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Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records


Objective To assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity.

Design Longitudinal

Setting 285 north-east London general practitioners (GPs).

Participants 63 418 (50.9% boys) Reception and 55 364 (50.8% boys) Year 6 National Child Measurement Programme (NCMP) participants, linked to GP electronic health records (EHRs).

Main outcome measure A GP consultation with a recorded musculoskeletal symptom or diagnosis.

Methods We calculated proportions with a musculoskeletal consultation by ethnic-adjusted weight status (underweight <2nd; overweight ≥91st; obese ≥98th centile), sex, ethnicity, and area-level deprivation. We estimated mutually-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) using Cox’s proportional regression models stratified by school year and sex.

Results We identified 1868 (3.0%) Reception and 4477 (8.1%) Year 6 NCMP participants with at least one musculoskeletal consultation. In adjusted analyses, Reception year girls with a body mass index (BMI) classified as overweight (HR 1.24, 95% CI 1.02 to 1.52) or obese (HR 1.67, 95% CI 1.35 to 2.06) were more likely to have at least one musculoskeletal consultation. Year 6 girls with obesity were more likely (HR 1.20, 95% CI 1.07 to 1.35), and boys with a BMI in the underweight range were less likely (HR 0.39, 95% CI 0.21 to 0.73), to have a musculoskeletal consultation.

Conclusions Girls living with obesity at the start or end of primary school are more likely to attend their GP for a musculoskeletal consultation. Routine linkage of NCMP data to EHRs provides useful insights into childhood health conditions related to excess weight in early childhood. Recognition of obesity as a contributing factor for musculoskeletal symptoms may inform clinical management, particularly in girls.

  • Obesity
  • Child Health
  • Primary Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available. NCMP data were accessed under data processing agreements with each of the local authorities as data controllers in line with Public Health England guidance. These agreements preclude onward sharing of data. Access to general practice data is enabled by data sharing agreements between the Discovery Data Service and general practice data controllers. The Discovery Programme Board has approved data access by the REAL Child Health programme team for research on the condition that it is not onwardly shared.

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