In Reply.—While it may be far out to think that there may be greater efficiency in conserving energy in some who gain weight with fewer calories and that this represents Darwinian improvement, I do believe that we should not be satisfied with an obvious explanation, thereby limiting thought processes.
I am delighted to read that Dr Kashani agrees that consumption of more calories and less activity results in obesity. This takes us to about 1890. I certainly do not argue that all practitioners should "consider advocating proper diet and moderate exercise."
Perhaps I erred in mentioning too many etiologic possibilities when I should have objected more clearly to the use of what I consider pejorative terms, especially when seeing and treating children, and I thank Dr Kashani for highlighting this. I did try unsuccessfully to think of better terminology. Even with the help of Stanley Garn, MD, who is a stellar