TORONTO - Children with developmental co-ordination disorder have a greater likelihood of being overweight or obese than their classmates, a study of close to 2,000 Ontario schoolkids suggests.
And experts say it would make sense to identify these youngsters early to intervene and prevent weight issues from developing and leading to the possibility of Type 2 diabetes and other health problems years down the road.
The condition used to be called clumsy child syndrome and is often identified when kids have ongoing difficulties with tasks such as tying shoelaces, doing up buttons and zippers, writing legibly and taking part in some physical activities.
"These are the children who tend to fall down and injure themselves a lot around the home and schoolyards," said Prof. John Cairney of the department of family medicine at McMaster University in Hamilton.
"These are kids who don't just struggle with sports. That's the tip of the iceberg. They struggle with the things that are required to do fundamental movement, which impacts sports, but it also impacts just about everything we do in day-to-day life."
Cairney and his colleagues reported their findings Monday in the Canadian Medical Association Journal, after following 1,979 students from Grade 4 to Grade 7 at 75 schools for two years.
Parents gave permission, and the researchers measured body mass index and waist circumference twice a year for two years, and also gave the children standardized tests used by occupational therapists to identify possible DCD.
For instance, the children were timed to see how long it took them to do a tracing exercise that was almost like a maze, and they would have to jump in the air and clap three times while they were jumping -- as well as perform other tasks designed to get a sense of their balance, co-ordination, movement and musculature, Cairney said.
For purposes of the study, children scoring at or below the fifth percentile were considered to have developmental co-ordination disorder.
"We expect them or anticipate that they won't be as physically active because of their co-ordination difficulties, and that that may lead to things like greater risk for obesity, greater risk for poor physical health across the board," Cairney said.
"What nobody had done until this study was follow the same group of kids, a large group of children over time to see if what we had seen in one-off studies actually held over time, and whether or not the risk actually increases, and that was in essence what we found."
They identified 111 children -- 46 boys and 65 girls -- who had possible DCD. These children had a higher mean BMI and waist circumference when the study began than the other kids, and the differences persisted or increased slightly over time, the paper said. Odds of a child with DCD being overweight were about three times as much as for a child without the disorder.
Cairney's concern is that DCD is under-recognized, and he hears from parents whose requests for help are dismissed by doctors and others who say that "not all children are gifted athletes" or "don't worry about it, the child will grow out of it."
"The data like this that we've been amassing suggests otherwise. These kids are at greater risk for a lot of health concerns," Cairney explained.
"Obesity is the focus of this paper, but there are other papers which have documented other health concerns, and we think it's time for this group to be recognized and taken seriously for the sort of struggles they have, and the consequences of those struggles."
Prof. Scott Montgomery, an expert in neurological associations with obesity, said the study adds to evidence that children with co-ordination problems are more likely to have excess weight gain than children with better co-ordination.
"This is important because it tells us they may be more likely to suffer unhealthy consequences later in life because of their obesity and because of these pre-existing deficits," he said from Sweden, where he is a professor of clinical epidemiology at Orebro University Hospital.
Montgomery, who wrote a commentary in the journal, noted that Cairney's study focused particularly on whether this poor co-ordination meant that children were less likely to get involved in sports or less likely to exercise.
"I think that's true, but I don't think that's the whole explanation."
Disadvantages in living conditions, such as unhealthy choices in food and lifestyle, have implications for development starting off in the womb and continuing through childhood, he noted.
Montgomery said he's been working with three-year-olds and has seen that mothers who are highly stressed have children more likely to have unhealthy weight gains as early as three years of age.
"Stress can influence behaviour ... We've seen mothers who are more stressed, (with) the children with unhealthy weight gain, are more likely to leave their children as young as three years old in front of the television for many more hours a day, presumably because they have problems coping with what's going on," he said.
"If we're going to fight obesity and some of its complications, interventions have to be at an early age, with the possibility of improving life in old age."
Cairney is concerned that a trend indicating increased risk for obesity among those with DCD isn't likely to go away without intervention, and this subset of the population may be at risk for cardiovascular disease.
Those trying to solve the pediatric obesity problem don't typically take into account problems with motor skills, instead offering up solutions like more physical activity or ParticipAction, he noted.
"Well, this is not the kind of population or public health intervention that's going to work with these kids. Telling them to get out and be active is not the solution to the problem, so we have to address their underlying motor abilities first, and then work to remediate some of these physical health concerns."
