OBESITY 43 



tention of water. A similar retention of water has been found during 

 milk-cures for obesity by Jacob and others. 



The nitrogenous metabolism is normal, both as regards equilibrium and 

 the nitrogen partition in the urine. During reduction cures nitrogenous 

 equilibrium is maintained, provided that somewhat more than half of the 

 maintenance calory requirement is given, as shown by von Noorden and 

 Dapper. The deficit is made up by the combustion of the body fat, and 

 protein is spared. If drastic measures are employed, such as the Moritz 

 milk-cure (1500-1800 c.c. milk daily), marked loss of nitrogen takes place, 

 up to 3 grams daily. This is in part due to the small nitrogen intake 

 (6 gm.), in part to the low carbohydrate, so that the protein-sparing action 

 of carbohydrate is lost. " 



Means found a low creatinin output, as reckoned per kilo body 

 weight; this may be due^simply to an increase of tissue which does not 

 take part in the metabolism. 



The blood shows occasionally an increased red count, fairly often a 

 moderate anemia, but there is no evidence that the obesity is responsible 

 for these changes. The blood lipoids have not been studied in obesity by 

 modern methods. 



The blood sugar was found increased by Roth in four out of sixteen 

 fat patients, in the absence of glycosuria. It is possible that he was deal- 

 ing with diabetics in the preglycosuric stage. Further studies on the 

 sugar metabolism in obesity are desirable. 



The restriction of -fluids, so often practised in reduction cures, has little 

 effect on the metabolism, tending rather to diminish it than to increase it ; 

 the loss of weight is due to loss of water and secondarily to the fact that 

 less food is taken if the meal is dry. 



The Metabolism in Endogenous Obesity. The chief interest centers in 

 the basal metabolism. Up till recently no definite lowering of the basal 

 rate in obesity had been found. During the last few years, however, such 

 a condition has been reported, as will be noted in detail below. Where 

 it was possible, the writer has recalculated the values, using the DuBois 

 height-weight formula for surface area, and the table of Aub and DuBois 

 for normal standards for age and sex. It should be noted that a normal 

 variation of ten per cent in either direction is allowable. 



Attempts have been made to show that simple obesity may be due to 

 a lessening of the normal rise in the metabolic rate consequent upon the 

 taking of food, but without success. Nor has it been possible to show that 

 the obese accomplish work with an abnormally small expenditure of energy. 

 It is possible that in the rare cases with lowering of the basal metabolism, 

 such differences may be found to exist, but they have not been demon- 

 strated up to the present. 



The water balance is not infrequently abnormal in endogenous obesity, 

 a fact that Grafe brings into relation with disturbance of the thyroid, 



