Definition

An over-development of body; an excessive deposit of fat in all parts of the body.

Etiology

There are two types of this disease which have a hereditary tendency. In one type it comes from a family of fat people. It is almost impossible to keep them from taking on an excess of adipose tissue. There is nothing strange about this; for, when permitted to choose the food they like best, their choice will almost invariably be something that produces fat. The second class are those who develop obesity because of excessive indulgence in carbohydrates. The American people consume about 125 pounds of candy per capita per annum. If this habit is continued, in a few generations from now the people of this country will all be more or less obese. Fat does not mean health, in spite of the fact that the majority of people look upon those who are rotund as pictures of health. The popularity of rotundity is so great that it proves to be a serious handicap in curing women of chronic diseases. They are so afraid of losing their weight and their good looks that they would rather be sick and well rounded than to be perfectly well and slender. Obesity is not always caused by overeating, but it is always caused by imprudent or improper eating or drinking. Many persons are light eaters. They live in such a way that they bring on a perverted nutrition. Enervation accompanies the derangement; also faulty elimination. The kidneys fail to carry off the solid constituents. Many of these subjects of obesity will get into a state where they neither gain nor lose, and can almost live without any food at all without losing weight. This is due to the peculiar influence of the intoxication coming from retained excretions. The gouty diathesis is more apt to take on obesity than the tuberculosis diathesis. A great many obese people are troubled with an inherent desire for sleeping. This is peculiar to those whose kidneys are not sufficiently active.

Treatment

It requires skill, and much more than the average judgment, to bring the obese down to a normal weight, and at the same time avoid doing them harm. No class of patients endure a long fast so badly. Long before they have the appearance of being greatly depleted, dangerous symptoms may develop. The reason for this is that nearly all the leading, vital organs of the body have been pressed upon by the accumulation of fat until they have all been weakened--enervated. When put on a fast, or a restricted diet, causing a steady reduction, in the course of three or four weeks the patients will begin to show a haggard appearance. Some of them will show a blueness or purpleness of the tissues of the face, which means oppression of the heart. To remove the pressure from the different organs is very enervating. To illustrate this point, I may say that, if patients suffering from over-distended abdomens on account of dropsy, acetous fermentation, and gas distention, or large ovarian or fibroid tumors, have the distention--the water in the dropsical tumor--drained off suddenly, or the ovarian cyst removed without preliminary preparation, they are liable to die of collapse brought on because of the sudden removal of the distention and pressure on important organs.

In obesity, as the accumulation in the chest is absorbed, the heart begins to palpitate and the pulse will become weak. This heart weakness may be marked by sharp, acute strokes of the pulse, with a decided emptiness following immediately. This is a pulsation of weakness. The kidneys also, will suffer from sudden removal of the accumulation, by becoming very sluggish. It is almost impossible to induce them to act. In cases of rheumatic heart trouble accompanying obesity, very great care must be exercised. Sometimes the reduction of ten or fifteen pounds in two weeks will bring on a very distressed condition of the heart. Whenever the heart begins to complain, the patient must have the food increased. A very good plan to start with is to put the patient on fruit-fresh, uncooked fruit morning, noon, and night, and no other food. If all goes well, this plan of eating need not be changed for one week, two weeks, or even three weeks. A few patients can go nearly four weeks on nothing but fruit; but at the end of that time they will begin to show a little purpleness about the tissues of the face. When this symptom presents, one meal of fruit should be dropped, and a meal of meat, cooked, non-starchy vegetables, and salad substituted. This meal is to be continued daily until the sypmtoms of depression have all passed away; then the patient may return to fruit until the weight is normal. If, however, after the meat and vegetable dinner is adopted, the weight continues to drop, the dinners may be continued; and perhaps in the course of one or two weeks one meat meal can be dropped every other day, and a baked potato meal, or any other decidedly starchy food, may be given, with non-starchy vegetables and a salad. After this plan has been carried on, and the weight shows a gradual decline, without any symptoms of oppression of any of the organs of the body, this kind of eating may be continued indefinitely, unless a feeling of weakness and lack of vim sets in. Then one starchy meal a day, with fruit, may be substituted for one of the two fruit meals; and this starch is to be continued unless the weight increases; if it does, then return to the fruit. It is very largely a matter of good judgment on the part of the physician watching the case; but no accidents will occur in these cases where the physician is experienced and does not become careless.

One or two cleansing baths a week may be used in conjunction with the treatment. Then, night and morning, dry towel-rubbing should be used--or friction mittens in place of the towel--to establish a thorough capillary circulation and a good, wholesome condition of the skin. Where the bowels are inclined to be constipated, one of the cooked, non-starchy vegetables with the dinners should be either spinach or onions. All the time a patient is taking this treatment he should avoid hard work or strenuous exercise. A very good exercise is the tensing movement. This may be taken in a recumbent position. It means tensing the arms and legs, abdomen and muscles, wherever they can be voluntarily contracted. It means making the muscles of the arm hard, then relaxing, and then hard again, etc. It is a very excellent exercise for people who are taking treatment for obesity. After the patient has been brought to the proper weight, regular eating may be resumed, leaving out the butter, sugar, cream, candies, pastries, cakes, etc.