Obesity in Childhood

Abstract

Determinations of basal metabolism are widely used in the clinical study of obese patients, apparently in the expectation of arriving at some understanding of the underlying disturbance. Von Noorden 1 classified obesity as exogenous and endogenous and defined endogenous obesity as characterized by a lowered metabolism or, as he called it, "Verlangsamung der Zersetzungsenergie der Zellen." He stated that obesity of the endogenous type is rare. Since hypofunction of the thyroid gland is associated with a depression of the basal metabolism, the conclusion is frequently drawn that a low basal metabolic rate in an obese person is indicative of hypothyroidism.The term basal metabolic rate is ambiguous, and its inconsistent use has caused much confusion. Many authors designate by basal metabolic rate the percentage deviation of the observed value from some normal standard. The most widely accepted standard uses surface area as the unit of comparison. In numerous clinical papers in which the diagnosis "obesity of primary or secondary hypothyroid origin" is based on the observation of a low basal metabolic rate, inadequate information is given as to the method of computation. Workers who have critically evaluated the significance of standards for the result have not recorded a lowered metabolic rate or even found an elevation corresponding to the excess in weight.2In dealing with growing children, who are constantly changing sub¬ jects, the interpretation of metabolic tests is even more difficult. The

Total Energy Expenditure and Patterns of Activity in 8‐10‐Year‐Old Obese and Nonobese Children

“…In spite of their greater sedentariness, the energy expenditure devoted to physical activity (plus thermogenesis)—i.e., TEE — PMR—in the obese children was significantly greater than that of the nonobese children. The higher energy expenditure necessary to move the heavier body mass during weight‐bearing activities (16) and the greater PMR of obese children (17) help explain the apparent paradox of a shorter time devoted to activity yet a higher absolute activity‐induced energy expenditure in these children. The higher PMR of obese children is consistent with the significantly higher FFM found in these children than in nonobese children.…”

The Use of Spontaneous Art in Analytically Oriented Group Therapy of Obese Women

“…H o w ev er, from a lim ited n u m b e r o f studies b y co m p e te n t o b serv ers, c e rta in a g re e m e n ts are em erging. T hese stu d ies h av e included, an aly sis o f su rv ey s of gro u p s of obese, including psychological te s t ing [19,33,36,7]; p sy c h o a n a ly tic a l stu d ies o f in d iv id u al p a tie n ts [10, 12b, 31], an d g en eralizatio n s from such analyses [12,9,17,29]. In a d d itio n , m u ch can be learn ed a b o u t th e dy n am ic facto rs m obilized in o b e sity from b asic stu d ie s o f su ch psychological ph en o m en a as depressions, b o d y im age a n d o ral a c tiv ity [2,6,14,16,21,22,34].…”

“…T h e relativ e p o sitio n o f th ese obese w om en w ithin th e ir own fam ily gro u p s is sim ilar to w h a t H ilde K ruch [8] found in her sta tistic a l a n a lysis o f th e special place w hich obese children hold in th e ir fam ily g ro u p s. O u r obese w om en w ere, also, e ith er only children, or the old est child, o r w ere placed in som e unique po sitio n , su ch as being th e only girl am o n g b ro th e rs ; a n d th ose wom en w ho were yo u n g est child ren w ere s e p a ra te d b y six o r m ore years from th e next oldest sibling.…”

“…F iv e of th em co n tinued to live in th e sam e b u ild in g or a p a rtm e n t w ith th eir m o th ers, an d th e oth ers lived in close p ro x im ity to th e ir m o th e rs; all th ese w om en had daily [8,11] in obese children.…”