Role of Physical Exercise in Prevention and Treatment of Childhood Obesity

Role of Physical Exercise in Prevention and Treatment of Childhood Obesity

Globally, childhood obesity is one of the main public health issues of concern. The prevalence of the condition has increased steadily since 1970s. The World Health Organization (2021) estimates that between 1975 and 2016, the prevalence of obese and overweight children in the world increased from 4% to 18%. In 2019, there were more than 38 million overweight or obese children below the age of five. According to UNICEF, as reported by Global Alliance for Improved Nutrition (2019), over 43 million children under age 5 are expected to be overweight by the year 2025.

Childhood obesity is defined as a body mass index (BMI) which is ≥ 95^th percentile for children’s age cohort (CDC, 2020). The condition is characterized by accumulation of body fat as a result of an imbalance between consumed and expended energy. Previously, childhood obesity mostly affected high-income nations. Today, both low and middle-income countries also have high rates of the epidemic. According to the World Health Organization (2021), the rate at which the condition increases in the developing countries is 30% higher than in developed nations.

Although childhood obesity prevalence is increasing at an alarming rate around the world, the condition is manageable. Changes in lifestyle habits and behaviors play a crucial role in the prevention and treatment of this health problem. The purpose of the current evidence-based practice (EBP) research paper is to examine whether physical exercise is effectual in reduction of BMI among obese children as compared to non-intervention strategies.

1. Impact of a Clinical Practice Problem on Patient(s) and Organization It Affects

Childhood obesity is associated with a severe impact on health and economy. In terms of health, the problem puts the patient at high risk for various diseases some of which are the leading causes of morbidity, mortality, and disability. These include high blood pressure, cardiovascular disease, type 2 diabetes, asthma, fatty liver disease, and joint problems (CDC, 2020). Apart from physical health problems, the condition is also linked to psychological problems such as depression, anxiety and low self-esteem (CDC, 2020). Childhood obesity is as well a predictor of adulthood obesity (Di Cesare et al., 2019). An obese child is more likely to experience the same health problem during adulthood.

Childhood obesity also has harmful economic consequences. It affects not only the healthcare organization, but also children’s productivity. In the healthcare sector, childhood obesity leads to high healthcare costs. The cost of the care for this condition varies from one country to another. For example, it is estimated that the United States spends around $14 billion yearly on direct medical costs associated with the condition. China is expected to spend more than 5% of its gross national product (GNP) on the health problem by the year 2025 (Finkelstein, et al., 2014; Shekar & Popkin, 2020). Childhood obesity also reduces the productivity of children. (Shekar & Popkin, 2020). This is due to disability and prolonged morbidity associated with this problem.

1. PICO Components of the Clinical Practice Problem

EBP often uses the PICO formula in addressing various health problems of patients. This approach enables nurses to make use of research evidence in evaluating and assessing clinical conditions (Christenbery, 2018; LoBiondo-Wood et al., 2018). The PICO statement comprises information about the population, patient, or problem under consideration (P), intervention used (I), comparison group (C), and the outcome that is expected (O).

Patient/Population/Problem (P)

The prevalence of obesity among children is high globally. According to the World Health Organization (2021), the world had over 340 million obese or overweight children and adolescents aged between 5 and 19 in 2016. This state of affairs makes childhood obesity an issue that has caught the attention of government agencies, non-governmental organizations, and policymakers.

Intervention (I)

As noted earlier on, childhood obesity is preventable through lifestyle changes. It has been established that evidence-based interventions that help to prevent and treat the condition can help in addressing it (Vine et al., 2013). One of such interventions is the use of physical exercises. These include weight training, running, swimming, cycling, and other physical activities that involve some form of exercising.

Comparison (C)

As part of a healthcare multidisciplinary team, nurse practitioners play a significant role not only in provision of care, but also in promotion of health. Nurses help to prevent childhood obesity as part of health promotion effort (Vine et al., 2013; McGrath, 2017). This is achieved through various lifestyle change programs that seek to promote healthy physical activity and good dietary habits.

Outcome (O)

Most of the interventions that are used in addressing the issue of childhood obesity seek to enhance unhealthy lifestyle behavior change. There is need to promote interventions that promote weight reduction, sustainable adjustments, and cost-effective changes (McGrath, 2017). This undertaking will help to ensure that the condition is effectively combated.

2. Evidence-Based Practice (EBP) Question

For the purpose of this research work, the following EBP question was adopted:

• For obese children (P), is physical exercise more effectual (I) than non-intervention approaches (C) in reducing BMI (O) within a short period of time?

1. Research-Based Article that Answers the EBP Question

The following research-based article can help in answering the above EBP question:

“Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children with Obesity or Normal Body Mass” by Tan et al (2016)

1. Background

Tan et al (2016) view childhood obesity as a public health problem of major concern globally. According to the researchers, the condition interferes with body fitness and muscle flexibility. The purpose of this study was to investigate the effectiveness of exercise training in promoting physical fitness, body composition, and cardiovascular function among 5-year-old obese and lean children.

2. Research Methodology

The study derives from a randomized controlled trial (RCT) study design. the researcher sampled 104 lean five-year-old lean and obese children from three kindergartens in Tianjin City, China. 42 obese participants were randomly allocated into the intervention group, while 62 lean participants were assigned into the control group. During the study, the intervention group was subjected to 10 weeks exercise training. Body composition, physical fitness, and cardiovascular function features were measured in the baseline phase and during the intervention period.

3. Level of Evidence

The article provides level I evidence as per the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. This is due to the fact it involves a RCT. Other types of research evidence in the same level include systematic reviews of RCTs, and experimental studies (OHSU, 2019). These studies provide quality data that can be relied upon in making generalized conclusions that are valid.

4. Analysis of Data

The collected data from Tan et al (2016)’s article was analyzed using statistical analyzes. A student t test was used to compare differences in variables measured between obese children and the lean ones during baseline. Intervention effects were tested using the split plot analysis of variance (SPANOVA). Mean ± SD was used to present all values, and a p < .05 statistical significance was applied. All the data was analyzed with the aid of Statistical Packages for Social Scinces (SPSS) Version 21.

5. Ethical Considerations

The researchers observed important ethical considerations in their study. Prior to the research, they sought written informed consents from the parents of the children involved in the study. This is due to the fact that the research involved minor participants. The investigators also sought approval for their research work from Tianjin University of Sport’s Ethics Committee.

6. Quality Rating

In terms of quality rating based on the JHNEBP model, the article is of high quality. Articles that belong to the high quality category tend to consistent, and they contain generalizable results. Such articles are based on sufficient study designs, and they involve adequate control groups (Dang et al., 2018). This article meets all these requirements.

7. Results/Conclusions, and How the Article Helps to Answer the EBP Question

From the results of the study, it was found that exercise training promoted reduction of BMI, body fat, and circumference waist among both trained obese and lean children. Among obese children, the training helped to decrease their heart rates by lowering systolic blood pressure. On the other hand, this training enabled lean children to improve in various physical fitness activities. It was concluded that exercise training is a safe and effective method of treatment for 5-year-old children with both obese and normal body mass.

This article answers the EBP question effectively since it involves all the components of the PICO statement adopted. The population considered here is that of children who are living with obesity. Exercise training is the intervention adopted. The effect of the intervention is compared with non-interventional approach. The expected outcome is improvement in body composition, cardiovascular functioning, and level of physical fitness. From the results, findings, and conclusions of the study, it is affirmed that the adopted intervention indeed helps in the achievement of the outcome expected among the members of the targeted population compared to the comparison group.

1. Non-Research Article for Answering the EBP Question

The following non-research article can be useful in answering the above EBP question:

“Exercise in the Treatment of Childhood Obesity,” by Bulbul (2020)

1. Background

According to Bulbul (2020), time that children spend on physical activities in a day has reduced as a result of changing lifestyles. This situation has led to an increase in prevalence of childhood obesity. The treatment of this condition is difficult due to non-compliance. However, physical activity, nutritional regulation, and psychological support can help to foster treatment adaptation. The researcher observes that although dietary therapy is important for reduction of body mass, there is need to combine it with physical activity. Physical exercise promotes weight loss through maintenance of non-fat body mass. The purpose of this paper is to examine the role of exercise therapy in the treatment of obesity among children.

2. Type of evidence

The type of evidence this article contains belongs to the category of clinical practice guidelines. Such evidence is basically in form of statements and recommendations meant for optimization of patient care. Clinical practice guidelines derive from systematic reviews of available evidence. The guidelines often involve the assessment of the strengths and weaknesses of alternative options of care (Institute of Medicine & Graham, 2011). This article contains valuable information on the benefits of exercise in the management of childhood obesity. It gives useful suggestions on the type of exercise activities suitable for children, how to plan them, and when to effect them.

3. Level of Evidence

Based on the JHNEBP model, the article provides level IV type of evidence. This level of evidence comprises opinions of reputable authorities, expert committees that are recognized at the national level, and well known panels’ consensus. It is often based on scientific evidence (OHSU, 2019). Bulbul (2020)’s article meets the criteria.

4. Quality Rating

When it comes to quality rating, the article can be ranked as being of high quality using the criterion of JHNEBP. Non-research articles are said to be of high quality when the material they contain is officially sponsored by public, private or professional organizations. Such articles also contain strong scientific evidence, and are not more than five years old (Dang et al., 2018). This article is supported by National Center for Biotechnology Information (NCBI). It was published in the year 2020.

5. How the Author’s Recommendations Help to Answer the EBP Question.

Bulbul (2020)’s article contains important recommendations that one can use to answer the EBP question stated above. The population that the author is concerned with is one of children who are obese. While the intervention is exercise, lack of intervention is the comparison group. Loss of is the outcome that is expected. The researcher recommends that short-term frequent exercises can play an important role in the treatment of obesity among children. This treatment should begin early enough in life in order to enhance compliance, and behavioral effectiveness. Additionally, the exercise should be planned based on children’s characteristics such as sex and age.

1. Recommended Practice

I recommend the use of school-based physical exercise in addressing the EBP identified above. This practice change will involve provision of fun and pain free exercises to overweight, obese, and healthy children. These may include simple exercises such as running, jumping, skipping, stretching, squatting, and dancing. Exercise is vital since it helps to reduce body fat and BMI (Tan et al; 2016; Bulbul, 2020). Thus, the approach will help in effective management of the problem of childhood obesity.

1. Involvement of Key Stakeholders

EBP recommends the adoption of a multidisciplinary approach in health promotion (Christenbery, 2018). Therefore, there is need to involve relevant stakeholders who can help to support school-based physical exercise for children. One of such stakeholders is the healthcare system. This sector can be engaged to provide school-based healthcare nurses and other care providers who can steer the program and provide health expertise. Another stakeholder that can be engaged is the education sector. The sector can provide physical education teachers who can play an active role in implementing the physical exercises in their schools. Another important stakeholder that cannot be left behind is the government. This stakeholder can provide important equipment that children can use to exercise in school.

2. Barrier in Implementing the Practice Change

One of the barriers that are likely to be encountered in the implementation of the recommended practice change is financial constraints. Recruitment of school nurses and physical education teachers requires financial resources. The same case applies to procurement of physical activity equipment (Khan & Bell, 2019). Therefore, unless there is enough money, it may be difficult to successfully implement the school-based physical exercise program.

3. Strategy for Overcoming the Barrier

The problem of financial constraints can be addressed if other stakeholders such as parents are involved. Parents need to be sensitized on the importance of physical activity in the treatment and prevention of childhood obesity (Khan & Bell, 2019). This will help them to realize the importance of supporting a school-based program on the same. They can do so by donating money that can be used to purchase equipment that children need for exercise.

4. Outcome to Measure the Recommended Practice Change

The recommended practice change is expected to promote weight loss. Childhood obesity is mainly caused by accumulation of body fat as a result of inactivity and poor eating habits (Di Cesare et al., 2019). This leads to gaining of excessive weight. Involvement in physical activity helps in reducing the fat (Tan et al; 2016). Therefore, a school-based program involving physical exercise is an important intervention that can be used in enhancing the outcome of reduced BMI among obese children.

References:

Bulbul, S. (2020). Exercise in the Treatment of Childhood Obesity. Turk Pediatri Ars., 55 (1): 2–10. doi: 10.14744/TurkPediatriArs.2019.60430

Center for Disease Control and Prevention (CDC). (2020). About Child & Teen BMI. Retrieved from https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Christenbery, T. L. (2018). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles. New York, NY: Springer Publishing Company.

Dang, D., Dearholt, S., Sigma Theta Tau International & Johns Hopkins University. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model And Guidelines. Indianapolis, IN : Sigma Theta Tau International.

Di Cesare, M., Soric, M., Bovet, P., Miranda, J., Bhutta, Z., Stevens, A. S., Laxmaiah, A., Kengne, A. & Bentham, J. (2019). The Epidemiological Burden of Obesity in Childhood: A Worldwide Epidemic Requiring Urgent Action. BMC Med, 17 (212). https://doi.org/10.1186/s12916-019-1449-8

Finkelstein, E., Graham, W. C. K. & Malhotra, R. (2014). Lifetime Direct Medical Costs of Childhood Obesity. Pediatrics, 133 (5).DOI: 10.1542/peds.2014-0063

Global Alliance for Improved Nutrition (2019). By 2025, 43 Million Children Under the Age of Five will be Overweight. Retrieved from https://nutritionconnect.org/news-events/2025-43-million-children-under-age-five-will-be-overweight

Institute of Medicine (U.S.). & Graham, R. (2011). Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press.

Khan, M. & Bell, R. (2019). Effects of a School Based Intervention on Children’s Physical Activity and Healthy Eating: A Mixed-Methods Study. International Journal of Environmental Research and Public Health, 16 (22): 4320.DOI: 10.3390/ijerph16224320

LoBiondo-Wood, G., Haber, J. & Titler, M. G. (2018). Evidence-Based Practice for Nursing and Healthcare Quality Improvement – E-Book. Mosby.

McGrath, S. M. (2017). Childhood Obesity Comorbitities Awareness Hospital-based Education. Unpublished Doctoral Dissertation, Minneapolis, Washington: Walden University.

OHSU. (2019). Johns Hopkins Nursing EBP: Levels of Evidence. Retrieved from https://libguides.ohsu.edu/ebptoolkit/levelsofevidence

Shekar, M. & Popkin, B. (2020). Obesity: Health and Economic Consequences of an Impending Global Challenge. Human Development Perspectives. Washington, DC: World Bank. https://openknowledge.worldbank.org/handle/10986/32383 License: CC BY 3.0 IGO.”

Tan, S., Chen, C., Sui, M. & Xue, L. (2016). Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children with Obesity or Normal Body Mass.Pediatric Exercise Science, 29 (2): 245-253. https://doi.org/10.1123/pes.2016-0107

Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic-And Community-Based Recommendations and Interventions. Journal of obesity.

World Health Organization. (2021). Obesity. Retrieved from https://www.who.int/health-topics/obesity#tab=tab_1