Tuesday, May 4, 2010

Children should gain weight to prevent head and face injuries!

I'm trying an experiment... This post didn't get much feedback so I am reposting with an attention-getting title. Sorry for those of you who already read this. Another post coming soon...

I recently picked up a medical journal. (April 2010, Journal of Pediatrics) Found this article:

Injury Patterns in Obese Versus Nonobese Children Presenting to a Pediatric Emergency Department.

Results section:
"Overall, obese and non-obese children had the same percentage of upper extremity injuries. However obese children were significantly more likely to have lower extremity injuries compared with upper extremity injuries than were non-obese children. In addition, obese children had significantly fewer head and face injuries than nonobese children.

"Obese children are significantly more likely to sustain lower extremity injuries than upper extremity injuries and less likely to sustain head and face injuries than nonobese children. Strategies for preventing lower extremity injuries among obese youth should be sought."

Read those two paragraphs again. When you hear about weight bias this is one example.

Here is the lay-media reporting on this article:
"Obese Kids Suffer More Leg, Foot, Ankle Injuries: Study " on Medicinenet.com
same headline on the NIH's website (National Instituet of Health) called Medline plus "Trusted Health Information for You." Babycanter.com reports "Obese kids suffer more leg, foot injuries, study shows" same for health.msn.com... Of the dozen or so articles on my quick search, two did mentioned the finding that obese children suffer from less head and face injuries...

Where to begin?
First off, the researchers themselves come to a biased and incomplete conclusion. I wonder, as head injuries are generally more severe than lower extremity injuries, were there also more deaths or permanent morbidity in the nonobese group? Then of course the lay media, without serious science journalists usually just picks up a press release without bothering to even read the actual study or even the synopsis and it gets picked up on hundreds of websites where the average reader gets one more dose of weight-based hysteria.

Imagine these headlines in an alternate universe– based on the same study results...

Nonobese children more likely to suffer serious head and face injuries!

Obesity in childhood protective of serious head and face injuries!

Children should gain weight to prevent head and face injuries!

Get a helmet for your child? Gaining weight might keep them safer!

Why your skinny child may be more at risk of dying-story at 11!

Just wanted to show one small example of how the data can be interpreted, picked up and reported by lay media. Why does the conclusion not also say, "Strategies for preventing head and face injuries in the nonobese population should be sought..." My guess is that childhood obesity is a hot topic right now. Lots of attention, lots of press, and maybe lots more funding for studies that focus on this issue...

What do you think? Does this make sense? Does it surprise, annoy you?


  1. Katja, this is Excellent. Oh the possibilities you bring up if we were to write different headlines. Thank you.

  2. I'm too lazy to research this but this tells us nothing. What kind of head /face injuries? Scratches? Concussions? Epidural hematomas? Coma? Death? What kind of leg/foot injuries? scratches? bruises? broken bones?

    Do the two groups have different activity levels? are non-obese children more likely to climb up a tree and fall down and hit their head than obese children? What are the kids doing when they get injured? What are we comparing?

    Meh to bad science.

  3. hasenpfeffer, I agree. I have yet to really pick apart the study. (Would take some time) I believe it was an analysis of just the billing information, so no specifics on how the injury happened. I agree that there could be explanations for the disparities. Setting aside the quality of the study for a moment, the analysis and reporting of the conclusions was interesting to me...

  4. 很以有啟發性的故事阿~感謝大大分享^^........................................

  5. The questions raised by hasenpfeffer are interesting. The study however, was just a retrospective epidemiologic (descriptive meaning no cause and effect, if I might add) study of medical records. Variables studied were age, chief complaint, discharge diagnosis (of injury), and demographics (like gender, race, 'disposition,' and weight). Disposition referred to what happened to the child like admitted to the hospital, trasnferred, etc. The activities the children were engaged in when the injury occurred was not recorded (a mistake, I think). Diagnosis of injuries included fractures, dislocations, sprains, strains, intracranial, intrathoracic, intraabdominal, and intrapelvic injuries and open wounds.

  6. So cracking your head open isn't a concern? This is another example of blaming every ill on obesity. Obese children don't need to be singled out and treated like they are diseased. Our children live in a profoundly unhealthy environment today that perhaps is causing some to be fat when they otherwise would not be, but focusing on that is preventing good health for all children.
    Assuming that the study is correct..gaining weight could be a symptom of malnutrition and lack of sleep and exercise. Maybe kids aren't eating enough good food or getting enough sleep at night and have no energy for play. No wonder kids like to sit and watch TV all day. If you aren't very active, you aren't going to develop strong bones, muscles and reflexes that will help prevent injuries like sprains.

  7. Thanks Heather! I like your point that losing our focus, or getting distracted detracts from achieving better health for all children!

  8. Thanks Katja, Ines. And now I want to see the actual study so I can grumble some more. Does anyone have a link?

    On the surface it sounds rather useless from pretty much any point of view. And I agree, it's not the useless study that's the problem (if I were to get upset about every useless study published even I would run out of steam) but the "slant".

    hasenpfeffer <------- will email the author with helpful comments if necessary. :-)

  9. Ok, I looked it up. Even my laziness has limits.

    Pediatrics, April 2010 issue, "Injury Patterns in Obese Versus Nonobese Children Presenting to a Pediatric Emergency Department Wendy J. Pomerantz, MD, Nathan L. Timm, MD, Michael A. Gittelman, MD"


    "Another interesting finding of our study was that obese children were significantly less likely to sustain head and facial injuries compared with the nonobese children. Two adult studies and 1 pediatric study showed similar results among obese trauma patients.10,25,26 In our patient population, the lack of head/facial trauma could be due in part to a lack of participation in activities that would put them at risk for head trauma. However, we did not evaluate the mechanism of injury in these children, so this conclusion is purely speculative as to the cause of this difference. Additional work will be needed to understand this variation."

    So ....yeah. That's what I would think. But speculation, indeed. And then:

    "There were several limitations of this study. First, this was a retrospective chart review of all patients who presented to a single PED. In this study we did not take into consideration either multiple injuries by the same patient or multiple visits by the same patients for different types of injuries. However, there is no reason to think that would result in a selection bias toward either the obese group or nonobese group, given that our percentage of obese children was consistent with national data.

    In addition, although the definition of obesity by the Centers for Disease Control and Prevention is based on BMI, we categorized the children on the basis of weight. This was also a result of the retrospective nature of the study and that documenting heights on children in our ED is not part of the medical record. We also divided our study population into 2 groups: obese and nonobese. We did not take into consideration the effects of overweight (85th to 95th percentile) and the influence that would have on affecting the nonobese population. In addition, some of the recorded weights may have been reported estimates by parents or medical providers and may not have been exact weights. However, there is no reason to believe that estimates were made more in 1 group than the other; therefore, they probably did not introduce bias.

    Finally, we did not evaluate the cause of the injury, whether it was sports related, a result of daily activities, or a result of other mechanisms. This information could provide insight into strategies for reducing these types of injuries."

    Ergo: this information is pretty darn useless.

    And this: "CONCLUSIONS Obese children are significantly more likely to sustain lower extremity injuries than upper extremity injuries and less likely to sustain head and face injuries than nonobese children. Strategies for preventing lower extremity injuries among obese youth should be sought."

    is simply weird. What about preventing head injuries in non-obese children? Those don't matter?

    Now I feel better.

  10. I feel better too Hasenpfeffer! Thanks for your effort!