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There are a variety of views about the etiology of obesity, and most lead with predictable neatness to treatment plans. Many workers regard obesity as multi-determined; hereditary and constitutional factors in the presence of adverse environmental influences may be responsible for generating the obese condition.
An older medical perspective divided etiological factors which produce excess adipose tissue into two major categories: (1) endogenous obesity, referring to hormonal or metabolic dysregulation, and (2) exogenous obesity resulting from excess food intake and inadequate energy expenditure. Following metabolic studies (e.g., Buskirk et al.)” of obese subjects it was clearly determined that all obese states result from long-term positive caloric balance. In effect, calories are absorbed and stored as adipose tissue before they are used to supply the body's energy needs. Metabolic rates vary from person to person. In the same person, they vary in accord with circadian and infradian rhythms, and they may vary further during states of illness. Nonetheless, long-term positive caloric balance produces weight gain.
Endocrine pathology rarely is responsible for producing obesity. Hypothyroidism, Cushing's syndrome (hyperadrenocorticism), hyperinsulinism, and Stein-Leventhal syndrome will each cause an increase in adipose tissue.” The psychiatrist who evaluates the obese patient needs to be alert to these organic contributions to obesity. If there is any suspicion of underlying endocrinological dysfunction, the patient should be referred for further medical evaluation.
Although treatment with hormones can produce weight loss, hormone therapy is not recommended for uncomplicated obesity.33 Clinical evaluation of human chorionic gonadotropin, thyroid hormones, human growth hormones, and progesterone have shown them to be generally ineffective or dangerous for the treatment of overweight.
The medical recognition that obesity results from prolonged positive caloric balance prov