58 THE INTERNAL SECRETIONS—1920 
Obesity, like emaciation, is not a disease but a symp- 
tom. Frequently it is the chief or only obvious symp- 
tom, the others being obscure and difficult to discover. 
Oftentimes it is a sign only and gives rise to no com- 
plaint, other than the disquietude of vanity. To cata- 
logue obesity then as a symptom rather than a disease, 
or a normal variation, lends a new aspect to the sub- 
ject and permits of a discussion along broader lines. 
It is necessary at the outset to determine definitely 
that a patient is indeed obese. This offers no difficulty 
in cases of extreme or moderate obesity, but is less 
easy in certain ones which show signs of endocrino- 
pathy. 
The customary procedure in ascertaining obesity is 
to take the height and read off from a height-weight 
chart the so-called ideal weight, or calculate it by for- 
mulae such as those devised by Broca, ‘‘Oeders of Van 
Noorden,”’* making a certain allowance plus or minus 
for presumably normal variations. Such a procedure 
is incorrect for it leaves out of account individual vari- 
ations in skeletal size and muscular development, the 
former being of special endocrinologic interest. A six- 
foot man with large framework and heavily-muscled 
may be twenty-five (25) pounds heavier than a man of 
equal height whose bones are small and muscular de- 
velopment moderate, yet he cannot be called obese. 
Such men, however, always exceed the so-called ideal 
weight. 
‘Obesity may be defined as an excessive proportion of 
fatty tissue in relation to all other tissues. This nor- 
mally is one-twentieth the body weight in males and 
one-sixteenth in females. This should be measured in 
pounds or kilos in proportion to height but must be 
judged in each individual case. 
It is customary to classify obesity under two head- 
ings, namely, exogenous and endogenous. The former 
