From the standpoint of their frequency, as well as from that of their chemical and especially hormonal mechanisms, the complications of obesity are much better known to us today than they were just a few years ago. All are agreed in recognizing the frequency of diabetes, atherosclerosis, gout, uric calculous disease, disturbances due to circulatory changes, emphysema, sudden cardiac collapse, and premature aging due to corpulence. On the other hand, the hormonal mechanisms of lipid metabolism are only gradually becoming clearer, although the origin of the lipid hyperanabolism itself remains to be discovered.If, instead of considering excess adiposity as an isolated and always identical phenomenon, varying only in intensity, one investigates the frequency of its complications according to its chief clinical characteristics, one is immediately confronted with invaluable etiologic relationships.Experience proves, in fact, that what is important in the evolution of obesities is not so much excess adiposity per se but the activity of this excess, which is dependent on the subjacent musculature and blood supply, controlled, in turn, by neurohormonal mechanisms.Although the means of evaluating these phenomena are available, their utilization on a large scale is still somewhat impractical. Therefore, for the past ten years, we have preferred to utilize an anthropometric method which is simple to carry out and which gives numerical values that are easily handled.Vague1. The degreeof masculinedifferentiation of Obesities: A factordeterminingpredisposition to diabetes,atherosclerosis, gout,and uric calculous disease. Am J CiinNutr. 1956;4:20-34 One aspect of excess adiposity which immediately attracts the clinician's attention is the distribution of subcutaneous fat in the upper portion of the body of hypersthenic obese persons, but in the lower portion of the body in others.In studying the distribution of subcutaneous fat tissue in healthy individuals, one notices considerable differences between the male and female by simply pinching the fat masses with calipers. This fat is thicker in the female allover the body except over the first three cervical vertebrae. At normal weight, the fat of the male allover the body is less than that of the female; and it is thicker in the upper portion of the body than in the lower portion. The reverse is true in the female, infant, and the adolescent. Therefore, it seemed useful to obtain a numerical value for this localization of fat.
