FROM the viewpoint of the pediatric psychiatrist, the problems of obesity, as seen clinically, can be thought of as having three layers. The first is constitutional, better described as physiologic, which may be broken down into genetic and structural elements. The second is psychologic, consisting of the values that food intake or the obesity itself come to have. The third layer is made of the cultural and social reactions to food and fat. These attitudes encountered inside and outside the home intermesh in their effects with the physiologic and psychologic levels. These, in turn, are also interwoven, until one cannot separate one layer from the other. However, when individual cases are scrutinized they reveal the pathology at one layer or the other to predominate and indicate where efforts to modify the abnormality might best be directed. Incidentally, the same levels operate on the other side of the coin, anorexia.
From the practical point of view, let us consider the natural history of obesity and the clinical varieties one sees in practice, and let us see how the three-layer concept fits. First, as pointed out by Gordon, there is a tendency to be complacent or even pleased with obese infants. At level one, the physiologic, such constitutional factors as those present in the neonate born with an excessive quantity of pepsinogen secreted by the gastric mucous membrane could have the effect of producing as Mirsky points out, a relatively intense or even continuous hunger, and make greater demands on its mother for nursing.
A jó, a rossz és a csúf
