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March 7, 1977

A New Problem From Obesity

JAMA. 1977;237(10):961. doi:10.1001/jama.1977.03270370033013

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To the Editor.—  Recently, I was thwarted again by obesity, but in a new and novel way that ought to be reported to your readers. A 39-year-old woman complained bitterly for months of right upper quadrant and right lower quadrant pain (it was difficult to tell where the quadrants began and ended). In addition, she had intermittent but well-documented rectal bleeding.Extensive gastrointestinal and other diagnostic measures had failed to show a cause for either symptom. Several sets of complete gastrointestinal contrast examinations at various institutions were normal. Proctoscopic evaluations performed 15 minutes before and 30 minutes after a bleeding episode—and even two Meckel scans—were also unrevealing. Cholecystography and excretory urography were normal. Sedimentation rates remained elevated throughout, but hemoglobin levels, WBC counts, and chemistry screening batteries were unremarkable. Repeated Minnesota Multiphasic Personality Inventory (MMPI) tests were either misplaced or malprocessed. Finally, in desperation, I sent the patient to the