In an earlier chapter we discussed the deposit of food reserves in the system. It was there set forth that whenever the amount of food taken into the body exceeded the requirements of the body, the excess is deposited in the form of fat. This plan of nutrition is true for mammals, birds, reptiles, and fishes. It is true, in fact, for all animals above the lowest orders of marine animals. The evident purpose of nature is to store up excess in time of plenty against the needs of a time of famine. In their natural state and subject to the natural conditions, such animals as the ox, the deer, the bear, and the horse lay on a heavy coat of fat in the summer and autumn, which will serve during the winter the double purpose of an overcoat and a supply of fuel.

These general facts of biology make it clear that whenever the human subject has an excess of nutrition the body will store this up against the time of need; this is all in harmony with natural law. When, however, this law is applied to the human subject, it results in an abnormal condition, because ordinarily the human subject has plenty all the time. He does not go into a state of hibernation as does the bear, nor does he have to put up with one scanty meal a day dug out from under the snow, as does the deer, or the ox, or the horse in a wild state. So his accumulated fat is retained, only to receive additional installments as the period of plenty continues. Thus nature's wise and conservative provision may become for man an actual calamity. This condition, which may be looked upon in its more serious excesses as an actual disease, can only be corrected by applying nature's method. This has been understood for ages long, and we have records dating back hundreds of years which show that long ago the condition and its significance was clearly understood. As far back as the days of William Harvey, the Elizabethan physician who demonstrated the circulation of the blood, we have a record of his treatment of the case of a patient named Banting. This method has ever since been known as the Banting Method. It would perhaps more appropriately be called the Harvey Method. According to that method the total amount of solid foods was reduced to not over a third of the usual amount - that is, twenty-one to twenty-seven ounces of solid food per day. Of this, lean meat comprised at least half; bread was reduced to the small amount of two ounces per day, and the balance of the bulk was made up of fresh fruits and vegetables. A drink allowance was limited to thirty-five ounces a day. All sugars and fats were absolutely eliminated from the dietary. This Banting diet, devised by Dr. William Harvey, represents about 1,100 to 1,200 calories per day. It will be remembered that the calory value of the usual diet figures up from 2,500 to 3,000 per day. Harvey reduced this to considerably less than one half; in fact, nearer one third of the usual average.

Oertel modified the Banting regime by allowing some fat and a slight increase in the permissible fluid ingestion. Oertel's diet produced about 1,200 calories, still considerably less than half the average.

Ebstein went a step further in the use of fats and permitted them to be taken freely, limiting only the proteins and carbohydrates, especially sugars and starches among the latter. Tea was allowed as a beverage. Ebstein's dietary represented about 1,400 calories.

Van Noorden's dietary, more recently planned and far more widely used than any of the others of the present time, will be here given in some detail (taken from Osier's "Practice").

Breakfast

Lean meat, 80 grams.

Bread, 25 grams.

Tea, one cup with milk, no sugar.

Morning Lunch

One egg.

Midday Lunch

Meat broth, one cup; followed in one hour by

Soup, one small portion.

Lean meat, 159 grams.

Potatoes, 100 grams.

Fruit, 100 grams, without sugar.

Afternoon Lunches

3 p.m. Cup black coffee.

4 p.m. Fruit, 200 grams. 6 p.m. Milk, 1/4 liter.

Dinner, 8 P.M

Meat, 125 grams of cold meat, or 180 grams meat grilled.

Bread, 30 grams, graham.

Fruit, small portion as sauce without sugar.

Salad, vegetable or fruit, or radishes or pickles.

Summarizing this menu, we find that there is a total of:

Lean meat, 400 grams during the day, which would yield of dry proteins about 76 grams and of fat probably not less than 50 grams, though it might be possible, by carefully cutting away every vestige of fat, to reduce this to 30 grams.

Bread, 55 grams, in which there would be about 4.4 grams of protein, a vestige of fat and 28 grams of carbohydrates.

Potatoes, 100 grams, in which there would be 2 grams of protein, hardly more than a trace of fat, and 30 grams of carbohydrates.

Milk, about 250 grams, in which there would be about 8.3 grams of protein, 10 grams of fat, and 7.5 grams of carbohydrates. One egg, estimated weight at 50 grams, would represent 6.5 grams of protein, 4.6 grams of fat.

Fruit, between 300 and 400 grams; if we take apples, there will be not over 2 grams of proteins and not over 40 grams of sugar.

Footing up these values, we find that there will be a little less than 100 grams of protein, a little more than 100 grams of carbohydrates, and about 65 grams of fat. Assuming the menu to represent 200 grams of combined carbohydrates and protein, that would give us (counting 4 calories per gram) 800 calories for the proteins and carbohydrates, while 65 grams of fat would yield about 600 calories, making a total of approximately 1,400 calories for the Van Noorden dietary.

Discussing this dietary, the reader will be impressed with the fact that it is evidently a hospital dietary. The almost continuous serving of broths and soups would be altogether impracticable for everyday use in the home. Most of the cases of obesity that the physician has to deal with are in people who are obliged to continue their daily activities. The amount of food allowed by Van Noorden is, without doubt, a sufficient one, and the general principles illustrated in Van Noorden's dietary are unquestionably sound. These principles are, first, the elimination of sugar, so far as it is possible to do so; second, the reduction of proteins to the physiological minimum; third, a moderate reduction only of the fats; fourth, the production of a feeling of comfortable satiety by the free use of liquids, such as meat broths, tea, and water, which contain a comparatively small amount of nourishment as compared to their bulk.

Applying these principles of Van Noorden's, the author would suggest the following modification as more practicable for use in the ordinary cases that come into the physician's practice:

In choosing our proteins we will be governed by the findings of Professor Chittenden, as set forth in his work entitled, "Economy in Nutrition," and reduce the proteins to the physiological limit as we now understand it. The following menu may serve as suggestive:

Breakfast

One cup hot water.

One egg, boiled or poached.

One slice toast.

One-half grape fruit, or one orange.

Lunch

Soup, ample bowl vegetable.

100 grams of meat (beef, mutton, veal, pork, fowl, game, or fish). 1 slice bread.

Fruit, choice of 1 apple, 1 orange, 1 bunch grapes, or a small portion of berries, or other fruit in season.

Dinner

1 cup bouillon. Meat, 150 grams. Potatoes, 100 grams.

Vegetables, 100 grams (spinach, cabbage, cauliflower, celery, radishes or lettuce).

Fruit, 1 apple, pear, peach, orange, half grape fruit, or other acid fruit.

If the patient will observe the following precautions - namely, eat very slowly, pulverize every morsel of food to an impalpable, creamy condition, until it gradually disappears from the mouth - he will find his hunger completely satisfied on these very limited rations. Until he gets used to this meager diet he is destined to feel a little empty at times. However, he will soon get adapted to the regime and his dilated stomach will shrink down to a condition in which it will feel comfortably full on the rations above outlined.

Combining this light ration with vigorous out-of-door exercise, such as golf, lawn tennis, rowing, horseback riding, or walking three or four miles each day to and from business, will in a very short time be followed by a substantial reduction in weight. This will continue until the subject has been reduced to normal proportions, unless there are some pathological conditions present that are out of the ordinary. One general rule that must be absolutely enforced if any progress is to be made in the reduction of weight is, that all alcoholic beverages must be prohibited absolutely, for reasons clearly set forth in a preceding chapter.