Pounds and Inches: A New Approach to Obesity, a book by Dr. Simeons, lays out three major causes of obesity.

Psychological Aspects

A lonely and unhappy person deprived of all emotional comfort and of all instinct gratification except the stilling of hunger and thirst can use these as outlets for pent up instinct pressure and so develop obesity. Among its many functions the diencephalon is also the seat of our primitive animal instincts, and just as in an emergency it can switch energy from one center to another, so it seems to be able to transfer pressure from one instinct to another. Yet once that has happened, no amount of psychotherapy or analysis, happiness, company or the gratification of other instincts will correct the condition.

Compulsive Eating

Most obese patients do not suffer from compulsive eating; they suffer genuine hunger - real, gnawing, torturing hunger – which has nothing whatever to do with compulsive eating. No end of injustice is done to obese patients by accusing them of compulsive eating, which is a form of diverted sex gratification.

On the other hand, compulsive eating does occur in some obese patients, particularly in girls in their late teens or early twenties.

I have occasionally been able to watch a compulsive eating attack without the patient's knowledge, and it is a frightening, ugly spectacle to behold, even if one does realize that mechanisms entirely beyond the patient's control are at work. When you enquire into what may have brought on such an attack it almost invariably reveals that it is preceded by a strong unresolved sex-stimulation. The pressure is then let off through another primitive channel, which is oral gratification.

In my experience the only thing that will cure this condition is uninhibited sex, a therapeutic procedure which is hardly ever feasible, for if it were, the patient would have adopted it without professional prompting, nor would this in any way correct the associated obesity. It would only raise new and often greater problems if used as a therapeutic measure.

It’s important to understand that patients suffering from real compulsive eating are comparatively rare. In my practice they constitute about 1-2%. Treating them for obesity is a heartrending job. They do perfectly well between attacks, but a single bout occurring while under treatment may annul several weeks of therapy. Little wonder that such patients become discouraged.

Many obese patients think that their desire for food (to them unmotivated) is due to compulsive eating, while all the time it is merely a greater need for food. The only way to find out is to treat such patients. Those that suffer from real compulsive eating continue to have such attacks, while those who are not compulsive eaters never get an attack during treatment.

Basic Reluctance to Lose Weight

I have found that some patients are deeply attached to their fat. They cannot bear the thought of losing it. If they are intelligent, popular and successful, this is a source of pride. Some fat girls look upon their condition as a safeguard against erotic involvements, of which they are afraid. They work out a pattern of life in which their obesity plays a determining role and then become reluctant to upset this pattern and face a new kind of life which will be entirely different after their figure has become normal and often very attractive.

An affectionate attachment to abnormal fat is usually seen in patients who became obese in childhood, but this is not necessarily so. In all other cases the best psychotherapy can do in the usual treatment of obesity is to render the burden of hunger and never-ending dietary restrictions slightly more tolerable.

There are thus a large number of ways in which obesity can be initiated, though the disorder itself is always due to the same mechanism, an inadequacy of the diencephalic fat-center and the laying down of abnormally fixed fat deposits in abnormal places. This means that once obesity has become established, it can no more be cured by eliminating those factors which brought it on than a fire can be extinguished by removing the cause of the conflagration.

Thus a discussion of the various ways in which obesity can become established is useful from a preventative point of view, but it has no bearing on the treatment of the established condition. The elimination of factors which are clearly hastening the course of the disorder may slow down its progress or even halt it, but they can never correct it.