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JAMA. 1963;186(6):27-40. doi:10.1001/jama.1963.03710060003002.
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The Endocrinologist  The concept of caloric intake in excess of caloric expenditure has generally been accepted as the fundamental cause of obesity. Factors which modify the normal energy balance in favor of calorie retention are manifold and may be environmental, hereditary, or the result of acquired central nervous system, endocrine, or metabolic disorders.Environmental influences include voluntary or forced inactivity (as in the sedentary life of the elderly, or after confinement to bed), without appropriate reduction in caloric intake. In addition, emotional disturbances, especially anxiety, depression, and hysteria may result in the excessive ingestion of food. Hereditary manifestations are not congenital, since only the predisposition to obesity is apparent among families. Ultimate obesity must be acquired. An inborn metabolic defect has been postulated by several investigators, as a result of which lipogenesis in adipose tissue would be accelerated without a corresponding increase in the rate of fat mobilization. However, evidence


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