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Associations between childhood obesity and upper and lower extremity injuries
  1. Annette L Adams1,
  2. Jeffrey I Kessler2,
  3. Krikor Deramerian3,
  4. Ning Smith1,
  5. Mary Helen Black1,
  6. Amy H Porter3,
  7. Steven J Jacobsen1,
  8. Corinna Koebnick1
  1. 1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
  2. 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
  3. 3Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California, USA
  1. Correspondence to Dr Annette L Adams, 100 S. Los Robles 2nd Floor, Pasadena, California 91101, USA; annette.l.adams{at}


Objectives To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children.

Methods This cross-sectional study used information from electronic medical records of 913 178 patients aged 2–19 years enrolled in an integrated health plan in the period 2007–2009. Children were classified as underweight, normal weight, overweight, or moderately/extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated.

Results Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities.

Conclusions Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries.

  • Obesity
  • body weight
  • childhood
  • fractures
  • injuries
  • populations/contexts
  • child
  • youth
  • outcome of injury
  • pain
  • risk/determinants
  • body mass
  • adolescent

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  • Funding NIH-National Institute of Diabetes and Digestive and Kidney Disorders, grant no. DK085395.

  • Competing interests The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

  • Patient consent This study was exempt from consent requirements as it was observational only, using only data collected as part of routine healthcare encounters.

  • Ethics approval Ethics approval was provided by the Kaiser Permanente Southern California Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Information on the KPSC Children's Health Study is available at: Because the information contained in electronic health records is protected and confidential, it can be extremely difficult to exchange or share individual-level information. Therefore, individual-level information from several sources is usually managed, analysed and aggregated at the KPSC data center for projects with external collaborators. Active collaborations are welcome and the principal investigator of the study (CK) can be contacted for more information.