A survey of the literature on untoward responses to dieting has established that [1] there is a high incidence of symptoms of emotional illness in outpatients treated for obesity; [2] such responses occur also during prolonged inpatient treatment, whether by fasting or by caloric restriction; and [3] short-term fasting of inpatients is far less frequently associated with untoward responses. Three variables may affect the incidence of untoward responses: [1] persons with childhood onset of obesity seem more vulnerable than those with adulthood onset of obesity; [2] severe caloric restriction may produce symptoms more readily than total fast; and [3] outpatient treatment may be more stressful than inpatient treatment. These variables should be controlled during evaluation of new methods of treating obesity, and further controlled studies of their influence are needed.
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