A Study of Obesity in General Practice

MUCH has been written on the subject of obesity, so much that it is impossible to review the literature here. Yet, after all the investigations on the subject, the cause of overweight still evades us, except in a few conditions (e.g., myxcedema), where it occurs as a secondary manifestation of underlying disorder. Basically, of course, if energy input is greater than output, there is increase in weight, but this brings us no nearer the solution to the problem. Why can some eat to their hearts' content and yet retain a slim silhouette, whilst others, who do equally as much exercise, become obese on the same diet? Have the slim some inborn metabolic defect which leads to extravagance in their use of food, or are they incapable of laying down a store? Conversely, have the obese, by some peculiar process of metabolism, the power to extract from their food more value than the "normal" person? What is the ideal weight? There are two distinct factors which decide this-the gesthetic and the medical. The first, and probably the dominant factor, varies from time to time and from place to place. Beauties of yesterday would not be considered as serious contestants in a present-day contest-nor would the possessor of that Central African hallmark of femininity, steatopygia. From the medical standpoint, the height and weight tables have developed only over the past century, and have been drawn up by the assurance companies, as the result of their experience of the effect of weight on the expectation of life. These tables, it should be realised, are based on commercial considerations, not medical ones, but they do show that the elimination of obesity is desirable. Considered as a disease, obesity has its complications-dyspncea, "chestiness," strain on the cardio-vascular system (especially in the elderly), leading in extreme cases to frank failure, mild diabetes of maturity-onset type. In the young, displaced epiphyses are commoner in the obese. The psychological effects, too, can be severe, no less on adults than on the young, who suffer the taunts of their school-fellows. Therefore, it would seem to me that obesity is a problem worthy of a serious approach by the general practitioner. In spite of the absence of a strict definition of obesity, the overweight patient is not difficult to detect, and the question which arises is what shall be done about it? Put simply, the answer should be "Eat less …