The article entitled “Physical examination findings among children and adolescents with obesity: An evidence-based review” by Sarah Armstrong, Sarah Hampl, Joseph A. Skelton, Charles Wood, David Collier, and Eliana M. Perrin presents findings of an in-depth evidence-based review relating to physical examination of children and adolescents with obesity. Armstrong et al. (2016) emphasize the lack of comprehensive understanding of how to conduct physical examination of children and adolescents with obesity as more attention is paid to prevention and treatment of obesity rather than to examination. However, the examination is an essential component of medical practice that can provide clinicians with information on how to guide management decisions and assist with revealing conditions as well as complications related to obesity at early stages. Overall, the article under consideration focuses on a topical clinical issue and provides a well-built and well-researched review of various aspects relating to physical examination of children and adolescents with obesity.
Nowadays, obesity is an extremely topical issue as according to Armstrong et al. (2016), 1 in every 3 children and adolescents in the USA suffer from this condition. These estimates are approximate, yet other sources confirm them as well. Hence, Fitch et al. (2013) indicate that more than 30% of all children are overweight or obese, while 17% can be definitely considered as obese. The above estimates are slightly higher than the ones provided by the CDC indicating that 16.7% of boys and 17.2% of girls aged 2-19 were obese in the USA as of 2012 (Fryar et al., 2014). In turn, about 4-6% of all children and adolescents in the USA suffer from severe obesity and this rate has been increasing (Kelly et al., 2013). All sources agree on the fact that the rate of childhood obesity has been rising at an alarmingly high pace over the past decade and currently poses a serious problem in the system of the US healthcare. Thus, Armstrong et al. (2016) have decided to review sources pertaining to a vital aspect of the condition under consideration that has been widely ignored or neglected in favor of such topics as prevention and treatment. Their expert-based review specifically deals with findings relating to physical examination of children and adolescents with obesity.
The review covers the following main issues regarding physical assessment and diagnosis: vital signs; examination of head, eye, ear, nose, and throat; chest examination; gastrointestinal examination; genitourinary examination; musculoskeletal examination; and skin examination (Armstrong et al., 2016). All of the above mentioned examinations are further subdivided into sections focusing on issues typical for obese children and adolescents. For instance, common skin problems that clinicians should pay attention to while examining children and adolescents with obesity include acanthosis, acne, hirsutism, striae, intertrigo, and pannus (Armstrong et al., 2016). Respectively, these issues constitute the main elements of the review in addition to the section providing background information on the issue under consideration, methods, and summary of all findings. It should be noted that each finding pertaining to physical examination elements is accompanied with a rather detailed description of the condition, its prevalence, importance and relevance of the finding with account for the general topic and purpose of the review, assessment techniques, and review of the evidence pointing at the need for further evaluation. Besides, the review refers to many credible sources to verify its findings and provide extensive evidence.
As compared to similar reviews focusing on physical examination of children and adolescents with obesity, for instance, by Alizadeh et al. (2013), the one by Armstrong et al. (2016) is much more detailed, comprehensive, and all-encompassing. Thus, Alizadeh et al. (2013) consider a thorough physical examination to be important, yet not as significant as obesity prevention and treatment. Therefore, they provide a general and brief overview of how to conduct examination, indicating that vital signs have to be assessed, endocrine problems have to be taken into consideration, reproductive system has to be checked, and some other signs and symptoms, including psychological disorders and musculoskeletal problems, have to be considered (Alizadeh et al., 2013). Similarly, other guidelines for physical examination of children and adolescents with obesity provide a description of steps needed to determine whether patients are obese like calculating BMI, waist circumference, and taking other growth data (Johansen et al., 2015). The same is evident in the guidelines for medical management of obesity in adolescents issued for primary care physicians who are to assess dietary habits, physical activity, readiness to alter lifestyle, as well as recording family history and history of obesity-related illnesses (“Section 4. Adolescent prevention health”, 2015). In turn, Armstrong et al. (2016) focus on each issue separately and their review of issues pertaining to physical examination covers all possible problems and conditions that children and adolescents with obesity may suffer from. Therefore, it makes the results of systematic review under consideration valid and applicable to the practice of both advanced practice nurses and registered nurses. The final result of the review is a detailed and virtually all-inclusive list of aspects that nurses and clinicians should consider during physical examination. This way, various conditions can be detected at early stages or even prevented in a timely manner. Besides, nurses can inform patients on how to prevent possible obesity-related conditions or treat them properly if they are already diagnosed.
With respect to funding of the review, Armstrong et al. (2016) indicate that no external funding has been used and that they have no financial relationships to disclose with respect to the review. In addition, this fact proves the unbiased nature of the findings presented in the article. The major strength of review consists in its comprehensiveness and coverage of all major issues relating to physical examination of the selected population. One more strength concerns the fact that only current evidence is used in the review, which makes it highly applicable and useful in practice. Besides, the authors provide expert opinion and critically analyze and synthesize available evidence rather than merely provide findings of other researchers. The way the article is structured and segmented is also an evident strength as it facilitates navigation and comprehension. With account for all these strengths, there are no obvious limitations of the review as it seems to cover all important issues and fulfills its purpose. The only limitation indicated by the authors themselves concerns a low strength of available evidence caused by the fact that the overwhelming majority of published data are observational.
Armstrong et al. (2016) state their objective for the review as follows: not “to provide screening recommendations but rather to alert the clinician to the presence of physical findings and to provide a framework for managing identified conditions” (p. 2). Having analyzed the article, it is possible to conclude that the objective has been accomplished as the authors alert readers to the presence of physical examination findings, as well as presenting a framework that can be used to managing the described conditions. Although they have not intended to provide screening recommendations, the list of physical findings can be used by nurses and clinicians in the process of conducting physical examination of children and adolescents with obesity as a checklist of conditions to be taken into account. Hence, the review seems to be more useful for nurses and clinicians than most other sources dealing with obesity as it discusses a wide range of conditions and issues caused by and relating to obesity rather than narrowly focusing on the most prevalent ones. Most sources focus on prevention and intervention for obese children and adolescents like in the article by Jenike (2013) or on particular conditions with a primary focus on hypertension as evident from the review by Flynn & Falkner (2011). Although such information is also useful, firstly, nurses have to conduct physical examination to reveal issues that need more attention and evaluation and cannot afford focusing only on the most prevalent conditions like hypertension as it would make them overlook other conditions at early stages.
Withal, the review by Armstrong et al. (2016) is a well-written high-quality article presenting valid findings pertaining to physical examination of children and adolescents who suffer from obesity. The authors manage to critically and expertly analyze and synthesize the most relevant findings and turn available low-strength evidence into a comprehensive systematic review that can be definitely implemented into the nurses’ practice. Physical examination is an essential part of the clinical process and nurses who are aware of conditions and symptoms prevalent among obese children and adolescents can ensure that they are not overlooked and problems are detected in a timely manner. This way, patients’ quality of life and satisfaction can be increased, while nurses will implement the evidence-based practice into the process of physical examination.
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