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First a number of aspects are mentioned that should be given special attention in the treatment of sex offenders. This is followed by a review of those treatment studies in which therapy was primarily either psychoanalytic or behavioral and which included a relatively large number of patients. Since the authors of the present study found that either a given treatment approach was indicated for a very limited group of patients only or the long-term outcome was poor, they developed an integrative approach for inpatient treatment of sex offenders. This approach includes behavior therapy, psychoanalytically oriented therapy and social therapy. The procedures are described briefly and the role of each is in the overall therapeutic concept pointed out.

Analysis of 31 686 patient records for obesity among hospitalised patients in the Second Medical Clinic of Düsseldorf University between 1952 and 1972 demonstrated a steep rise to a plateau of 24 +/- 2% in 1956-1972. Adding a corresponding analysis from the Bonn Medical University Clinic some 66 000 hospitalised patients could be included for a period of 40 years. Socio-economic conditions in the war and post-war period produced a marked fall in obesity to a minimum of 2% in 1946. The mean incidence before 1935 was 10%, by 1958 it had increased two-and-a-half fold. It is thought that this had been due not to a corresponding higher calorie intake by the population but rather a general reduction in physical activity. The increase in obesity among the population, reflected in these hospital statistics, is likely to lead to a parallel increase in cardiovascular risk factors and with it the ever-rising curve of death from cardiovascular disease in the Federal Republic of Germany.

In 500 obese patients (146 men, mean age 37 +/- 13 years, Broca index 147 +/- 24; 354 women, mean age 36 +/- 14 years, Broca index 151 +/- 28) cardiovascular risk factors (RF) were investigated. The most frequent RF was hypertension (71 per cent), followed by glucose intolerance (49 per cent), hypertriglyceridemia (31 per cent), hypercholesterolemia (22 per cent) and hyperuricemia (22 per cent). Only 12 per cent of the patients were without RF. These patients were younger and less obese than the patients with RF. The prevalence of RF increased with increasing age and overweight. Analysis revealed significant correlations between overweight and blood pressure, blood glucose, insulin and age. Significant correlations between age and hypertension, blood glucose cholesterol, triglycerides and overweight were detected. The correlation between overweight and the sum of all RF was higher (r = 0.35) than the one between age and the sum of all (r = 0.23). Obese patients had a high prevalence of RF. Increasing overweight and (to a lesser extent) age are both associated with increased prevalence of RF. On the basis of the prevalence of RF, patients with gross obesity (Broca index greater than around 150) were considered to be at a high risk in respect of coronary heart disease.