Obesity

"A fat person, at whatever period of life, has not a sound tissue in his body: not only is the entire muscular system degenerated with the fatty particles, but the vital organs--heart, lungs, brain, kidneys, liver, etc.,--are likewise mottled throughout, like rust spots in a steel watch spring, liable to fail at any moment. The gifted Gambetta, whom M. Rochefort styled the fatted satrap died--far under his prime--because of his depraved condition; a slight gunshot wound from which a clean man would have speedily recovered ended this obese diabetic's life. Events sufficiently convincing are constantly occuring on both sides of the Atlantic; every hour men are rolling into ditches of death because they do not learn how to live. These ditches have fictitious names--grief, fright, apoplexy, kidney troubles, heart disease, etc.,--but the true name is chronic self abuse."

Fortunately there is a considerably greater apprehension in the public mind now than a few years ago as to the evils of growing fat. The writings of Mr. Banting, an enthusiastic layman who was greatly helped by a reduction of obesity, and whose interest in his fellow men prompted him to make as widely known as possible some thirty years ago his method of cure, has done much to dispel dense ignorance concerning this topic; and in more recent years the illness of Bismarck, and his restoration through the reduction of his obesity, was also a great help to spread knowledge on this most important subject. 

The exciting cause of obesity is the ingestion of more food that the system requires, together with the weakening of the excretory organs, which results in the failure of the system to adequately throw off its waste matter. But the profound and primal cause of obesity will one day be recognized to be the use of cereal and starch foods. An obese person weighing two, four or six stone, twenty-five, fifty, or eighty pounds, or even a still larger amount, more than is natural, may be given a diet of flesh with water with or without the addition of starchless vegetables, as lettuce, watercress, tomatoes, spinach, and the like, excluding bread, pulses and potatoes, and the patient will be gradually but surely reduced to his normal weight. As soon, however, as the patient returns to his usual diet of bread and potatoes he straightway begins to increase in weight; and while an obese patient can easily be reduced eight pounds per month when placed upon a flesh diet, he will gain fully this much or more upon returning to a free use of bread and starch vegetables. If this patient who has been reduced, and who has again developed obesity, is persuaded to again adopt the exclusive flesh diet, again the reduction is sure to take place; and in the course of our practice this process has been repeated among many patients, and in a few a reduction and return to flesh has been repeated three times. It is plain from such demonstrations that without starch foods corpulency would not exist. Chemically starch foods are chiefly carbon; adipose tissue is also carbon, and it would naturally be expected that a diet of oil and the fat of animal flesh would contribute quite as much to obesity as bread and starch foods. But experience proves that such is not the case. The reason for this is not, in the present state of science, understood; it will likely be found in the fact that starch foods undergo a complicated process of digestion, whereas oils require only emulsion to render them assimilable by the system. 

The courage and strength of conviction possessed by the average family doctor is curious to behold. It will be found to be inversely to the ratio of his knowledge. The less conversant he is with this malady the greater confidence he seems to have in his opinions. During the years that we were in practice some hundreds of patients came to us for assistance in this trouble, a large number of whom were under the control of their family physician. Many of these patients came in defiance of the express orders of their physicians; and while they had assumed courage enough to disobey their orders and come to us, they needed much encouragement to enable them to proceed with any confidence. They were usually told by their medical advisers that in them it was natural to be stout, that they had "better leave well enough alone," and the direst results were prophesied in the event that they had the temerity to proceed. In point of fact these patients quite invariably experienced nothing but the happiest results. many of them came out of an interest in their personal appearance; finding their figures destroyed and their beauty going, they desired restoration to their youthful form and feature. Others, again, were annoyed at clumsiness in getting about, shortness of breath in climbing stairs, and the general awkwardness and inconvenience that result from this "too, too solid flesh." Only a small proportion of these patients came from a knowledge that obesity is a disease, that it encourages other states of inflammation and other diseases, and that its reduction is a great aid in the return of health. But while thees patients as a rule did not come to us with this expectation, it was common for them to testify to geat benefits that had resulted from their treatment. These benefits were quite frequently greater than the patient would readily admit or remember. It was our custom, with all patients beginning treatment, to take the name, age, height, weight, and a list of the infirmities, if any, from which they were suffering. These details were elicited by a series of questions, and the answers duly recorded. Out of sight out of mind is the old adage; and human beings are fortunately so conditioned that when their aches and pains have taken flight they forget not infrequently that they were ever present. many of these patients would have stoutly denied the benefit rendered but for the diagnosis taken at the beginning of treatment, and a reference to wich only would convince them of the coniditon they had been in. 

The class of carbohydrates have much in common with the fats. They serve the same purpose of checking albuminous waste ; like them, they are resolved by combustion within the body, ultimately, into carbonic acid and water, and so, like the fats, are capable of yielding heat and mechanical work. Unlike the fats and the albuminates, however, they do not appear to enter into the structure of the tissues, although they are found in some of the fluids and organs of the body. 

All the carbohydrates are converted into glucose, or grape sugar (or maltose), before they are absorbed, and in this form they are much more readily metabolised than the fats or albuminates. 

It is believed by many, and the weight of evidence, as will be seen, is in favour of the conclusion, that carbohydrates can be converted into fat within the organism. Bauer,* however, is indisposed to accept this view. Basing his opinions on the experiments of Pettenkofer and Voit, who showed that carbohydrates, even when administered in great excess, are almost completely destroyed within the body, he maintains that although the carbohydrates, when given together with albumen and fat, favour an increase of the constituents of the body, and especially of fat, yet it is not because they are themselves converted into fat, but because, owing to the facility with which they are metabolised, they protect the other food-stuffs from destruction. 

"When fat and carbohydrates co-exist in the food, the latter are always the first to be consumed; and when they are present in sufficient amount, the consumption of fat in the body may be completely suspended." And he explains in a similar manner the fact that a deposit of fat may be observed to take place when the diet consists of albuminates and carbohydrates alone, without any fat; for in that case, he says, the fat, which "originates as a product of the splitting-up of albumen, is withdrawn from further metabolism in favour of the carbohydrates, and contributes to the gain." He also rejects the view that the ready decomposition of the carbohydrates in the body depends on their great affinity for oxygen; he considers it lies rather in the properties of the animal tissues, and he points out that the assumed equivalents of starch and fat, as 240 of the former to 100 of the latter, calculated on the quantity of oxygen required for their combustion, are incorrect; and that in the living organisms "175 parts of starch are in the material actions approximately equivalent to 100 of fat." 

Germain Sée begins by supporting the view taken by Bauer, and asserts that the principal function of the carbohydrates is the immediate development of heat and mechanical work ; that they are not annexed in any way directly or indirectly to the organisms ; and that the fat that is deposited in consequence of their use is derived from the splitting-up of albuminates. He urges the experiments of Boussingault, who found that when he fed ducks on a pure carbohydrate like rice, they grew thin; but on adding a small quantity of butter, they grew fat. The same experimenter also asserted that milch-cows only gave out the quantity of fat in their milk that was contained in their food. Sée also points out that the particular kinds of grain selected for fattening animals are always such as contain, like maize, a considerable quantity of fat. But, notwithstanding all this, he appears in the end to yield to the weight of evidence that fat may be, under certain circumstances, formed from carbohydrates. 

Dujardin-Beaumetz believes in the possibility of the transformation of glucose, the product of the digestion of carbohydrates, into fat. He sees a great analogy between the formula for glucose, C6H12O6, and that of glycerine, C3H8O3, and thinks that the latter may result from the splitting up of the former with the addition of hydrogen. He also shares, to a certain extent, Pavy's views, and considers that a portion of the glucose derived from the digestion of carbohydrates is deposited as " hepatic glycogen" in the liver, and thus furnishes the glucose necessary to the organism when the food does not contain any carbohydrates, Pavy maintains, as is well known, that saccharine matter, when absorbed, "on reaching the liver is transformed by that organ into amyloid sub- stance [glycogen], which is stored up in its cells for subsequent further change preliminary to being appropriated to the purposes of life." The occurrence of this "amyloid substance" in the liver, even when a purely animal diet has been taken, he accounts for by the supposition that the liver is the organ in which the splitting-up of the albuminates into urea and a non-nitrogenous substance occurs, and that the latter is metamorphosed by the liver into "glycogen." Pavy believes that carbohydrates are first converted into this "amyloid substance," and that this is afterwards converted into fat. But he points out what is doubtless a most important condition in the conversion of carbohydrates into fat, namely, "the co-operation of nitrogenous in conjunction with saline matter," for it is probably by the changes occurring during the metabolism of the albuminates that this transformation is excited. The presence of a small amount of fat with the carbohydrates would seem also to favour this conversion, for the rapid deposition of fat which sometimes occurs when animals are fed on such a mixture appears to be more than can be accounted for by the small quantities of fat ingested. Pavy dops not admit that any of the carbohydrates undergo direct oxidation in the system, or contribute strictly to force production.

In connection with this interesting and important discussion, the following observations by Tsclierwinsky arc referred to in Landois' "Textbook of Human Physiology." He fed two similar pigs from the same litter. 

No. 1 weighed 7,300 grammes ; 

No. 2 7,290 grammes. No. 1 was killed, and its fat and proteids estimated. No. 2 was fed for four months on grain, and then killed. The grain and excreta and the undigested fat and proteins were analysed, so that the amount of fat and proteins absorbed in four months was estimated. The pig then weighed 24 kilos. ; 11 was killed, and its fat and proteins were estimated : — 

No. II. contained 2.50 kilos. of albumen and 9.25 kilos. of fat 

No. I.                        0.94 „                                        „ 0.69 „ 

Assimilated            1.56 „                                        „ 8.56 „ 

Taken in in Food   7-49 „                                      „ 0.66 „

Difference            — 5.93                                      " +7.90"     

There were therefore 7.90 kilos, of fat in the body which could not be accounted for in the fat of the food. The 5.93 kilos. of albumen of the food which were not assimilated as albumen could yield only a small part of the 7.90 kilos, of fat, so that at least 5 kilos. of fat must have been formed from carbohydrates. Lawes and Gilbert calculated that 40 per cent of the fat in pigs was derived from carbohydrates. How the carbohydrates changed into fat in the body is entirely unknown." 

As has already been stated, the weight of evidence appears to be distinctly in favour of the conclusion that, in some way or other, the carbohydrates are capable of being converted into fat in the system ; but, in any case, the same result occurs, and they promote, either directly or indirectly, the deposition of fat within the body. 

The probability that lactic and other acids of the same class are formed in the body, chiefly or solely from carbohydrates, is drawn attention to by Parkes. "The formation of these acids is certainly most important in nutrition, for the various reactions of the fluids, which offer so striking a contrast (the alkalinity of the blood, the acidity of most mucous secretions, of the sweat, urine, etc.), must be chiefly owing to the action, of lactic acid on the phosphates or the chlorides, and to the ease with which it is oxidised and removed." We may conclude, then, that the carbohydrates by their capacity for rapid metabolism contribute largely to the production of heat and mechanical work, find also that their use greatly favours an increase in the constituents of the body, and especially of the albumen and fat. If we desire to increase the albumen without adding greatly to the store of fat, we should (according to Bauer) give a liberal allowance of albuminates with relatively small quantities of carbohydrates. But if we desire a substantial addition to the fat, the food should contain less albumen and more carbohydrates, with a fair proportion of fats.

Simple Rules for a Successful

Reduction Cure.

IT ALL DEPENDS ON THE DIET

Food Containing Sugar and Starch Must Be put aside - The Quantity of Food Eaten Is Not of Importance if the material is of the proper kind— Ice cream, potatoes, and bread must be abolished--  No water or Liquors at meals.

"This is the season of the year in which people who want to reduce their flesh would do best to begin," said a doctor who has made himself more famous in this particular field than any other American physician. "For one reason, there are fewer privations which the patient is compelled to endure now. Very few of the things that are delicacies at this time of the year are prohibited by a course of diet intended to reduce one's flesh. As a matter of fact, the forbidden articles are very few indeed, so surprisingly few that I always wondered why people look upon a course of banting as a hardship. Practically the only spring vegetables which should not be eaten are potatoes, beets, and peas, and no fruits are on the proscribed list.

"Patients who come to me receive one invariable prescriptlon. All fat comes from the same natural cause, and can be made to disappear in the same way.

I never can give any medicine beyond what is needed to put the patient in a state of good natural health. After I have accomplished that the reduction begins by following a method so publicly known that there is no reason why I should hesitate to reveal its use in my own case. It is wrong to say that only by a regimen of eating can a person's flesh be reduced. What is drunk has quite as much to do with the result. 

"I begin by refusing to allow my patients to eat anything containing either starch or sugar. Bread must first of all be given up. There is enough fat-making material in one breakfast roll to counteract the effects of mineral water treatment taken for months. Bread must absolutely be kept off the bill of fare of any one who wants to get thin. Sometimes very dry toast may be eaten in very small quantities, but nowadays there are excellent substitutes for bread provided, and th ese are quite as toothsome if a person can only break himself for a while of the feeling that he must accompany every meal abundantly with rolls or crackers, as the case may be. The new breads made without any starch are, of course, admissible, because if they are what they pretend to be there can be no fattening substance in them.

"The bread out of the way, one great step has been accomplished. Sugar must follow, and the substitutes for that are so nearly the same in effect that nobody should mind taking saccarine in coffee, instead of several lumps of sugar. It is in puddings, pies, and other similar combinations of flour and sugar that these two substances are most missed, but all pastry, puddings, and desserts of any kind in which sugar is employed are forbidden. Sugar and starch must be left alone. And this includes all corn bread and similar bread foods made of flour, cornmeal, and similar substances.

All Liquors are Fattening.

"With practically no other foods forbidden, it is possible for a person to lose as much as five pounds a week by following the rules outlined. I have known thirty pounds to be lost in six weeks on this sort of a regimen. All meats, all kinds of fish, except salmon, and all vegetables, except beets, peas, lima beans, and potatoes, can be enjoyed. Liquor must in nearly every form be left entirely alone. Beer is, of course, so fattening hat no one with any idea of reducing his weight would ever touch it, and some other alcoholic drinks are very nearly as bad. Whisky is very fattening, and so is champagne. Such concoctions as cocktails, all kinds of punches, and other mixed drinks put on more fat that years of diet could take off. There is no hope in a reduction diet for the person who continues to take alcohol. Candles, of course, and sweets should never be touched, while ice cream and similar edibles are just as high up on the forbidden list.

"This practically completes the entire cure. One need only observe carefully these rules of diet to lose flesh certainly and quickly. More than that, such a selection of food would improve the patient's general health. Abstinence from starch and sugar is known to cure many bad cases of indigestion, and I don't believe there ever was a person following such a course that did not feel better for it. Wine in small quantities and usually white in color, and rather dry in quality, may be taken with a meal, but water."

How to Reduce Flesh

A man or woman who feels that flesh accumulating too rapidly may lose it by drinking sassafras tea, either cold or hot, with or without sugar, as the taste demands. There might be conditions of the system when it might be injurious, however, and it would be better to consult a doctor before using it. A strong infusion may be made of one ounce of sassafras to a quart of water. Boil half an hour very slowly, let it cool, and keep from the air.

A perfectly safe way to get thin is to eat chopped meat without any potatoes. Drink as little as possible of any fluid. Exercise a great deal without drinking and if possible eat no bread, butter, or sweets. Lemonade, acid drinks of any kind, a little strong tea and saline mineral waters will assist you, but of thees take only as little as possible. Start the morning by drinking a glass of clear water.

How to Increase Flesh

Thin people who wish to get stout should eat oatmeal, hominy, or any of the preparations of wheat now sold. Wheat rolls, corn mush, cream, chocolate, milk, sugar, omelets, jams, eggs, potatoes, bacon, and all other fattening foods.