Obesity

“ Those who believe as I do, that an excessive development of fat may induce and sustain a generally diseased condition of body, will readily admit that the diminution of excessive obesity is the only rational means of cure in such a case. ”

“ Adiposity or obesity occurs when we have an excessive amount of fat stored in the normal connective-tissue areas of adipose tissue. It may be caused by various conditions, e.g. over nutrition with lack of muscular energy, beer-drinking, castration, lactation, disturbed metabolism, some forms of insanity, and may follow on some fevers. ”

“ Among female patients who consult me in reference to their obesity, many complain of a general sense of uneasiness, with frequent pains in the stomach, kidneys, headache, &c., asserting that their excess of fat came on after a confinement and when they had not suckled the infant, and thence infer that their obesity is owing to a decomposition of milk within the system. ”

“ To the many individuals of both sexes who are afflicted with an excessive development of fat, rendering the ordinary duties of life not only irksome but ofttimes impossible,—an easy method of reducing obesity, in nowise interfering with the ordinary daily avocations of the patient, nor demanding any diminution in the actual amount of food consumed ”

“ Physicians who have derived their knowledge from books, and from the lectures of their teachers, must find it difficult to change their opinions in reference to obesity. With [96] the public, when any one is told that the imbibition of large quantities of water is productive of fat, and that feeding upon animal food induces leanness, a similar degree of doubt is excited as when Galileo asserted that the sun did not revolve around the earth. ”

“ Cases are recorded of individuals of excessive obesity, who, being subject to the authority of an absolute master, have been submitted to most rigorous treatment for the purpose of reducing their fat. They have been shut up in a room, and fed upon an amount of food only sufficient to sustain life, and consisting solely of dry bread and water. Dry bread and water however, in sufficient quantity, and an endurable captivity, are not infallible means of inducing leanness. ”

“ Why not do the same with diabetes? We have seen that overeating is the common cause. Let us, therefore, teach the virtues of keeping lean and fit. Incidentally, such teaching may help to control other chronic diseases. There is reason to believe that heart trouble, high blood pressure, gallstone and cancer, occur in the obese with greater frequency than in the lean. Obesity is a mark of long continued functional overstrain of all the organs of the body. ”

“ Obesity caused by overeating
In every case of obesity, one or more of these causes are present. If one is blessed with good digestion and good assimilation, or, in other words, if all the nutriment taken into the body is absorbed into the tissues, then the quantity must be regulated by one's work or labor, otherwise any excess of fat-producing food is stored up by provident Nature, contemplating future use; and if it is not used, by actual work, the result is a gradual accumulation of fatty tissue. ”

“ For the development of obesity, there must exist a certain predisposition. We meet with many who do all in their power to grow fat, and who still remain thin, because, no doubt, they possess some peculiarity of organization which prevents the development of fat.
Obesity may be hereditary; that is to say, the father or the mother may transmit to their children a peculiar formation, having a tendency to make fat. From certain physiological conditions, we may recognize at an early age a natural tendency on the part of some persons to become corpulent. ”

“ All medical writers agree that want of sufficient exercise—as by lying too much in bed, riding in a carriage, &c.—is favourable to the development of obesity. The explanation is simple. We are all cognizant of the fact, that the body is sustained chiefly by means of food; but we also know that the atmosphere by which we are surrounded, plays an important part in the nourishment of the body. ”

“ Any weight above two and one-half pounds to the inch in stature may be considered as excessive, inasmuch as it adds nothing to one’s mental or physical efficiency, and is frequently the forerunner of obesity, the remedy for which is to live on a selected diet and to burn up more through exercise. ”

“ The abdomen attains a vast size, and impedes walking; so that a person labouring under obesity carries the head erect, and the body thrown back, as in the case of a pregnant woman, in order to preserve the necessary equilibrium and not fall forward. The intestinal mass, with its surrounding fat, being connected with the kidneys, by its weight gives rise to a dragging sensation, and causes pain on walking. It also pushes up the diaphragm, compresses the lungs and the heart, and becomes one of the causes of the sense of oppression complained of by fat people. ”

“ Those who are under-weight suffer from the disease in fatal form less than one-half as frequently as the average. Hence, obesity and diabetes are evidently closely related. As we have suggested, the disturbance of metabolism due to the failure to use sugar properly in the system and to its consequent elimination, corresponds in some, as yet not well understood, way to the other metabolic disturbance by which unnecessary fat is accumulated in the system. ”

“ The external appearance of such cases of obesity, which we have described before the French Congress of Medicine in 1904, and the London Pathological Society, February 21, 1905, as endogenous obesity, is also clinically different from the appearance of those caused by overfeeding. As we have shown, persons addicted to rich food, with little exercise, are often red in the face, and are plethoric; they easily become overheated and perspire freely. They seldom complain of constipation. ”

“ Limiting the Fluids in Obesity.—Thus it is seen that when the intake of fluids is limited, the body will call upon that surplus which is stored in every nerve, tissue, and fluid throughout the entire organism to assist in the necessary work of the organs, thus reducing the body weight just that much.
Exercise.—The athlete who is overweight, due to adipose tissue, increases his exercise at times, even adding to the weight of his clothing, causing an increased energy output, profuse perspiration, etc., all of which causes the body to use its surplus fuel in the form of the stored fat. ”

“ The Appetite.—The great trouble with most women who undertake an obesity cure which calls for an increased amount of energy is that they will develop an increased appetite thereby which they appease with food instead of forcing the body to use the store in hand, thus entirely doing away with any good the treatment might have accomplished. No amount of exercise without a proper regulation of the diet will prove satisfactory as far as the reduction of fat is concerned. The following methods recommended by Banting, Oertel, and Ebstein are included here. ”

“ When once fat begins to make its appearance in more than ordinary amount, there is no reason why this augmentation should naturally cease at any given point. This corpulence continues to increase until some disease, often occasioned by the condition itself, terminates this frightful increase of size.
Cases of obesity are rarely met with in mountainous countries, and those having a great elevation above the level of the sea, where the atmosphere is dry; whilst they are frequent in valleys and plains at the level of the sea, having a moist atmosphere. ”

“ Little do the faculty imagine the misery and bitterness to life through the parasite of corpulence or obesity.
I can now confidently say that quantity of diet may be safely left to the natural appetite; and that it is the quality only, which is essential to abate and cure corpulence. I stated the quantities of my own dietary, because it was part of a truthful report, but some correspondents have doubted whether it should be more or less in their own cases, a doubt which would be better solved by their own appetite, or medical adviser. ”

“ Looking back over the whole subject, it will be well for the physician to remember that increase of fat, to be a wholesome condition, should be accompanied by gain in quantity and quality of blood, and that while increase of flesh after illness is desirable, and a good test of successful recovery, it should always go along with improvement in color. Obesity with thin blood is one of the most unmanageable conditions I know of. ”

“ Sometimes the secretion of fat, and its accumulation in the adipose membrane, is almost as rapid as that of water in anasarca; on which account some of the old writers have called obesity a dropsy of fat. Persons in easy circumstances, of indolent habits, who live freely, and who are of a cheerful and contented deposition, are those most liable to obesity. The treatment consists in the very gradual reduction of the diet, until it falls rather below the average quantity required by a healthy adult; the very gradual disuse of fermented liquors, more especially beer ”

“ With us the over-fat are chiefly to be found among the women of the well-to-do classes of the cities, and from thirty years old onward. They persecute the medical men to reduce their weight, and the vast number of advertisements of quack and proprietary remedies against obesity indicate how wide-spread the tendency must be. ”

“ As we have shown in our previous researches, there is an abundant formation of fat in the early cases of degeneration of the thyroid gland, which sometimes progresses to a colossal obesity, which obesity has nothing to do with overfeeding. Such individuals have, as a rule, but poor appetites, and eat very little. ”

“ It has been said not to constitute a disease: that it is a normal condition: that it is a condition intermediate between health and disease: that a fat person is predisposed to disease.
For my part I cannot comprehend a condition between health and disease, with corpulence; and if such do exist it is attended with those infirmities and serious inconveniences already mentioned. Predisposition to disease and morbid tendency are, in the case of persons labouring under obesity, the precursors of serous or sanguineous apoplexy, obstructions, &c. ”

“ If the body is overweight or inclined toward obesity, the diet should consist of fewer fat-producing foods, such as grains, potatoes, milk, [1228] eggs, and an excess of vegetable proteids. If underweight or inclined toward emaciation, the fat-producing foods should predominate.
Under all conditions of nervousness the patient should take an abundance of exercise and deep breathing in the open air, and sleep out of doors, if possible. ”

“ Men are less subject to obesity than women. The areolar tissue which contains the fat is firmer in the male than in the female, and is not so readily distended by the accumulation of adipose matter. Corpulence is usually developed after the body has acquired its full growth, but childhood is not exempt. ”

“ A person afflicted with obesity develops such symptoms as shortness of breath, thirst, ravenous appetite, excessive sleepiness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech. Owing to the softness of fat, a fatty person is unritted for every kind of work. ”

“ This fat is then stored up in the tissues though there is no need at all for such an accumulation, and the food stuff is wasted quite as much as in diabetes.
The Will in Treatment.—The important element in the treatment of obesity is the readiness of the patient to follow directions. Nine out of every {293} ten stout people are thoroughly able to control the accumulation of fat and even to bring themselves down to about normal weight, if only they will to do so. ”

“ Although obesity may be ranked among the diseases arising from original imperfection in the functions of some of the organs, it is also, without doubt, most intimately connected with our habits of life. The inconveniences arising from it are, therefore, to be removed by correcting those habits, especially such as relate to diet and regimen. Drugs without number have been tried, both for the removal of corpulence itself, and for the many troubles to which it gives rise; but they have almost uniformly failed when diet and exercise have been neglected. ”

“ Sir,—Having read your book on the treatment of obesity, I wish to ask if you will undertake my case, although living at a distance of three hundred miles from Paris. I am fifty years of age, and possessed of a vigorous constitution. Since I have retired from business, now ten years ago, I have steadily increased in corpulence; my present weight being one hundred and eighty-nine pounds. I am troubled with an affection of the heart, shortness of breath, and my legs swell, especially when not taking much exercise on foot. I am not fond of walking, since it induces great fatigue. ”

“ Medical authors assert that food has a most important bearing in the production of corpulence. They forbid the use of meat, and recommend watery vegetables, such as spinage, sorrel, salad, fruit, &c., and for beverage water; and at the same time they direct the patient to eat as little as possible. These instructions, like too many others, are given because they are asked, and that in every disease, curable or incurable, the physician is bound to offer some advice. Medical men themselves put no faith in them, since they pronounce obesity to be incurable. ”

“ When the body gets to an immoderate degree of obesity, it will be necessary to melt it down and reduce it. It was mentioned formerly that the warm temperament renders the body lean, and therefore it ought to be superinduced, if possible, upon that of fat people, in order to reduce them to the proper state. ”