Introduction

While obesity is not a disease in the common acceptation of the term, it is a condition which seriously disturbs the patient's comfort, curtails his ability to enjoy many of the pleasures of life, and indirectly leads to disease and premature death. In later life the obese subject is heavily handicapped, every ounce of superfluous fat may tell against him in his combat with disease. In the prophylactic treatment of obesity, attention is being directed to preventing the fatty heart, the sluggish liver, the restricted lung surface, the development of renal disease, and the inevitable cardio-vascular failure, that all too surely await the majority of obese subjects while they are yet young in years.

Causes

Obesity is hereditary in some instances, and in these cases it is much more difficult to cure. It is, however, essential to note that the obesity seen in subjects who have a hereditary tendency to it does not essentially differ from the acquired form, the difference is entirely one of degree. Such a patient has through his forbears acquired a tendency to lay on fat, but there is good reason to believe that he can by means of diet modify this tendency materially, and hand on to his progeny a diminished susceptibility to the condition.

To what, then, is obesity due. It results from the excessive consumption of certain foods, and more especially of foods which are fat-forming. Of these the most important clinically are the carbohydrates. The chief function of carbohydrates and fats is that of energy producers, and all the excess of these foods above the bodily requirements is stored up in the tissues of obese subjects as fat. Contributory factors are lack of exercise, and excessive indulgence in wines and malt liquors. A vicious circle is often set up; lack of exercise tends to promote obesity; obesity still further restricts the active bodily movements which are so essential for good health.

The following table is a useful one. indicating what should be the relative weight and height of a person at adult age in good health. On the higher scale a certain percentage is allowed for differences in build, size of bones, etc. A weight beyond the extreme, means diminished respiration and impeded action of the heart, conditions incompatible with robust health and condition: -

Stature.

Normal weight.

Extreme limit.

Male.

Female.

Male.

Female.

ft.

in.

St.

lb.

St,

lb.

St.

lb.

St.

lb.

5

O

8

4

7

9

8

II

8

I

5

I

8

9

7

12

9

2

8

4

5

2

9

0

8

2

9

6

8

7

5

3

9

7

8

8

10

0

9

0

5

4

9

13

9

2

IO

6

9

7

5

5

10

2

9

8

10

10

10

0

5

6

10

5

9

13

ii

0

10

7

5

7

10

8

10

5

ii

5

10

13

5

8

II

I

ii

0

II

10

II

4

5

9

11

8

ii

6

12

2

12

0

5

IO

12

0

11

10

12

9

12

6

5

11

12

6

12

2

13

3

12

12

6

0

12

10

12

8

13

12

13

4

Principles Of Treatment

The first essential in treatment is to greatly reduce the amount of fat-forming foods. These are not required. When these are cut off, nature draws on the reserve fat in the tissues, until that which is superfluous is gone. By this means we reduce the total amount of energy taken in the form of food. At the same time combustion in the tissues must be promoted by increased physical exercises, which should take the form of walking, riding, golfing, or the like; and if for any reason these are not obtainable, by physical exercises carried out at home daily under direction. By this means the output of energy in the form of work is increased. A third important factor in treatment is to promote the activity of the skin by a carefully planned course of baths, which must be prescribed with special caution in the case of very obese subjects. The last general point to which attention must be directed is the amount of fluid taken, and its relationship to food. On this point a good deal of difference of opinion prevails.

There are many systems of dietetic treatment, some of which only differ in detail. It is unnecessary to describe all the different "systems" that have been advocated at one time or another. Attention will only be directed to the main ones. Before doing so, it is perhaps necessary just to mention the different degrees of obesity clinically met with. For example, there are slighter forms, in which the organs of circulation are unaffected, and rigorous bodily exercise is possible; and more serious forms, in which the heart muscle is invaded, the liver and other viscera are congested, and the tissues generally are embarrassed. The treatment, both as to diet and exercise, varies considerably in the two classes of case.

Banting's Method

In this system the amount of food is reduced, and fats and carbohydrates are largely excluded. The diet consists of animal food, 13 to 16 ounces; bread, 2 ounces; fruit and vegetables, 6 to 12 ounces; total fluid restricted to 35 ounces, made up as follows: -

Breakfast

5 to 6 ounces of animal food; meat (except pork and veal), boiled fish, or kidneys; 1 ounce of toast or biscuits; 9 ounces of tea without milk or sugar.

Dinner -5 to 6 ounces of lean meat, poultry, game, or fish; eels, salmon, and herrings are excluded; any vegetable except potato, parsnips, beetroot, turnips, or carrot; cooked fruit, unsweetened; 1 ounce dry toast; 10 ounces good claret, sherry, or Madeira.

Tea

9 ounces plain tea without sugar or milk; 2 to 3 ounces of cooked fruit; a rusk or two.

Supper

Meat or fish as at Dinner, 3 to 4 ounces; claret, or sherry and water, 7 ounces.

On this diet Ranting reduced himself in one year from 14 stones 6 lbs. to 11 stones 2 lbs. The diet, it will be observed, contains very little carbohydrates. This system of diet is a simple one, and it can be easily regulated, hence its popularity. The large amount of meat in this regime is very distasteful to some people, and in cases where there is some renal disease, this diet is unsuitable. Apart from the existence of renal disease, a prolonged course of this regime in some patients sets up dyspepsia and intestinal derangement, with general nervous depression, and these must be guarded against. Another objection to this diet is the alcohol. This is unnecessary, and unless there are special indications for its use, it should be avoided.