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No Bones About It

With Walid Khaled Yassir, MD

It is no longer surprising news that the obesity epidemic, which is crippling adult Americans, has now reached children and adolescents. Over the past 20 years, the Centers for Disease Control reports that the proportion of overweight children ages six through 11 has more than doubled and the rate for adolescents ages 12 through 19 has tripled.

There are a number of factors at place, which have contributed to the rise in childhood obesity. No single factor is solely to blame. Instead, childhood obesity is the result of a combination of leading a sedentary lifestyle, the availability of processed, packaged and high-fat foods, socioeconomic status, heredity, environmental factors and underlying metabolic or hormonal conditions.

The health consequences associated with those who are overweight or obese seems to grow every day as new research gleans important insight into how carrying extra body weight predisposes the individual to host of medical and mental conditions and illnesses. The medical community is seeing that the same diseases that are associated with obesity in adults are now being observed in children. Diabetes, early signs of heart disease and weight-induced orthopedic conditions are being diagnosed in children, some as young as 6 years old.

Even though these factors paint a grim picture of the health of our children, for Walid Khaled Yassir, MD, a pediatric orthopedic surgeon, he encounters the faces behind the statistics and research every day at Children’s Hospital of Michigan in Detroit. For the past decade, Detroit has continued to rank as one of the nation’s top cities with the highest rates of residents who are overweight or obese.

“Children’s Hospital serves the population that is so vulnerable to the obesity epidemic,” says Dr. Yassir.

Because of this, it makes his work that much more important for the health of southeast Michigan’s youth.

In his practice, Dr. Yassir treats two orthopedic conditions in children that are directly linked to carrying excess weight: Blount’s Disease and Slipped Capital Femoral Epiphysis.

Blount’s Disease affects the inner part of the tibia, just below the knee. This area fails to develop normally and causes angulation of the bone. With too much weight on the growth plate of the bone, which is the area where the bone grows, the cells won’t form and essentially shut down so that all bone growth is stopped.  The effects are severe arthritis of the knee and physical changes in the leg that resemble bow legs.

Those who are predisposed to this condition are adolescents who are bow-legged to begin with and who are also overweight. The progression of Blount’s Disease can be halted if it is caught early and if the child controls his or her obestiy through lifestyle changes. Surgery is required in cases where the condition has progressed but the disease has the potential to resurface when the child is older if they continue to remain overweight, says Dr. Yassir.

Slipped Capitol Femoral Epiphysis (SCFE) is a bit more serious. It is marked by a hip problem that starts if the growing end of the femur or thigh bone slips from the ball of the hip joint. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. Pain and stiffness are two side effects that make the problem worse because often the child is in too much pain or too immobile to exercise. The lack of physical activity adds to the overweight problem creating a vicious cycle, says. Dr. Yassir.  The most serious complications of SCFE are avascular necrosis, which is a lack of blood flow to the bone and arthritis.

Two surgical procedures can be done too correct SCFE. The most common treatment is called “in-situ fixation” which uses a single screw to hold the bone in place. A more involved surgery that carries more serious risk factors is also done in certain advanced cases.

In both Blount’s Disease and SCFE, the disease can be prevented with proper weight management.

Dr. Yassir suggests two actions parents can take to ensure that their children lead healthy lives so that their bone development can occur uninterrupted.

“First, you must start early. At a young age, start teaching your child not only about making healthy food choices but about lifestyle behaviors as well. Kids today should spend equal amounts of time indoors as they do outdoors,” he says.

Second, Dr. Yassir recommends that parents must control what kinds of food their children eat and how much they eat. Too much of the wrong kinds of foods will result in an overweight child and the potential for years, or even decades of medical complications if these lessons are not taught and learned early.

If you are concerned about your child’s health, talk to your family doctor about creating a nutrition and exercise plan that your entire family can participate in.

Walid Khaled Yassir, MD is a board certified pediatric orthopedic surgeon at DMC Children’s Hospital.  He is a graduate of SUNY Health Sciences Center at Brooklyn College of Medicine and completed his Fellowship at Children’s Hospital of San Diego.  He is a member of the American Board of Orthopedic Surgery and specializes in Pediatric Orthopedics.