( Originally Published 1916 )
Though much attention is given to Weight Reduction, the important subject of Weight Increase is sadly neglected. By a proper selection of food it is an easy matter to increase one's weight to a degree sufficient for the maintenance of health and strength. This is a startling but by no means rash statement. It is a conclusion based upon experience.
There are some diseases which preclude the possibility of adding materially to one's weight. We are not here interested in persons so badly diseased. However, the vast majority of those generally supposed to be difficult subjects for weight increase do not belong to this class. The reason they have been underweight can be easily determined, and a change in diet or manner of life will produce any desirable gain.
Contrary to general opinion, assimilation of food is seldom at fault. By very careful scientific experiments, the fact has been established that in typhoid fever the assimilation of fats and carbohydrates is practically normal, and that of proteids is not materially reduced. In other words, the typhoid patient, with intestine badly inflamed and suffering from a high degree of fever and an intense toxaemia, assimilates every class of food. The causes of thinness must therefore be sought elsewhere.
The thin fall into two classes. There are those whose food demands are unusually high because of a great degree of activity. There are those who are unable to eat a fair amount of food. In other words, the food demand of the body is not supplied in some because it is so great; in others, because the food eaten is lacking either in quality or in quantity.
Any one able to eat a sufficient amount of food can undoubtedly maintain a proper weight. This is to me a very simple proposition, yet I know that in the mind of every reader of this statement there occur instances which seem to disprove it. Some furnaces require a large amount of coal because they heat many rooms, or because the houses are exposed. The human furnace does not vary to any great extent, but activity among different individuals is seldom the same. A farmer requires almost twice as much fuel as a professional man; a six day bicycle racer requires four times as much. This is a variation dependent upon occupation. There is likewise a great difference due to temperament. The activity of the nervous type is much greater than that of the phlegmatic. A suburbanite working about the home mornings and evenings and very active on Sundays and holidays may have food requirements approaching those of the day laborer.
Those who seem to eat a sufficiently large amount of food may really fall short of requirements because of the quality selected. They may fail to eat a fair proportion of concentrated foods, such as the fats and the less bulky carbohydrates. Olive oil is forty-five times as nourishing as lettuce. Butter is almost six times as nutritious as meat. Bacon is more than four times as nourishing as egg. One generous slice of bread and but-ter equals two eggs. Bread is ten times as nourishing as cauliflower. Suppose, for the sake of argument, that one could live on eggs alone. Thirty would be required daily. Fifteen generous slices of bread and butter have the same value. These few illustrations suggest the possibility of a diet which is large in quantity but insufficient in quality. The total food value of the diet for the twenty-four hours is the important consideration.
Again, there are many individuals who seldom have a sufficient appetite. The least excitement or fatigue will prevent them from eating the accustomed amount. Most of these were always thin; they show a tendency to lose rapidly when the environment is unfavorable, and gain with the greatest difficulty under the most favorable circumstances. The scriptural saying is quite apropos:
For he that hath (fat) to him shall be given; and he that hath not, from him shall be taken even that which he hath."
Thinness is not necessarily undesirable. A certain degree of slenderness favors activity, grace, freedom of motion, and mental alertness. I think that one's weight should not be below the average up to the thirtieth year. After this time the averages, as shown in insurance tables, are about five or ten pounds too high. However, a certain allowance should be made for the variation in bony framework.
On the other hand, nutrition should never be permitted to reach too low an ebb. In such case, there will not be sufficient fuel for moderate activity, sufficient reserve for emergencies, or sufficient vitality to resist tuberculosis, influenza, and similar diseases when exposed. Every motion of the body is performed by energy derived from the oxidation of food, which is as truly fuel as is the coal consumed by an engine. The food is utilized to repair worn out tissue and develop energy for the various activities of life. An insufficient supply renders the daily repair work of the human machine incomplete and the generation of adequate energy impossible. Therefore, too great a degree of underweight is practically synonymous with weakness, low vitality, and lessened resistance to disease.
Your ideal body must be neither thin nor fat; it must approximate the average as shown in insurance tables.
In a certain number of instances, it is possible to increase one's weight by simply eating more of the fats. Taking larger amounts of cream, butter, olive oil, and bacon will suffice. If a tendency to biliousness exists, this method may be impracticable. Carbohydrates are the only other class of foods which have any value for the purpose. The chief examples are cereals, flour — bread and all flour products — tapioca, macaroni, and potatoes.
Some will be unable to increase weight by such general rules, and more careful attention to the diet will be necessary. The very tall require generous amounts of food because of their height; the active, because they are developing a great deal of energy. Those who find difficulty in following a prescribed diet should be examined carefully to discover the cause.
The foregoing diet is sufficient to cause a gain in weight. It contains enough proteins to increase the muscular strength as the adipose layer be-comes greater.
Now we come to the last and most difficult class. We can guarantee results, however, to the patients who comprise this group if they will persist in doing what we ask. It is much easier to decrease the diet of one who is eating too much than to increase that of one who is eating too little. If the amount of food taken by some of these patients at a given meal is more than that to which they are accustomed, it may lie like a heavy load in their stomachs, and a certain portion may still remain when the time arrives to eat again. In other words, there is an atonic condition of the gastric musculature which prevents the successful administration of forced feeding unless it is carried out under most favorable circumstances, coupled with a very close study of every feature of the case and a careful selection of the diet.
By frequent, small meals, consisting of the most nourishing foods, the problem can be solved. In many cases the patient must for several weeks keep forcing herself to take a little more than she really wants before she can finally eat a sufficient quantity daily without feeling stuffed, or even more or less nauseated. With some of these patients the habit is soon formed, and with the resultant gain in strength comes increased ability to eat and digest all that is necessary. Any patient who thus conscientiously tries, but cannot soon respond to such efforts on the physician's part, is too sick to come within the scope of this chapter. Such patients have ulcer, adhesions, stenosis, cecalstasis, or at least a degree of impairment of gastric motility requiring the initiation of the treatment by rest in bed, with a thorough study of the case from every standpoint.
Some of these persons I find are taking a very small amount of food indeed — less than a maintenance diet. I have been surprised to find that they increase in weight quite readily when put upon a diet which is just sufficient to serve as a maintenance diet for one of their height on very light exercise. In such cases a gradual gain takes place, until the ideal weight is nearly or entirely reached.
I favor carbohydrates and fats for these people, and always try to get them to take two slices of bread and two balls of butter at each meal. Individualization is important in these diets, but an increase in the amount of bread and butter is always desirable. For fattening purposes, any kind of bread will suffice, although whole wheat bread is preferable, since it insures a sufficient supply of vitamines, minerals, etc., without which health and strength cannot be maintained. As soon as a patient of this type begins to increase in weight, she feels better. A gain of three or four pounds gives a feeling of well being even in one very much under weight. This is explained by the fact that before a gain can take place, not only must the immediate needs of the body be met, but also a surplus added. However small the surplus may be, these facts are obvious — that the patient is getting more than she requires, is on the up grade — consequently she feels stronger and better. Aside from the psychological effect on the patient, a gain of a pound a week is as satisfactory, if not more so, than a gain of two or three pounds would be. In fact, the more rapid the gain the higher will be the proportion of increase in adipose tissue; the more gradual the gain, the higher will be the proportion of increase in muscular tissue and the greater the improvement in the quality of the blood.