Abstract
SELECTED CASE A 55-YEAR-OLD married white woman presented with a 30-year history of progressive morbid obesity. Her birth weight was normal, at 3.8 kg. Her weight gain continued progressively, except for two self-induced remissions by means of severe restriction of energy intake (840 to 1680 J/d [1 cal = 4.2 J]). Her usual diet consisted of 18 900 to 21 000 J/d. Associated medical problems included choledocholithiasis, resulting in a cholecystectomy at age 29 years, and severe osteoarthritis involving both knees and the lower vertebral column. Meningitis with encephalitis occurred at age 3 years. The patient had normal urinary free cortisol (70 μg/d) and thyroid function test results. The patient was treated with moderate restriction of energy intake (decrease of 4000 J/d) without anorexigenic medications. She walked 3.3 km/d five times per week. Results of physical examination were as follows: blood pressure, 220/120 mm Hg in the left arm with a
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