Obesity

But a good hunter has additional considerations when he is choosing a bride. To an Eskimo, a wife is more or less an advertisement. The degree of ease and comfort in which she seems to be living is the measure of his ability as a hunter and provider. Although she has a thousand tasks to perform, she is never required to do any heavy or dirty chores. Her value to him lies in how neat, gentle, and loving she can be; hard work would only weaken her for lovetime, Chewing skins and sewing is the woman's job, but flensing the animal is the man's job; cooking the meat for the guests is the woman's task, but taking it down from the meat rack, chopping it up, and bringing it into the house is the man's. The wife's composure and attractiveness tell the guests of the husband's wealth. It follows that a girl who shows industry and talent, and who keeps herself neat, is much desired for a mate.

On the other hand, the busier a hunter keeps his wife sewing, entertaining guests, and bearing children, the prouder she is of him. Coquettishly, she calls him "the terrible one" because he keeps her in such slavery, and it is every girl's dream sometime to be able to shout: "Oh, a poor woman does not have the ability to prepare all the skins that a man can bring home. How I envy those women whose husbands give them only a few skins to prepare!"

With such a speech, she can make the other wives green with jealousy.

If such a neat and clever girl should also happen to be fat, then she is really the village belle. An Eskimo cannot give his wife jewelry, new hats, or other things that will demonstrate his wealth, nor can wealth be demonstrated in clothing: all the women's apparel is pretty much alike. It is therefore essential that she appear well fed! As a result, there must always be lots of food--and fattening foods, too--at his house, and his family will enjoy respect and a good reputation. A fat girl is always popular because, as a wife, she will be easier to keep in style, and stoutness is identical with beauty among the Eskimos.

This reminds me of Inuiyak who was one of my Eskimo helpers during the Fifth Thule Expedition and whom, when I was about to return to Denmark, I paid with such gear as I was not going to use any more. He got sled and dogs, axes, knives, and a gun. All of a sudden he became a tycoon among his people, and his first thought was to get a wife. In Repulse Bay he asked for a few days off, and came back with a bride. Being so rich, he had of course no difficulty in getting the fattest one in the place. When Inuiyak came driving up with her on his sled, he made a big to-do out of puffing and panting so that we all could see how hard he had to push. We gave them a real celebration, but the next day we regretted it. We had counted on Inuiyak to take a load on his sled for us on the month-long journey we still had left. But he was no longer the same man!

"My wife is so fat," he bragged. "No dogs can drag this heavy burden. She is too big to run, so others will have to take those boxes!"

This was shouted in a loud voice so everybody could hear it. The intention was to flatter the beauteous lady; being in love has strange effects on people. So Inuiyak wasn't very useful to us any more.

In 1920, while Vilhjalmur Stefansson was just beginning his campaign to convince nutritionists that an all-meat diet was a uniquely healthy diet, it was already making the transition into a reducing diet courtesy of a New York internist named Blake Donaldson. Donaldson, as he wrote in his 1962 memoirs, began treating obese patients in 1919, when he worked with the cardiologist Robert Halsey, one of four founding officers of the American Heart Association. After a year of futility in trying to reduce these patients ("fat cardiacs," he called them) with semi-starvation diets, he spoke with the resident anthropologists at the American Museum of Natural History, who told him that prehistoric humans lived almost exclusively on "the fattest meat they could kill," perhaps supplemented by roots and berries. This led Donaldson to conclude that fatty meat should be "the essential part of any reducing routine," and this is what he began prescribing to his obese patients. Through the 1920s, Donaldson honed his diet by trial and error, eventually settling on a half-pound of fatty meat-three parts fat to one part lean by calories, the same proportion used in Stefansson's Bellevue experiment-for each of three meals a day. After cooking, this works out to six ounces of lean meat with two ounces of attached fat at each meal. Donaldson's diet prohibited all sugar, flour, alcohol, and starches, with the exception of a "hotel portion" once a day of raw fruit or a potato, which substituted for the roots and berries that primitive man might have been eating as well. Donaldson also prescribed a half-hour walk before breakfast.

Over the course of four decades, as Donaldson told it, he treated seventeen thousand patients for their weight problems. Most of them lost two to three pounds a week on his diet, without experiencing hunger. Donaldson claimed that the only patients who didn't lose weight on the diet were those who cheated, a common assumption that physicians also make about calorie-restricted diets. These patients had a "bread addiction," Donaldson wrote, in that they could no more tolerate living without their starches, flour, and sugar than could a smoker without cigarettes. As a result, he spent considerable effort trying to persuade his patients to break their habit. "Remember that grapefruit and all other raw fruit is starch. You can't have any," he would tell them. "No breadstuff means any kind of bread…. They must go out of your life, now and forever." (His advice to diabetics was equally frank: "You are out of your mind when you take insulin in order to eat Danish pastry.")

Had Donaldson published details of his diet and its efficacy through the 1920s and 1930s, as Frank Evans did about his very low-calorie diet, he might have convinced mainstream investigators at least to consider the possibility that it is the quality of the nutrients in a diet and not the quantity of calories that causes obesity. As it is, he discussed his approach only at in-house conferences at New York Hospital. Among those who heard of his treatment, however, was Alfred Pennington, a local internist who tried the diet himself in 1944-and then began prescribing it to his patients.

THE NATURE OF OBESITY

L. H. NEWBURGH AND MARGARET WOODWELL JOHNSTON 

(From the Department of Internal Medicine, Medical School, University of Mickigan, Ann Arbor) (Received for publication April 22, 1929) 

The medical profession in general, believes that there are two kinds of obese persons-those who have become fat because they overeat or under-exercise; and those composing a second group whose adiposity is not closely related to diet, but is caused by an endocrine or constitutional abnormality. The first apparently scientific support of the hypothesis that obesity was often of endogenous origin, came with the finding that some obese persons had an abnormally low basal metabolic rate, on the basis of body weight. When, however, it was shown that the expenditure of energy is proportional to the surface area and not the weight, it was found that most such persons have a normal basal metabolic rate. However, it is true that there remains a small group of fat people whose basal rate is definitely low. Later writers maintained that a common cause of endogenous obesity was to be found in a lessened specific dynamic response to food. But the increase in metabolic rate caused by food is relatively small, so that a method possessed of a high degree of accuracy is needed in order to deal quantitatively with this phenomenon. Our prolonged study of this question has convinced us that the inherent error in the method to date, when it is applied to the human subject, is such that it precludes the possibility of making quantitative statements regarding the specific dynamic response to food in man. Other writers have attributed endogenous obesity to a constitutional anomaly of the cells which somehow lowers the rate of intracellular oxidations.

....

These considerations lead to the conclusion that the fundamental cause of endogenous obesity is not to be found in some type of metabolic abberation; but rather, that these individuals, in common with all obese persons, are the victims of a perverted appetite. In normal people there is a mechanism that maintains an accurate balance between the outgo and the income of energy. All obese persons are, alike in one fundamental respect,-they literally overeat.

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The unspoken proposition is that if researchers could only figure out how to induce those of us who eat too much to rein it in, curb our out-of-control appetites, eat smaller portions, and refrain from reaching for the doughnuts, we’d lose weight or not fatten to begin with. This, again, evokes implicit judgments about why we might fail should we have the misfortune to remain fat. It’s not a failure in our bodies, not some hormonal or physiological phenomenon, that’s drove us (but not our lean friends or siblings) to amass fat. Rather it’s some behavioral quirk, whether moral turpitude, lack of willpower, lack of vigilance, or the sin of gluttony and/or sloth. That’s why we’re still fat. It’s not the expert advice or thinking that’s misguided. It’s us. This blame-the-fat-person, look-who’s-reaching-for-the-doughnuts thinking, the moral judgments and fat shaming, has always been embedded within this idea that obesity is caused ultimately by overeating. Here’s one of the many areas in this controversy in which it helps to know the history. This fat-shaming implication was institutionalized as far back as the 1930s by the University of Michigan physician Louis Newburgh, who was largely responsible for convincing decades of physicians and obesity researchers that obesity is indeed caused by eating too much—“a perverted appetite” or a “lessened outflow of energy,” as he put it—and not by some hormonal or physiological defect. Obesity, he and his colleague Margaret Woodwell Johnston wrote in 1930, is “always caused by an overabundant inflow of energy.” The cause is never an “endocrine disturbance”—that is, hormones—that would manifest itself as a tendency to store calories as fat rather than burn those calories as fuel. By Newburgh’s dictate, the cause is always some form of eating too much. This left open, though, the obvious question: What causes this overabundance? Or, rather, why don’t fat people voluntarily curb their appetites, curb the overabundant inflow, and not get fat? Is it only a question of willpower? This too requires an explanation (just as the NIH authority in Nutrition Action still has to explain why some of us eat too much in this food-rich environment and others don’t). Hence Newburgh, and all those who have come after him, transformed a physiological disorder into a character flaw. The overabundant inflow, said Newburgh, is the result of “various human weaknesses such as over-indulgence and ignorance.” My suspicion, and I hope I’m not doing the man a disservice when he’s no longer around to take offense, is that Newburgh’s thinking was strongly influenced by the fact that he appears to have been pencil thin. Even in cases that seemed obviously hormonal—the pounds of fat often gained by women, for instance, when they pass through menopause or after a hysterectomy, the surgical removal of the uterus—Newburgh refused to concede an explanation other than overindulgence and weakness. Endocrinologists who studied this “well known” phenomenon in animals had concluded by the late 1920s that a critical role for female sex hormones—particularly estrogen—in the process of fat accumulation was implied. Secrete less estrogen, as women do during this phase of their lives or after a hysterectomy, and fat will accumulate. It happens to female animals. Maybe it should be no surprise it happens to female humans, too. So this, at least, must be hormonal. Not so, insisted Newburgh. It’s all eating too much: “Probably she [the woman getting fatter as she goes through menopause] does not know or is but dimly aware that the candies she nibbles at the bridge parties which she so enjoys now that she is rested are adding their quota to her girth.” Very scientific, that.

Gary Taubes. The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating (Kindle Locations 635-640). Knopf. Kindle Edition. 

The reducing diet. 

A nutrition problem of considerable importance has arisen with the present-day fashion for a slender figure. It is doubly essential that the restricted diet be well balanced. A very important consideration in the reducing diet is the preservation of nitrogen equilibrium. In reducing there should be no loss of body protein. The reducing diet should be low in caloric value but sufficiently high in protein to abundantly equal the body needs. In addition to a liberal supply of protein, the quality of the protein is important. Proteins of high biologic value are necessary. These are the proteins which supply all of the amino-acids in adequate amounts for building the body tissues. Such proteins are found in meat, milk, and eggs as supplements to the cereal grain proteins. Sometimes in planning the reducing diet, the satiety value of the foods included is entirely overlooked. This gives rise to an unsatisfied feeling which is reflected in the disposition of the person on the diet. On this point McLester says: 

"Other things being equal, the patient should be allowed to eat the food which in largest measure allays his hunger and which gives him the greatest degree of satisfaction. Meat has the highest satiety value of all foods; it 'sticks to the ribs' longest. Therefore, the protein that the patient receives should be largely in the form of meat. For the same reason, clear meat soups and broths are also useful; they have high satiety values without carrying much real nourishment."! 

It is obvious that reducing is not to be entered into carelessly and without competent medical advice and direction. The growing girl who chooses a reducing diet neither wisely nor well is taking grave chances with her future health. She runs the risk of so lowering her resistance that she is an easy prey to disease. McLester points out the necessity of viewing the protein intake from a clinical viewpoint. He says: "I have been impressed by the anemia shown by many patients who, from necessity or from a desire to become fashionably thin, have subjected themselves to rigid dietary restrictions. Animal experimentation has proved that a diet which contains liberal amounts of meats is the best blood builder, and one wonders whether an optimum protein intake is not, after all, a good insurance against disease. Clinical experience shows that it is."2 

Overweight may be due to an organic condition which only a physician can diagnose, and a physician's guidance in matters of diet is essential. Where there is no organic cause for overweight, rational diet should still be the rule.

Abstract : The observations were made in Angmagssalik in 1936-1937. The natural Eskimo diet was found to provide oh the average 299 g. protein, 169 g. fat and 22 g. carbohydrate, equivalent to 2800 Cal., with 0.5 g. Ca and 2 g. P per man value. Per head the energy value of the diet was 1900 Cal. per day, and the vitamin C [ascorbic acid] intake averaged 36 mg., of which one-half was derived from marine algae. The daily vitamin A intake was judged to be about 50, 000 I: U. per head.
Influenza and pneumonia occurred, especially in the summer and autumn, after visits of ships; Colds occurred frequently but ear and sinus complications were rare. Tuberculosis seemed to have a comparatively mild course. Acne was not seen, but carbuncles and impetigo were frequent, especially in the winter. Obesity, albuminuria, goitre and chronic constipation were not seen. Arteriosclerosis was relatively common and occurred at an early age. Convulsions in children under one year were frequent. Rickets was not seen in Eskimos living on a primitive diet. Bleeding of the navel in the newborn and from the nose and lungs in adults was frequent. The visual acuity in dim light was higher in the Eskimos than in North European seamen. Basal metabolism was on the average 13 per cent. higher in the Eskimos than that prediered bythe DU Bois standard. R.Q. values lower than 0.7 were not observed in starvation experiments, hut lower values were found on diets rich in fat. Ketone bodies were not commonly found in the urine, in spite of the low carbohydrate intake, and appeared in small amounts only in starvation and on diets rich in fat. The N.P.N. and the CO2-binding capacity of the plasma were 29 mg. per 100 ml. and 60 volumes per cent., respectively. The fasting blood sugar averaged 88 mg. per 100 ml.-R. Nicolaysen (Norway).