| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
TRACK to:
|
|
Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Barriers to physical activity are afoot for overweight youth
A new insight
The locomotor system exam in the young obese population
Comment on article
|
|
|||
|
Anne L. Dunlop, Atlanta, USA Asst Professor of Family Medicine, Emory University School of Medicine, Divya Narayan
Send response to journal:
|
The work by Krul et al. (1) demonstrates that overweight and obese youth experience musculoskeletal problems more often than do children of healthy weight, and are more likely to seek physicians’ care for their lower extremity problems, suggesting an increased severity of their problems. As the study is cross-sectional in nature, it is not possible to discern whether the musculoskeletal problems contribute to lower activity levels that in turn contribute to overweight and obesity, or whether excess body weight brings about the musculoskeletal problems for the study sample. However, existing studies show that obesity, particularly during the growth period, places high levels of stress on bones and joints that may result in joint damage and, ultimately, contribute to osteoarthritis in later years (2). Regardless of whether excess body weight begets musculoskeletal problems or musculoskeletal problems beget excess body weight, an important clinical implication of the study is that musculoskeletal problems may present an additional barrier to initiating and sustaining recommended levels of physical activity for overweight youth – an important means of achieving and maintaining a healthy body weight. Those who provide health care to overweight youth should be cognizant of this and other important barriers to physical activity for these overweight youth, including the following: 1. Obesity appears to play a role in airway hyperresponsiveness and asthma severity. Both asthma prevalence and severity are increased in obese persons (3). In fact, obesity seems to play a role in irreversible airway remodeling. In children, the mechanical load of obesity results in smaller lungs and reduced pulmonary function. For youth, weight loss improves lung function but does not affect airway hyperresponsiveness (4). For adults, when morbidly obese asthma patients lose weight, there is a decrease in asthma symptoms and severity (5). Among inner-city children, there is a high concordance between asthma and obesity (6), and obesity is a strong predictor of the persistence of childhood asthma into adolescence (7). Studies also demonstrate that youth with asthma have lower levels of physical activity in comparison to youth without asthma, and that activity level of youth with asthma is related to disease severity as well as parental health beliefs (8,9). 2. Youth who are overweight or obese have lower participation in sports and less positive attitudes toward physical activity (10). In addition, there is a strong correlation between parents’ attitudes and participation in physical activity and children’s attitudes and participation in physical activity (11). 3. Peer victimization and childhood depression are negatively associated with physical activity among overweight youth (12). In particular, depressive symptoms and loneliness mediate the relationship between peer victimization and physical activity (13). 4. For overweight youth, particularly overweight girls, body-consciousness and concern about others seeing their bodies while being active are among the most frequently reported barrier to physical activity (14). Clinicians should bear in mind these barriers to physical activity and effective strategies to increase physical activity when counseling and making recommendations for physical activity for overweight youth. For adolescents, multicomponent interventions (those with an educational component as well as an environmental or policy component) and interventions that include both school and family or community involvement have the potential to make important differences to levels of physical activity, and should be promoted. Notably, the environmental or policy element of the effective multicomponent interventions mostly consisted of alterations to the school-based physical education program or the availability of additional equipment. While it should be noted that research in this area is lacking, especially for children (15), counseling and behavioral strategies to promote physical activity for overweight youth might include the following: 1. Inclusion of the children’s parent(s) in role modeling physical activity, and counseling of the parents regarding the importance of their attitude regarding physical activity. 2. Assisting the child and his or her family to choose activities that they enjoy and in which they can take part in settings and attire comfortable to the child. 3. Consideration of body-related barriers, including musculoskeltal problems and self-consciousness, for a particular child and assistance in identifying activities and venues that might minimize bodily discomfort or harm and self-consciousness. There is limited research to suggest the particular type of physical activity that might be most effective for achieving a healthy body weight and most acceptable for the child. However, activities such as walking, stationary biking, or cycling may be a good starting point since they may be more comfortable for the child physically and psychologically. 4. Evaluation of exercise tolerance and airway hyperresponsiveness with institution of appropriate therapy and counseling regarding the benefits of exercise for those with elevated body weight. 5. Inclusion of a psychosocial component to address coping with peer victimization and depressive symptoms. In addition to achieving a healthy body weight, there are other reasons for promoting physical activity among all youth, including those who are overweight or obese. The regular participation in physical activity is recognized as an essential component of a healthy lifestyle (16). Specifically, physical activity in childhood is associated with the prevention of the later development of chronic disease and improvement of psychological wellbeing (16,17). Among adolescents and teens, increased physical activity is followed by an improvement in self-esteem and a reduction in anxiety (18). Given the higher rates of depression and psychosocial stress among children who are overweight and obese, improvement of psychological wellbeing may be particularly important for overweight youth. Finally, recent research links increased physical activity and improved academic performance in the school setting. In recent years, many school systems have reduced or eliminated physical education under the assumption that more classroom instructional time will improve academic performance and increase standardized test scores. However, the available evidence today contradicts this view (19). Studies suggest that allocating more curricular time to physical activity does not negatively affect academic achievement, even when time for other subjects is reduced (20). In fact, some studies suggest a relative increase in academic performance, (20,21) and a positive influence on concentration and memory (22) and classroom behavior (20). Advocating for the inclusion of physical activity, particularly “lifestyle physical activity” in the daily experiences of our youth is a way in which physicians can address another important barrier to physical activity, i.e., the lack of opportunity to be active. References:
Competing interests: None declared |
|||
|
|
|||
|
Remy A Hirasing, Amsterdam, the Netherlands Professor in Youth Health Care, EMGO institute, Free University Medical Center, Amsterdam, Luuk Schwiebbe
Send response to journal:
|
This article is one of many research projects about childhood overweight and obesity. A lot of studies are so called ‘me- too’ studies and are just showing similar results as previous ones. These are of minor importance to the scientific state of affairs and (for) the daily practice of health care workers. However, this research is inventive and the results are valuable. Even though existing data from 2001 has been used, the results are adding scientific knowledge on this topic. Musculoskeletal problems of the lower extremities are more prevalent among overweight and obese children compared to normal weight children. This should be taken into account by professionals involved in treatment and prevention of overweight and obese children. Physical activity plays a major role in the treatment and prevention of overweight and obesity [1]. Musculoskeletal problems make active behaviour more difficult. Health care workers should check if these problems exist in their patients before treatment is started. In the Netherlands, the development of over 90 % of the children is monitored by the Youth health care system [2]. Children diagnosed with overweight are treated according to ‘the transitional plan for the treatment and prevention of overweight’ [3]. A major aspect of this program is increasing the levels of physical activity of these children. This program does not take musculoskeletal problems into account. When health care workers, especially within the setting of the Youth Health Care system, encounter a child with overweight explicit questions about musculoskeletal problems should be asked. If they are present, a tailor made intervention could be provided to this child that does not increase the amount of musculoskeletal problems and prevent new problems from arising. If not, attention should be paid to prevent musculoskeletal problems in these children. This research has provided a new insight that attention should be paid to musculoskeletal problems in overweight and obese children. For prevention and treatment it is important to take these problems into account. Future research should address the difference in effectiveness between existing interventions like the ‘transitional plan for treatment and prevention of overweight’ and a tailor made version of this plan which takes the existence of musculoskeletal problems into account. References
Competing interests: None declared |
|||
|
|
|||
|
Ana Lucia S Pinto, Sao Paulo - Brazil Paediatrician, Sports Medicine Group, Rheumatology Department, University of Sao Paulo
Send response to journal:
|
There are still few data regarding the relationship between BMI and musculoskeletal pain. This study reinforces how important is a detailed locomotor system exam in the young obese population in order to detect early alterations that could negatively impact their future quality of life. Competing interests: None declared |
|||
|
|
|||
|
Stewart C Morrison, London, United Kingdon Senior Lecturer in Podiatric Medicine, University of East London
Send response to journal:
|
Marjolein Krul and colleagues have presented an interesting study which enhances current understanding on musculoskeletal problems in overweight and obese children. The foot and lower limb are prone to musculoskeletal pathology and this work (albeit with limitations) is a welcome addition to the literature, particularly as the foot is an often neglected part of the body. This research highlights some key findings and raises the concern of whether obesity and musculoskeletal pathology are barriers to engagement with physical activity. It is evident that further work is essential to further consolidate our understanding of the impact of excessive body mass on the child’s musculoskeletal system and to direct and enhance the specialist assessment and management available to these children. Competing interests: I am the lead author of one of the cited articles. |
|||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
TRACK: