Weighing on my mind

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The conductor moves down the aisle of the train. Two sets of keys jangle as he advances reminding me of Marley’s visit to Scrooge on Christmas Eve. In this case, the conductor’s antalgic gait is due to his own weight – evidenced by an abdomen that precedes the rest of his body. Imagine the stress on the joints of someone who spends his entire day striving to remain balanced while the moving train sways from side to side. And how much damage those extra pounds inflict.

Obesity is the next big thing for orthopaedics – literally. I’ve thought about this a lot recently as I watch a friend struggle to regain mobility after a fall; one which did not cause a fracture but required bed rest, for what seems like a short time. The event was momentary but the recovery continues, impacting all aspects of her life months after the fall.

So when offered an opportunity to write in these pages about something on my mind, I thought I would address the super sizing of people. Little did I know; I really know little about obesity. The causes are multifactorial, the solutions shift as research progresses, and the range of government and international groups working on interventions is staggering. What can I say that will not sound naïve or preachy?

As a nurse practitioner I care for many young adults with high BMIs at a time in their lives when they should be in prime physical shape. Unfortunately, statistics show childhood obesity is on the rise and my patients are only the advance guard of this trend. The World Health Organization projects that by 2015 approximately 2.3 billion adults will be overweight and more than 700 million will be obese (WHO, 2006). One third of children and adolescents in the US are overweight or obese and 70% of these teens become overweight/obese adults (Ludwig, 2007). Government sponsored reports in Canada, the UK, Australia and New Zealand all document increases in obesity rates over the last several decades. This pattern is reflected worldwide. At least 20 million children under the age of 5years were overweight in 2005 (WHO, 2006). Even in poorer countries, obesity exists alongside malnutrition. As the economic picture remains uncertain in many countries, job loss may translate to a less healthy, more fattening lifestyle.

Orthopaedic problems begin early for overweight children: slipped capital femoral epiphyses, Blount disease and increased susceptibility to ankle sprains are most evident (Wills, 2004). These same children will develop osteoarthritis as young adults, decades before prior generations.

Governments have launched wide ranging initiatives (e.g., Healthy Weight, Healthy Lives in the UK; Healthy Eating-Healthy Action in New Zealand) and professional organizations have added their voice and talents to a range of programs (e.g., Get Up, Get Out, Get Moving! from the American Academy of Orthopaedic Surgeons). The Royal College of Nursing sponsored a conference on obesity earlier this year and nurses are strong advocates for policy and practice initiatives (Berkowitz and Borchard, 2009). The issues are daunting and many factors are out of our individual control.

So, what can we do – when we seem to have so little time in our daily lives? Begin at home. For many of us that means evaluating our diet, limiting TV and computer time, and increasing physical activity. We can encourage our local communities and schools to take advantage of government sponsored programs and resources (e.g., US Center for Disease Control Physical Activity Guidelines for Americans). Professionally, we can support initiatives in the community that encourage active lifestyles and in the work setting that promote safe patient care while protecting healthcare workers from injury (National Association of Orthopaedic Nurses Safe Patient Handling Algorithms). Write to your elected officials; encourage them to support appropriate interventions and thank them when they do.

Musculoskeletal problems associated with obesity limit an individual’s possibilities. They restrict mobility and cause pain with the most basic activities, even for children. The world becomes a very small place; and how sad that is. We cannot solve the problem alone; but we can be part of the plan to intervene, to be part of the solution. What one thing can you do today?

Eat an apple. Take a walk. Bring a child or neighbor with you. Me – I’m on my way to an exercise class. I’ve gotten on the scale; and the result is weighing on my mind.

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References 

1. Berkowitz, B., Borchard, M., January 31, 2009. Advocating for the prevention of childhood obesity: a call to action for nursing. OJIN: the online journal of issues in nursing 14:1. <http://www.nursingworld.org> (accessed 01.08.09).
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2. Ludwig, D.S., December 6, 2007. Childhood obesity – the shape of things to come. The New England Journal of Medicine 357, 2325–2327.
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3. World Health Organization, 2006. Obesity and overweight. Fact sheet no. 311. <http://www.who.int/mediacentre/factsheets/fs311> (accessed 28.07.09).
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4. Wills M. Orthopaedic complications of childhood obesity. Pediatric Physical Therapy. 2004;16:230–235
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