Nutrition - Obesity, A Case History
( Originally Published 1954 )
All cases of obesity are the same in this respect: excess weight accumulates about the abdomen and back. Some patients may have very thin legs even though the rest of the body suffers from excess fatty wastes.
One of my patients, Miss M. W., was one of those obese persons who had fat distributed thickly all over her body, including over her legs, arms, face, neck, and upper and lower back. She was a matron in a state institution for women, and her work required a pair of strong legs. When she was admitted for treatment one of her complaints (besides obesity) was arthritic pains in her knees.
Her weight was 246 pounds, her height about five feet four inches. Clearly she was overweight by at least 100 pounds. Anyone who is so much overweight has a load of waste within the tissues. These wastes irritate the vital structures of the body and consequently lead to various organic diseases.
Miss M. W. had had a recent history of virus pneumonia, from which she had luckily recovered. But on arrival for treatment she was puffing for breath. She could barely walk up one flight of stairs. She complained of constipation, headache, general weakness and fatigue.
Miss W. showed me the stereotyped "diet list" that had been given to her for weight reduction by a prominent internist. That list was dated 1941. It was amazing that the patient had clung so long to those stereotyped two pages. The list was obviously valueless since she remained fat even though she claimed that she followed it. The items on it followed the ordinary medical pattern: it included some kinds of meat, coffee, tea, eggs, skimmed milk and other low-calorie foods, haphazardly mixed, for the various meals of the day.
It illustrated the fact that the sick are groping in the dark when they cling to the old-school MDs who travel a bumpy trial-and-error road] The doctors of the old school are plainly deeply set in their ruts, and their patients follow in the same ruts. Miss M. W. had struck out on a new path in the search for better health by reading progressive health publications, and yet she subconsciously hung on to her faith in the old diet list. She too was in a deep rut. When I saw the date of the list, I had to tell her that it was of no use to either of us.
I explained to Miss W. that my approach consists of educating the patient to exercise while lying still, resting and relaxing. The skeletal muscles of the body that are infiltrated with fat must be rebuilt and regenerated by oxidizing the unwanted weight, which consists of waste. This oxidation process can be carried out only by exercising the muscles in accordance with their anatomical functions. The body muscles must alternately be tensed and relaxed by flection, by bending and stretching.
For example, you can exercise the legs while you are lying still and resting: first you extend the toes outward, and then you bring the toes toward the body and extend the heels outward. These two movements, alternated, take the place of walking, without straining the entire body. Likewise, the arm muscles can be exercised by spreading the fingers and tensing the muscles all the way to the shoulder. This arm exercise can be alternated with a second: make a fist with each hand, and bend the elbows upward and sideways so that the fist reaches the shoulder.
These exercises help to tone up muscles that otherwise become flabby when a fat person loses weight. Similarly, the abdominal muscles can be reduced in size and improved in tone by pressing the belly wall in toward the mattress.
No special gymnasium apparatus is required—just your own limbs, joints and muscles. While you are exercising with the body at rest in bed, a tremendous amount of good is being accomplished in conserving nervous energy. These exercises are really a form of therapy.
Furthermore, these exercises will help the patient to lose a pound or two a day. Of course, the diet must be very strict, also. From my standpoint, a strict reducing diet consists of several pieces of citrous fruit per day.
Grapefruit and lemons are the best fruits for intensive reducing. I encourage the patient to chew some grapefruit, because the chewing process reduces the fat that has infiltrated into the facial and chin muscles.
Of course, some patients prefer sweet or bland foods. Miss M. W. was at first disinclined to sour grapefruit salads. But when she discovered that she had lost fourteen pounds in the very first week of treatment she became very conscientious about doing her exercises faithfully on the appointed hour, somewhat in the same spirit that sick people take pills.
Within two weeks Miss M. W. lost 25 pounds. A month after she left my care, I received the following report from her:
"Have lost another 20 pounds- My arthritis in the knees is all gone. I have no pain. I am continuing with your diet and hope to reach my goal of normal weight as soon as it is possible. I feel fine. You may show this letter to other patients.—Gratefully, Miss M. W."
My dietary instructions for home care, as well as for the second week of treatment under my own care, were as follows:
First thing in the morning—the juice of a lemon, undiluted; choice of one other fruit; a grapefruit or two oranges, or some fresh raw pineapple (fresh, not canned).
For the noon meal—a raw salad consisting of lettuce, celery, cucumber and grated carrots, with no seasoning except lemon juice; additional food can be two ounces of cottage cheese or one glass of buttermilk, plus a piece of raw fruit.
For the evening meal-two steamed green vegetables, a glass of raw vegetable juice, and fresh raw fruit of the subacid varieties.
Peaches, pears and raw apples are the kinds of fruit permitted on this reducing diet. Grapes, dates and figs are not permitted. No animal meat is permitted- The only other food permitted is an egg, twice a week; no bread is allowed except in cold weather and not until weight is considerably reduced.
Miss M. W. is now pursuing her daily tasks as the busy executive of a state institution. According to her reports, the simple diet plan I have prescribed has improved her alertness and her outlook on every-thing, as well as her physical condition.
In the case of this patient, a laboratory examination of blood and urine was made as a matter of routine, as usual. There were no pathological findings.
The method of weight reduction that is described above is so easy that anyone can follow it safely.
"Health Rest" Exercises
The object of the exercises which I use is threefold:
(1) To improve the circulation of the blood and lymphnotes.
(2) To prevent stagnation of waste matter in certain areas that are especially susceptible to waste retention.
(3) To tone the muscles of the body, particularly those muscles that are not used in routine daily activities.
Here are some important points to keep in mind about when to exercise and when not to exercise.
Do not exercise when tired. Under such conditions, look for the causes of the fatigued feeling and remove them. If that "tired feeling" is not relieved by a short rest (a half hour or so), it requires special attention. It points to chronic fatigue, and that is a danger signal of disease. Daily exercises taken when the body is sufficiently rested will, in fact, help to relieve chronic fatigue. But exercises must be taken only after a refreshing sleep or rest.
Most of the exercises outlined below may be done in a reclining position, though some of them are done sitting up. The springy surface of a bed or couch is good, for it helps the body to relax. Each exercise must be followed by a period of relaxation.
Exercises for the Feet, Legs and Thighs
First exercise: Lie flat on your back, and extend the toes forward, downward and inward, applying the force from the joints of the toes, metatarsals and ankles. Tense the muscles of the legs and thighs. This movement should not last longer than it takes to put the muscles into action. If the movement is too protracted, too much acid may accumulate in the muscles that are being exercised. After each tensing movement, relax for about twice the time that the movement itself has lasted; then tense again; and alternate the tensing and relaxation about 10 to 15 times.
Second exercise: Bend your feet upward, starting the motion from the ankle joints. Extend the heels forward and tense the muscles of the legs and thighs. Again, relax for about twice the time that the motion itself lasted, and then repeat. Do this exercise ten to fifteen times, and then go back to the first exercise.
Note: To strengthen the muscles and joints of the lower limbs, these exercises should be done for at least five minutes in the morning and in the evening.
Exercises for the Upper Extremities
Extend your fingers as far as possible and tense the arm muscles all the way to the shoulders. Relax, and repeat about ten times. Make a fist with each hand and tense the muscles up to the shoulders; relax, and repeat.
Note: Anyone with weak joints or arm muscles will soon feel new strength if he or she exercises regularly in this manner.
Exercises for the Abdominal Muscles and the Muscles of Respiration
Lie on your bed or couch in the supine position and flex your knees—that is, bend your knees till your legs are resting comfortably with the feet on the bed or couch. This exercise helps to relax the abdomen to the maximum extent.
With one hand upon the other, press down on the abdominal muscles gently but firmly, and resist by bearing down as if taking a deep breath. At the same time expand your chest from the ribs side-wise. Relax with a complete expiration. Repeat, doing those exercises at least 25 times twice a day.
Note: These exercises, done regularly, will prevent and cure abdominal weakness, flabbiness and dropped internal organs.
Exercises for the Abdominal and Pelvic Organs
Fold a pillow and put it under the hips. Raise your legs over the abdomen, going through the movements of riding a bicycle. Do this exercise about ten times. Rest—relax—repeat.
Another supplementary exercise: raise the legs straight into the air (while still resting the hips on a pillow), spread the legs and cross them like a scissors.
Exercises for the Muscles of the Spine
Get on your knees and elbows with the forearms resting forward, having the fingers of both hands interclasped. Push the body forward until the chin rests on the mattress. Push the body backward until the buttocks rest on the heels. Repeat fifteen times, at least, before stopping. Lie prone and rest for a while.