for musculoskeletal problems

Primary school girls between the ages of 4 and 11 with a body mass index (BMI) considered overweight or obese are more likely to see a family doctor (GP) at least once about musculoskeletal problems than their healthy weight peers, suggests research, focused on one area of London and published online in the Archives of Disease in Childhood.

There is some evidence to suggest that obesity increases the likelihood of back pain, chronic pain, and a hip condition (SCFE) more common in teens, caused by the additional stress placed on the body's joints by excess weight.

However, the association isn't clear, largely because of the quality and paucity of previously published studies, suggest the researchers.

To strengthen the evidence base, they set out to discover if musculoskeletal symptoms are more common among young children with a BMI considered obese/overweight than they are among their peers with a healthy weight.

They included primary schoolchildren from 4 ethnically diverse north east London local authorities from the National Child Measurement Programme (NCMP) for the academic years 2013-14 to 2018-19. The results were linked to general practice health records.

The study sample included 63,418 (51% boys) 4-5 year-olds (reception year) and 55,364 (51% boys) 10 to 11 year-olds (year 6). Most of the children lived in areas of high deprivation.

Just under 9% of reception year boys and just over 7% of reception year girls were living with obesity compared with just under 20% of year 6 boys and 14.4% of year 6 girls.

Some 3% of reception year children and 8% of year 6 children had at least one consultation with their family doctor for a musculoskeletal issue following their NCMP measurement. And 194 reception year children, and 875 year 6 children had more one than such consultation.

On average, the first musculoskeletal consultation occurred nearly 3 years after the reception year NCMP measurement and just over 2 years after the year 6 measurement.

When analysed by gender, reception girls with obesity were more likely to see their doctor about a musculoskeletal problem than their healthy weight peers, but there was no difference among the boys.

Compared with children with a healthy weight, a higher proportion of girls with obesity and a smaller proportion of boys with a BMI considered underweight saw their doctor about a musculoskeletal problem after their measurement in year 6.

Reception year girls who were living with a BMI considered overweight were 24% more likely to see a doctor at least once for a musculoskeletal issue, while their peers who were living with obesity were 67% more likely to do so than girls with a healthy weight in this year.

And year 6 girls with obesity were 20% more likely to do so, while boys with a BMI considered underweight were 61% less likely to do so than children with a healthy weight.

Knee and back symptoms or diagnoses were those most often recorded. For example, among reception year children with at least one musculoskeletal consultation, 46% of boys and 41.5% of girls reported knee pain. Among the year 6 children, the corresponding proportions were 40.4% and 36%. 

Among the reception children, 22% of boys and 32% of girls reported back pain, compared with 30% of year 6 boys and 45% of year 6 girls. 

This is an observational study, and as such, no definitive conclusions can be drawn about cause. And the researchers acknowledge various limitations to their findings, including the lack of information on each child's physical activity level—a factor known to reduce obesity but also to increase the risk of musculoskeletal injury.

But they point out: "Poor musculoskeletal health during childhood has the potential to have a significant impact on quality of life, throughout childhood and continuing into adolescence and adulthood. Participation in some physical activities may be limited by musculoskeletal problems. 

"In turn, increased weight has the potential to contribute to continued musculoskeletal pain, and consequently children may experience a perpetual obesity/musculoskeletal pain cycle as adolescents and adults."