New study shows leap in cases of painful disorder

SCOTLAND'S obesity crisis has led to the number of children suffering from a painful hip disorder almost trebling in the past two decades.

A new study has revealed that cases of slipped capital femoral epiphysis (SCFE) - which is normally treated by major surgery - have risen over the last 20 years, linked to a dramatic increase in obesity levels.

While the condition is rare in children under eight years old, the findings show that more cases were diagnosed in this age group between 1991 and 2000, compared with the previous decade.

Experts said the research highlighted the immediate impact that being overweight can have on children's health, as well as concerns over conditions such as diabetes and heart disease developing in the future.

Symptoms of SCFE - which can either appear gradually or suddenly - include hip or knee pain, with the child left unable to walk in the most severe cases. It appears during periods of accelerated growth in adolescents and is a separation of the ball of the hip joint from the thigh bone at the growth plate of the bone, which causes it to slip.

Study co-author Neil Wilson, consultant orthopaedic surgeon at Glasgow's Royal Hospital for Sick Children, said being overweight was a known risk factor in SCFE, which usually requires surgery using pins to stabilise the hip.

"With so much talk about everybody getting obese I thought it would be interesting to see if there has been a change in the incidence of this not very common condition," he said. "It is one of the most obvious things that the forces in heavy people on that area, during the period they are finishing their growth, will result in this condition happening.

"We weren't sure enough to know if the effect would show up, but it is clear enough that these two are associated and they have steadily gone up over that time," he added.

The study, published in the Journal Of Bone And Joint Surgery, found that the incidence of SCFE in Scotland showed a two-and-a-half times increase, from 3.78 per 100,000 children in 1981 to 9.66 per 100,000 in 2000. During that time, the average age of diagnosis fell from 13.4 to 12.6 years old in boys and from 12.2 to 11.6 years old in girls.

Although the condition is rare in younger age groups, seven cases were diagnosed in children aged six to eight between 1991 and 2000, compared with just two the previous decade.

While surgical treatment for minor "slips" which are identified early is relatively successful, the study warns that the outcome for more severe cases is often poor, despite treatment. Long-term damage from SCFE can include loss of motion in the hip and arthritis.

The researchers concluded: "The data presented here show that the increasing prevalence of obesity in Scottish children has been matched by an increase in the incidence of SCFE. This may be a previously unrecognised consequence of increasing childhood obesity, but one which adds a yet greater incentive to tackle the obesity epidemic."

Dr Ian Campbell, medical director of the charity Weight Concern, said the study was a "salient reminder" of the impact obesity can have on child health.

"There is no question that this is a major orthopaedic complication that no-one would wish on their children," he said. "Tomorrow's fat adults were, in the main, fat children and the sooner we start intervening the better.

"This needs to start at home, but be supported by government, industry and the educational system."

Dr David Haslam, clinical director of the National Obesity Forum, pointed out the condition would prevent children from participating in day to day activities, such as sport.

"We all hear about issues such as diabetes and a 10-year reduction in life expectancy, but these are all so far down the line that most kids don't care less about it," he added.

Dietician Laura Stewart, who runs the Children's Weight Clinic in Edinburgh, agreed both parents and children often did not appreciate obesity could have short-term consequences. Other conditions caused by obesity which impact on children include sleep apnoea, which causes irregular breathing at night.

"What tends to happen is their sleep pattern can be disturbed," she said. "This can affect them during the day at school, with not being able to concentrate and being very tired from not getting a good night's sleep."