ENDOCRINE ASPECTS OF OBESITY 61 



know that many thin persons of sedentary habits who 

 eat excessive quantities of food and apparently digest 

 it still do not put on weight. 



Obesity, of whatever type, is an expression of dis- 

 turbed metabolism ; and metabolism, we believe, is defi- 

 nitely controlled by the glands of internal secretion. 

 We recognize that the height of the skeleton is directly 

 under the control of several of these glands and it 

 seems more than likely that the weight also is governed 

 by their activity. 



The problem is not a simple one, however, and re- 

 quires much investigative effort. Even the relatively 

 accurate determination of basal metabolism does not 

 lend much aid, for investigators have shown that the 

 basal metabolism of even very obese persons is practi- 

 cally normal when measured by the heat-production per 

 amount of body surface. Those estimations that are 

 based on the measurement of heat-production per unit 

 of weight and which show a lowered metabolism in 

 obesity, obviously are incorrect, for as Benedict 6 has 

 pointed out, the fatty tissue is inert and does not affect 

 the basal metabolism which "is a function of the total 

 mass of active protoplasmic tissue." 



Nearly every one of the endocrine glands has been 

 named as producing a special type of obesity and we 

 read of obesity of the genital and pituitary types or 

 of thyroid, pineal, or adrenal origin. This has arisen 

 through the fact that obesity often is associated with 

 signs and symptoms which implicate dysfunction in dif- 

 ferent ductless glands. The real condition in every case 

 is one of pluriglandular dystrophy with the obesity as 

 a feature common to them all. The most that can be 

 said on the subject is that obesity is a disturbance of 

 metabolism and metabolism is under the direct control 

 of the ductless glands. Certain of these glands are 

 known to be concerned more directly with the metabol- 

 ism of carbohydrates and fats. 



