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Effective long-term treatment options for obese children are currently limited, but critics suggest that the primary goal of managing uncomplicated childhood obesity should be healthy eating and physical activity, not achievement of ideal body weight. Data are sparse for trends in overweight/obesity in children, but in the USA there has been a significant increase from 4% in 6-11-year-old boys and girls in 1990s to 11% in boys and 10% in girls in 2000.
An increase in body mass index (BMI) and percentage ideal body weight are good predictors of morbidity, some researchers suggest that visceral obesity represents a variant that is more closely related to excess morbidity. Daniels states that obesity-problems and diseases "once thought applicable only to adults are now being seen in children and with increasing frequency. Examples include high blood pressure, early symptoms of hardening of the arteries, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary disorder, and disordered breathing during sleep" (Daniels 2006, 47). Following Wadden and Stunkard (9) blood volume is increased in obesity in proportion to the increased body mass. Because blood volume increases with obesity proportionally more than does cardiac output, even simple obesity is a volume expanded state. Even in simple obesity, cardiac stroke volume and pulse rate are increased in line with the hypervolaemic conditions mentioned above. Obese patients with co-morbidities have cardiac dilation and hypertrophy demonstrable by echocardiography (Hills 82). ECG diagnosis of hypertrophy is more problematic because of the effect of thickening of the chest wall. ...
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