Treatment Of Overweight
( Originally Published 1936 )
Regardless of the type of obesity, diet and exercise are the two most important factors in its treatment. Increase of weight has been accompanied by too much food and too little exercise; in reducing weight the essential pro-gram requires less food and more exercise. We do not advise a loss of more than eight to ten pounds per month, and in some instances even a slower loss of weight is advisable.
Excess weight cannot be lost rapidly. A pound of human fat will yield between 3600 and 4000 calories. Suppose a patient who walks 3 to 5 miles a day, uses approximately 2200 calories per day. If he consumes a 1000 calorie diet, the difference, or 1200 calories, must be supplied from his own body weight. It will require three days at this rate for him to burn up 3600 calories, or the number of calories in one pound of his own fat.
Diet. The diet should be carefully planned in order not to violate any of the accepted principles of nutrition.
It should contain an adequate amount of protein, carbohydrate, minerals, vitamins, and residue. The number of calories allowed per day will vary with individual needs, and will usually range from 800 to 1200. This is intentionally planned to be below basal metabolic requirements of the patient when he is at rest, the deficit, of necessity, being made up from fat stored in the body.
In general, we have preferred to reduce the number of calories in our reducing diets by eliminating a large part of the fat and the concentrated carbohydrates or sugars and starches which have come to be used in the average diet. By this method we are able to include generous and satisfying amounts of the essential protective foods—fruits, vegetables, and milk.
The quantity of protein should be at least a gram per kilogram of the average between ideal and present body weight. We rarely advise less than 75 grams of protein per day, and often plan as much as 90 to 100 grams. This quantity of protein in the diet satisfies the appetite, has a stimulating effect on metabolism with increased respiratory exchanges, and aids in preserving a proper nitrogen balance in the body. Protein is not stored in the body, so there must be a regular intake. The necessary protein can be obtained from skimmed milk, cottage cheese, eggs, and meat, fish, and fowl from which all visible fat has been removed.
The diet should contain in addition, as much carbohydrate as is possible, keeping within the caloric requirements. It is believed that a liberal amount assists in the burning of body fat. The carbohydrates should be obtained from the low percentage fruits, vegetables, and skimmed milk.
As far as possible, fats are avoided in this type of diet, except as explained in the following paragraphs. Vegetables are served without butter or cream. Dressings pre-pared without oil, or with mineral oil which is not assimilated, are used on salads. Meats are prepared by removing any fat that can be seen and without the use of added fats. Pastries and all foods in which shortening is used must be avoided.
Vitamins which are essential in all diets, are of two types—those that are fat soluble, and those that are water soluble. To supply the first group a small quantity of butter or cream and eggs are included in every reducing diet. The second group are adequately supplied when fruits and vegetables are used generously.
Mineral elements are supplied mainly by milk, fruits, and vegetables.
Since a reducing diet as outlined will tend to be less than an average diet in quantity, it is essential that special attention be given to the inclusion of residue containing foods in the form of fruits and vegetables.
It is not surprising that numerous dietary schemes have been announced for the benefit of the patient who is overweight. The preparation of a balanced diet as out-lined above requires careful study. Freak diets in which fasting, single articles of food, or foods very low in nutritive elements are the basis, have resulted in real harm to many. To maintain the proper chemical balance within the body, a diet must be selected supplying elements essential in the daily metabolism. Fruit or vegetable juices, while excellent articles of food, are inadequate as a complete diet. The same can be said of a vegetable diet. Ill advised diets in reducing have made it necessary for many a victim to be under prolonged medical care to repair the needless damage done.
Exercise. The amount and type of exercise taken will depend upon the individual's general physical condition. Exercise should be prescribed only after a careful physical examination of the patient, because of the frequency of heart, blood vessel, and kidney complications in obese individuals. In the presence of heart failure, or impending heart failure, patients should be kept in bed. Massage and bed exercises are valuable in such cases to maintain normal muscle tone. Walking is not only one of the least expensive, but one of the best forms of exercise. Patients usually know how far they can walk without undue fatigue. The distance walked each day should be in-creased gradually. Golf, horseback riding, tennis, and swimming are entertaining types of outdoor exercise. Supervised gymnasium exercises, associated with reducing massage, are valuable if the patient can afford the extra attention. Some persons require orthopedic adjustments before walking or other exercises can be undertaken comfortably. No form of exercise should be undertaken vigorously until one has trained himself to it.
Medication. Many persons have wished that there were some royal road to reduction of weight some tablet or pellet which could be used without strict adherence to a diet. It is not surprising that thyroid extract and certain drug preparations of which dinitrophenol is an example, have been appropriated to such purposes. The ignorant use of these has resulted disastrously many times. Thyroid extract has a place in medicine if used intelligently under medical guidance (after determining that it is needed). Used too freely just to reduce weight, it often results in nervousness and over-stimulation of the heart. Dinitrophenol increases the basal rate, causes sweating, and a loss of weight. All too late, some have found that they were using too much, illness has followed, and in some instances, death. Recently, the formation of cataracts with increasing blindness has been reported in women over forty years of age who have used this drug to reduce. The only safe policy in using medicines for reducing is to avoid them unless they are part of the program which your physician plans for you.
When one has reached the desired weight, a more generous diet may be used. This cannot be unlimited in amount, and should be planned so as to avoid the gaining of weight again. Where 1000 calories have been served as a reducing diet, it will be observed that the maintenance diet may contain as much as 1800 to 2000 calories. In a diet of this value, fats must be kept low, proteins should have a normal place, and a moderate amount of carbohydrates should be used to give current energy. Reasonable exercise should be continued.