Inducible Metabolic Abnormalities During Development of Obesity

The attitude reflected in the above quotation from Dr. Astwood's classic address in 1962 on the Heritage of Corpulence has been the prevalent one for some years. Except in rare instances of hypothalamic injury or Cush­ ing's syndrome, the obvious positive caloric balance of the obese is blamed upon the patient and the disorder is labeled exogenous obesity. The over­ weight today are discriminated against and physicians project on them their frustration in usually not being able to effect a cure. Over recent years, however, three types of evidence have accumulated which have lead to a suspicion that there may after all be formidable inherited anatomical or bio­ chemical defects which, together with the factors in our society which pro­ mote overnutrition, lead to obesity in certain individuals. First, there is the evidence that at least some obese patients from an early age are burdened with many more than the usual quota of adipose (and other) cells. Second, when more sophisticated techniques, such as radioimmunoassay of peptide hormones, were applied to the study of biochemical changes in obesity, it was found that there were deviations from the normal range, especially in the striking hyperinsulinemia. Some of the deviations are itemized in the left-hand column of Table 1. Finally, an old and oft-refuted doctrine that the body could adapt to excess caloric intake by altering its energy metabo­ lism, the Luxuskonsumption of the early German writers, has again been brought under serious consideration. It thus becomes more difficult to attrib­ ute obesity to a simple behavioral disorder. The obvious question arises, however, as to whether the derangements observed are the consequences of the obesity or part of the cause.