Definition And Effects

It is impossible to draw a line between stoutness and obesity. The latter word is applied to all grades of stoutness in which the normal, healthful action of organs is interfered with by deposits of fat. In health, fat is deposited in connective tissue. In the obese, this deposition becomes excessive, so that even the thinnest strips of connective tissue are loaded with it. Often fat-cells are crowded in among muscle-fibers, where they interfere with the active contraction of the muscle and may finally cause its atrophy. The viscera are also frequently enveloped in masses of fat. The increased load that an obese person has to carry interferes with his activity and vigor of movements, but the fatty infiltration of muscles does so even more. The heart is frequently weakened to a serious extent by infiltration with fat or by fat enveloping it. Respiration also is made shallow and imperfect by the fat about the chest and the weight of the abdomen. Excess in weight greatly lessens one's chances of longevity. So great is this that life insurance companies refuse most applicants who are overweight.

Causes

Fat is derived from fat eaten, from carbohydrates, and from proteins, but it is produced most abundantly from the first and second groups of food. Each of these foods, however, is chemically broken up and refashioned by the human organism to make the fat of living tissue. Even the fat that is absorbed directly from the intestines must be made over to fit it to the human organism.

For the production of obesity a predisposition, and generally an inherited one, is necessary. Obesity may develop at any age, but it is rare in infancy and seldom as great in advanced life as in middle life. It usually develops and is greatest between the thirtieth and the fifty-fifth year. A tendency to obesity is often inherited. Numerous statistics show that one-half of all obese persons inherit such a tendency. Two-thirds of the excessively stout people are women.

Obesity is frequently caused by eating too much. The habit of eating excessively is often acquired during the years of growth, when large amounts of food are needed both to repair loss and to provide material for growth. This habit is maintained long after the necessity for generous meals has passed. However, the obese do not always eat excessively. Bouchard found in 50 per cent, of such patients that the amount of food 25 eaten was quite normal and its character well adapted to the needs of the individuals. In 40 per cent, the amount was excessive, and in 10 per cent, it was less than normal.

Too little exercise plays an important part in producing obesity. It was a feature of 38 per cent, of Bouchard's cases. But in 28 per cent, an excess of exercise was taken.

All observers admit that the habitual use of alcoholic beverages increases any natural tendency to obesity that may exist. This increase is effected by interfering with complete metabolism and by producing an inclination to fatty degeneration. While all alcoholic beverages produce these results, beer, ale and sweet wines are especially apt to do so.

The chief known causes of obesity can be summarized as an inherited predisposition, overeating, too little exercise, and too much alcohol. In individual cases any one or several of these conditions may be wanting.

Obesity is not infrequently associated with gout, lithemia, and diabetes.

Treatment

The treatment of obesity is not always satisfactory. While it is possible to reduce an individual's weight by some pounds, it is often extremely difficult to prevent renewed taking on of flesh without great discomfort. When, however, there is not an inherited disposition to obesity, the patient has it in his power to maintain a normal weight with comfort by eating abstemiously and taking sufficient exercise.

The indications for treatment are: (1) To diminish the food-supply and to modify its character; (2) to increase the rapidity of tissue destruction by exercise; (3) to affect general vitality.

All plans of treatment are directed toward meeting the first indication. It is best accomplished by greatly lessening the amount of food eaten. The quantity consumed must be less than the average man will take when in health. For instance, it is estimated that under normal conditions a man needs in a day food that will produce from 2500 to 3500 calories. Banting advocated a diet that would furnish only 1112; Oertel, one that would produce 1200; Ebstein, one that would produce 1400. These are starvation diets. I do not mean diets that will cause loss of life, but that provide less than the amount of nourishment needed to maintain health and strength. Many-obese patients eat so large an amount of food that it is not sufficient to tell them to reduce the quantity of food they take from one-quarter to about one-half, for these directions may not reduce it even to a normal point, much less below normal. It is necessary to inquire particularly in each case as to the character of food taken and the quantity. Oftentimes a reduction in quantity will effect as marked a reduction in weight as is desired, without very much change in the character of the food. The disagreeable sensations arising when one is deprived of quantities of food to which he is accustomed are felt less if the change in diet is made gradually. There are many who find it extremely difficult to lessen the amount eaten so long as they are permitted to eat food that they especially like and usually take. For such persons a diet should be prescribed that will involve the withdrawal of foods that they have especially enjoyed and the substitution for them of kinds that they have not learned to relish and of which they will not be tempted to partake very generously. Ebstein recommends the use of an excess of fats because they quickly produce satiety, and therefore a smaller quantity of food is eaten. On the other hand, Banting, Oertel, Dujardin-Beaumetz, and other clinicians who have written upon diet for the obese diminish the quantity of fat that these patients eat. But all agree that the carbohydrates must be very much reduced. Ebstein prescribes 50 grams a day; Banting, 80; Oertel, from 70 to 100; and Dujardin-Beaumetz, 95 grams. The last-named also reduces the albuminoids below the average - to 55 or 60 grams; Ebstein recommends 100 grams; Banting and Oertel give an excess - the former 170 grams, the latter from 150 to 180.