Obesity

Abstract

Dr. Gilbert H. Mudge: Obesity is a condition which constitutes a serious public health problem because of the frequency and severity of its associated complications. In today's clinic, obesity has been considered in terms of physiological and biochemical mechanisms as well as in terms of the therapeutic procedures available to the clinician. The physiological mechanisms may be divided into those primarily associated with total energy balance of the organism and those primarily related to disturbances of intermediary metabolism. The problem of food intake has been discussed in terms of the control of appetite by discrete functions of the central nervous system. The prevailing theories of the physiological basis of satiety have been reviewed. Hypothalamic centers, which are probably sensitive to glucose or other related metabolites, have been described. The function of these centers has been analyzed in terms of the glucostatic theory of appetite control. The metabolism of fat is regulated by enzymatic, hormonal and neural factors, and these are briefly reviewed. Adipose tissue itself has been found to have a surprisingly active metabolism. Three types of experimental obesity are discussed in terms of disturbances of specific metabolic reactions. These demonstrate the possibility that, from a metabolic point of view, obesity may be considered in terms of multiple etiologic factors. In considering the various forms of therapy it is concluded that dietary restriction of caloric intake must still be considered the major component of any therapeutic program for obese persons. Psychiatric factors are frequently found to be responsible for the discrepancy between appetite and energy expenditure which results in clinical obesity. It is therefore emphasized that the advisability of weight reduction must be carefully evaluated in relation to the emotional problems presented by each individual patient.