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Review of Related literature of the case Obesity is a serious health problem, and an obesity epidemic is spreading in alarming rates

among children.1 Currently about 16% of the children in Europe are overweight, and 8% are obese.2 Obesity-associated problems and diseases decrease the quality of life and life span. Many studies have shown that overweight children are more likely to become overweight adults than their normal-weight peers. Furthermore, children may also be more vulnerable to specific obesity-related health problems (such as hypertension, hepatic steatosis, hyperandrogenism, and pseudoacromegaly)8because their bodies are growing and developing. Adult obesity has been associated with a higher prevalence of musculoskeletal disorders, primarily affecting the lower limbs,913 but comparative data in children are scarce. Some musculoskeletal disorders that are unique to childhood, such as slipped capital femoral epiphysis14 and tibia vara (Blounts disease),15 have retrospectively been associated with excess weight. Few studies have quantified the prevalence of musculoskeletal problems in overweight and obese children.1619 Although these few studies imply that childhood obesity may predispose children to musculoskeletal problems, convincing empirical verification is currently lacking. In our present research we use the results of a large survey in Dutch family practices performed in 2001 and aim to answer the following questions: (1) do overweight and obese children report more (lower extremity)

musculoskeletal problems in daily life than their normal-weight peers; and (2) do overweight and obese children seek help for (lower extremity) musculoskeletal problems more often than their normal-weight peers? http://annfammed.org/content/7/4/352.full

The problem of obesity has grown to become a major concern. In adults, an individual with a BMI of more than 25 is classied as overweight and those with a BMI of more than 30 are dened as obese [1,2] In children and adolescents, the denition of obesity has been dened as having a BMI greater than the 95th percentile for age [36]. The prevalence of obesity has largely increased in the last few decades. In the years 20032004, the prevalence of obesity has been reported to be 17%, which is a signicant increase from the last two decades [7]. The increase in prevalence of obesity in children is multifactorial but has been largely attributed to the level of physical activity, increase in caloric intake and environmental factors. Obesity is known to lead to a wide array of medical comorbidities, and its physical and psychological impact on the affected individual cannot be understated. These complications include an increased risk of developing musculoskeletal problems, which include osteoarthritis, a decline in function and musculoskeletal pain. Until recently, the majority of the studies in children have associated known orthopedic conditions such as slipped capital femoral epiphysis (SCFE) and Blounts disease with increased weight [812,13 Newer studies have concentrated on the effect of increased weight on the development and overall function of the childs locomotor system. This article reviews the current literature on the various musculoskeletal effects associated with obesity in children and adolescents. Effect of obesity on the musculoskeletal system The impact of obesity on the musculoskeletal system of the growing child is not fully understood. Most of the effects of obesity have been previously attributed to abnormal loading of the bone and joints; however, newer studies are showing that obesity affects the musculoskeletal system as a whole and may impede the overall function of the individual. Arthritis

Although uncommon in children, the development of arthritis has been traditionally linked with obesity [4043]. Studies have shown that obese children have twice the risk of developing obesity in adulthood [44]. Persistence of obesity may lead to the development of osteoarthritis in the weight bearing joints, particularly at the knee. Studies have shown a correlation between obesity and progression of knee osteoarthritis but not of the hip [45,46]. Although increased weight is a risk factor, it is not the sole cause in the development of osteoarthritis. Other risk factors in the development of osteoarthritis include joint alignment, previous injury and muscle weakness. Authors have implicated elevated inammatory markers, particularly the adipokine, leptin, which was noted to have a proinammatory and catabolic role on articular cartilage metabolism [47]. Because the end stages of osteoarthritis are involved in constant joint pain and joint inammation, it often leads to total joint replacement. A recent study by Harms et al. [48] found a strong correlation between high BMI and total joint replacements, especially in young adults. This study suggests that the high BMI imposes a greater risk of osteoarthritis in the lower weight-bearing joints, specially knee and hip, but, interestingly, not in ankles. Weight loss decreases serum leptin levels and has been hypothesized as one mechanism through which weight reduction increases overall function [49]. Although multiple factors are involved in the development of osteoarthritis, obesity is a potentially modiable risk factor; addressing obesity in the child may help improve the overall function of the individual at maturity. Summary The growing number of overweight and obese children continues to pose a serious health concern. In adults, the consequences of obesity have been well documented and have been known to be associated with multiple medical comorbidities, which presents as a global burden to healthcare. In children, the impact of obesity on the overall function and development of the growing child

has not been fully studied. The majority of studies in the literature have shown a structural effect associated with obesity. Association of childhood obesity with various musculoskeletal conditions such as SCFE and Blounts disease is documented in the literature; however, the specic effects of obesity on the overall function of the musculoskeletal system in the growing child remain unclear. At present, we are beginning to see studies emerging which do associate obesity with various musculoskeletal symptoms such as pain and decrease in function, increase in fracture risk and development of structural deformity; the evidence presented in the literature, however, is not concrete. As the obesity epidemic grows, newer studies will be needed to help us fully understand the true impact of obesity on the locomotor system of the growing child. http://www.nutrociencia.com.br/upload_files/artigos_download/musculo%20 efects%20of%20obesity.pdf

Excess weight, especially obesity, diminishes almost every aspect of health, from reproductive and respiratory function to memory and mood. Obesity increases the risk of several debilitating, and deadly diseases, including diabetes, heart disease, and some cancers. It does this through a variety of pathways, some as straightforward as the mechanical stress of carrying extra pounds and some involving complex changes in hormones and metabolism. Obesity decreases the quality and length of life, and increases individual, national, and global health care costs. The good news, though, is that weight loss can curtail some obesity-related risks. (1) Losing as little as 5 to 10 percent of body weight offers meaningful health benefits to people who are obese, even if they never achieve their "ideal" weight, and even if they only begin to lose weight later in life. Entire books have been written detailing the effects of obesity on various measures of health. This article briefly summarizes associations between obesity and adult health. Obesity, Depression, and Quality of Life The high rates of obesity and depression, and their individual links with cardiovascular disease, have prompted many investigators to explore the relationship between weight and mood. An analysis of 17 cross-sectional studies found that people who were obese were more likely to have depression than people with healthy weights. (17) Since the studies included in the analysis assessed weight and mood only at one point in time, the investigators could not say whether obesity increases the risk of depression or depression increases the risk of obesity. New evidence confirms that the relationship between obesity and depression may be a two-way street: A meta-analysis of 15 long-term studies that followed 58,000 participants for up to 28 years found that people who were obese at the start of the study had a 55 percent higher risk of developing depression by the end of the follow-up period, and people who had depression at the start of the study had a 58 percent higher risk of becoming obese. (18)

Although a biological link between obesity and depression has not yet been definitively identified, possible mechanisms include activation of inflammation, changes in the hypothalamicpituitaryadrenal axis, insulin resistance, and social or cultural factors. Studies of the effect of obesity on specific health outcomes such as diabetes or depression provide only a glimpse of the full impact of obesity on health and well-being. Health-related quality of life (HRQoL) integrates the effect of obesity (or any other condition) across physical, psychological, and social functioning. Although HRQoL is a relatively young field of research, a number of such studies have evaluated the overall impact of obesity. Among 31 studies in adults, the majority demonstrated that obesity was significantly associated with reduced HRQoL, compared with normal weight. (19) Researchers found a similar association among five HRQoL studies in children and adolescents. http://www.hsph.harvard.edu/obesity-program/resources/obesity-healtheffects/index.html