PICOT Question: Impact of Exercise on Body Mass Index in Children with Obesity

PICOT Question: Impact of Exercise on Body Mass Index in Children with Obesity

1. Introduction

Even though several children develop childhood obesity due to epigenetics predisposition, the current prevalence of the condition could be blamed on poor human lifestyle, characterized by a lack of routine exercise and poor nutrition habits. In an ideal health condition, a typical child should have a BMI of between 18.5 and 24.9.  A child with a BMI less than the given limit is said to be underweight while anyone with more than 24.9 is said to be overweight. Any individual, regardless of age, with a BMI of more than 30, is considered obese. Being obese is, though, not harmful to a person but could predispose them to other deadly conditions such as heart diseases, some cancers, diabetes, and hypertension. This paper examines and describes various aspects related to childhood obesity. The reader is meant to understand the PICOT question, mainly the intervention section, as it relates to childhood obesity, epigenetics, BMI, and physical exercise.

2. Description of the Clinical Problem
3. The PICOT Question

In children with a predisposition to obesity due to epigenetics, how can exercise intervention impacts their BMI, compared to children with a predisposition to obesity due to epigenetic that do not participate in an exercise intervention, for six months? This PICOT question can be simplified as follows:

1. Importance of the Problem to the Nursing Practice

While it’s easy for nurses to devise interventions to remedy obesity caused by lifestyle modifications, it is a challenge for them to initiate strategies that can limit childhood obesity predetermined by epigenetics. An individual could sometimes become obese, not because of the excess fats and calories that they have consumed, but due to inherent genetic factors that the person has been predisposed to. Controlling such a unique form of obesity requires the nurse to understand the potential biomarkers before the BMI of a child is considered obese (Symonds, Sebert, and Budge, 2011). In other words, nurses could better devise interventions to prevent obesity if they understood the various factors that could predispose children to the condition.

• Discussion of the chosen Outcome

Obesity and overweight are the chief public health problems in adolescents and children across the world. Various interventions to reduce the incidence of the conditions around the globe have been devised, routine physical exercise being one of them. A study conducted by Kelley, Kristi, and Pate showed that taking part in exercise significantly enhanced the BMI z-scores of adolescents and children. By taking part in physical activity, adolescents and children increase their overall energy expenditure, which help them to reduce weight and maintain a healthy and balanced energy level. Another critical function of physical exercise is to reduce the amount of fats in the body, especially around the waist. Body fats account for a significant quantity of an individual’s weight, and reducing it could be an essential step towards lowering the risk of obesity.

1. Impact of the Intervention on the Outcome

Epigenetics play a critical role in the .two highlighted functions of physical activity in reducing the risk of obesity. It denotes a condition in which heritable gene expression changes occur without a single modification in the respective DNA material. In relation to obesity, PPARGC1A is one of the most studied genes due to its significant function in mitochondrial biogenesis. Physical activity alters the expression of PPARGC1A gene and the corresponding mRNA, and repositions the nucleosome in the regulation site of DNA methylation (Symonds, Sebert, and Budge, 2011). These changes in the expression of PPARGC1A and mRNA, and the repositioning of nucleosome decrease the accumulation of intracellular lipids and enhance carbohydrate metabolism (Voisin et al., 2015). This implies that epigenetic-induced modifications can minimize the accumulation of body fats while improving an individual’s utilization of carbohydrates.

3. Barriers

Despite the determination by a master’s nurse to conduct a study and seek evidence on a particular health condition, remedy, or intervention, several barriers usually curtail their smooth progression. Regarding this study, the first barrier that a nurse could encounter would be the lack of access to a rich nursing library. Only 32% of nurses in the United States have workplace libraries where they can access different nursing journals easily. The rest, some of which rely on the Internet, face a lot of challenges in finding relevant research articles. Unfortunately, Internet users equal encounter some difficulties. About 42% of the nurses have no Internet access.

Although time is often underestimated as a barrier to evidence-based practice, in this case, it would be treated as the second most hurdles that the nurse would have to battle with. Searching through an online nursing database is not a one-hour activity. To find enough evidence to support the hypothesis that physical exercise can limit the risk of obesity in children predisposed to the condition due to epigenetics, it would require a nurse several days to months. Unfortunately, a nurse could spend such a considerable time but still fail to access the required material. In a case where the nurse gets the relevant content, he or she would always need extra time to analyze and validate the sources.

4. Mitigating the Barriers

In the absence of a workstation nursing library, the nurse can make use of the online sources provided that they have reliable Internet access. Researching the Internet databases would need the nurse to understand and review the resource-access procedures specified by the specific repository. The most common online nursing databases include EbscoHost Web, PubMed, and CINAHL Complete. In terms of the time required, the nurse would need to rethink and reschedule his or her activities to create some sufficient time each day to conduct the research. During the time of the study, he can suspend some of his actions that are not so urgent to create additional time. He could equally assign other individuals some roles that are not related to the research.

5. Inclusion and Exclusion Criteria

The research included studies that only measured the epigenetic modifications associated with obesity. Only reviews published in English and conducted on adult individuals with at least 18 years were analyzed. The researchers removed all academic works that focussed on other pathologies apart from obesity. Equally, the researchers removed all duplicate manuscripts.

6. The Database used

The research was conducted over the PubMed medical database. The terms entered into the search field included “Exercise and Epigenetics,” as well as “Exercise and Obesity and DNA methylation.” About 2650 articles were retrieved from the repository. Subjecting them to the illegibility criteria yielded 177 sources. Out of the 177 items, only 24 met the inclusion criteria while the rest were discarded.

7. Conclusion

The study findings revealed that physical activity had a considerable impact on the BMI of children predisposed to obesity due to epigenetics (Milagro et al., 2013). Therefore, it is recommended that children be subjected to routine physical exercise to minimize the risk of being obese during adulthood.

References

Milagro, F. I., Mansego, M. L., De Miguel, C., & Martinez, J. A. (2013). Dietary factors, epigenetic modifications, and obesity outcomes: progress and perspectives. Molecular aspects of medicine, 34(4), 782-812.

Symonds, M. E., Sebert, S., & Budge, H. (2011). The obesity epidemic: from the environment to epigenetics–not merely a response to dietary manipulation in a thermoneutral environment. Frontiers in genetics, 2, 24.

Voisin, S., Eynon, N., Yan, X., & Bishop, D. J. (2015). Exercise training and DNA methylation in humans. Acta physiologica, 213(1), 39-59.