Young schoolgirls who are overweight or obese are more likely to see their GP with MSK issues

London-based study

In a bid to strengthen the evidence base, Ms Firman and her colleagues examined whether MSK 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 four ethnically diverse north east London local authorities from the National Child Measurement Programme (NCMP) for the academic years from 2013-14 to 2018-19. The results were linked to general practice health records.

Schoolgirls aged from four to 11 whose body mass index (BMI) means they would be considered to be overweight or obese are more likely to see a GP at least once about musculoskeletal (MSK) problems than their peers deemed to have a healthy weight.

That is the conclusion of an article by researchers, who focused on one area of London, that is published online today (13 March) in the Archives of Disease in Childhood. The article’s first author is Nicola Firman, a health data scientist from the Wolfson Institute of Population Health at Queen Mary University of London.

There is some evidence to suggest that obesity increases the likelihood of back pain, chronic pain, and slipped capital femoral epiphysis (SCFE) – a condition that is found more commonly in teenagers than adults – 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.

Gender differences emerge

The study sample included 63,418 (51 per cent boys) four-to-five year-olds (reception year) and 55,364 (51 per cent boys) 10 to 11 year-olds (year six). Most of the children lived in areas of high deprivation.

Just under nine per cent of reception year boys and just over seven per cent of reception year girls were living with obesity compared with just under 20 per cent of year six boys and 14.4 per cent of year six girls.

Some three per cent of reception year children and eight per cent of year six children had at least one consultation with their family doctor for an MSK issue following their NCMP measurement. And 194 reception year children, and 875 year six children had more one than such consultation.

On average, the first MSK consultation occurred nearly three years after the reception year NCMP measurement and just over two years after the year six measurement. When Ms Firman and her colleagues analysed the data by gender, they found that reception girls with obesity were more likely to see their doctor about an MSK problem than their peers deemed to have a healthy weight, but there was no difference among the boys.

Poor MSK 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 MSK problems [Nicola Firman et al]

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 an MSK problem after their measurement in year six.

Reception year girls who were living with a BMI considered overweight were 24 per cent more likely to see a doctor at least once for a musculoskeletal issue, while their peers who were living with obesity were 67 per cent more likely to do so than girls with a healthy weight in this year. And year six girls with obesity were 20 per cent more likely to do so, while boys with a BMI considered underweight were 61 per cent 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 MSK consultation, 46 per cent of boys and 41.5 per cent of girls reported knee pain. Among the year six children, the corresponding proportions were 40.4 per cent and 36 per cent. 

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

Caveats and conclusion

As the study was observational in nature, Ms Firman and her colleagues acknowledge that no definitive conclusions can be drawn about causes. Limitations included the lack of information on each child’s physical activity level – a factor known to reduce obesity but also to increase the risk of MSK injury.

Ms Firman and her colleagues 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.' 

They add: ‘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.’

To read the full version of the article – titled Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records doi: 10.1136/archdischild-2023-326407 – click