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To the Editor.—
In an era of increasingly complex medical care, further additions to this complexity can be justified only if they represent meaningful contributions to the understanding or management of disease. The two related papers on obesity by Bray et al (235:1487 and 235:2008, 1976) present a complex algorithm for the investigation of obesity that obscures the most prevalent treatable factors in this disease (eating patterns and psychological concomitants) by omitting them from the algorithm and relegating them to a small table.Obesity is a frustrating clinical problem, but the traditional endocrine workup contributes little to its resolution. The authors report finding one case each of elevated and depressed thyroxin levels in their series of 261 obese patients. They do not state whether either or both of these might have been suspected clinically, and give us no data to show that indications for thyroid evaluation are different in obese
Gillette RD. Evaluation of the Obese Patient. JAMA. 1976;236(15):1691–1692. doi:10.1001/jama.1976.03270160015009