“We do not yet know why certain individuals grow fat. Perhaps it would be more accurate to say that we do not know why all the individuals in this overnourished community do not grow fat. There is no stranger phenomenon than the maintenance of a constant body weight under marked variation in bodily activity and food consumption. To take a specific instance, a man, aged forty years, now weighing 165 pounds (seventy-five kilo-grams) weighed the same amount twenty years ago. If during that period he has consumed an average of 2,500 calories, a day, the total for the twenty years would amount to 18,250,000 calories. The amount of extra fat stored in or lost from the body could hardly be more than one kilogram or 9,300 calories. This means that the total intake of food must have been adapted to the total expenditure with an error of only 0.05 of one per cent. This is an extraordinary exactness which is equaled by few mechanical devices and almost no other biological processes. Does it mean that the individual appetite has unconsciously balanced the bodily needs with such extreme delicacy? There are many people who maintain constant weights during these decades without any conscious limitation or increase in their dietaries. There are many in this civilized land who maintain a constant weight only by frequent use of weighing machines and careful observations of the tightness of the waist bands of skirts or trousers.”
Dogs maintain an optimal state of nutrition and a fixed body weight when they have free choice of foods and their freedom. All animals, particularly the ignorant cow, will go in quest of the deficient or absent food element and often come to destruction through eating poisonous vegetation, metal, lime or fragments of cement. But civilized man with all his culture and scientific attainments will usually eat imprudently in quantity and quality when left to choose his food without inculcated knowledge and oft-repeated advice on the subject of proper food chemistry and bodily requirements.
If we eliminate the composite and endocrine types of obesity to which reference has been previously made, the only remaining serious causes of obesity are over-eating and under-exercising. I suppose that ninety per cent of the obesity cases which I treat are due to these two factors. The remaining ten per cent are due to disorders of the thyroid, ovarian and pituitary glands alone or a combination of these with the alimentary type.
The Japanese preach that all diseases’ enter by the mouth. Obesity certainly comes that way.
But we must go deeper and find the causes of over-eating itself. They are many and various. They include:
The generous father. The fond mother. The genial host. The good cook. The persuasive grocer. The attentive waiter. The business luncheon. The public banquet. The idle life.
We bow down to false ideas of hospitality and generosity and we welcome feast days in jovial spirit when we should rather fear them.
Is it not in a spirit of vanity that the father, the breadwinner, delights to heap the family’s plate with food, or that the mother who has cooked a dinner urges everybody to take second and third helpings of the dishes on which she has labored so hard?
Good and Bad Cooks
Some wit remarked that the world is made bright with good cooks and ruined by bad ones.
Actually, a bad cook whose lack of skill makes food only reasonably palatable, may save you from obesity. The Lord provided raw food and the devil introduced cooks to drown it in grease and destroy it with seasoning.
An engaging grocer whose salesmanship loads your larder down with tempting delicacies may be gently pushing you toward your doom.
The friends who congratulate you on your fine appetite, the business associate who urges you to linger over the luncheon table, the kindly host who presses his excellent fare upon you, the waiter who insinuates into your ear the news of the latest triumph of the chef, the dinner committee who want to impress you with seven courses where three or four would suffice these are wolves masquerading in sheep’s clothing.
And your final undoing is your own philosophical temperament or good nature which urges you to accept rather than refuse in seeming ungraciousness.
Comforts of Old Age
As people grow older they are inclined to be-come fat. The actual physical hardships of youth are ended. Hours of labor are lessened, the restlessness of youth is gone and in its stead has developed a mellowed, philosophical attitude toward life. Financial worries have often ceased or have been materially reduced. And eating, unfortunately, is one of the greatest pleasures of old ,age. When a man reaches thirty he is likely to weigh ten pounds or more than he did when he was twenty. As he approaches forty or forty-five he has acquired an additional ten or fifteen pounds. Average statistics show that people of from forty to forty-five are twenty to thirty pounds heavier than they were when they were twenty years of age.
Habits of exercise are closely connected with weight increase. The amount of exercise one takes definitely determines the extent of tissue oxidation and combustion. A Canadian woodsman who labors from early morning to late at night deep in the heart of a virgin forest can eat with relish and safety a fat and starch meal twice the size of that eaten by Chief Justice Taft or Tetrazzini, be-cause the last two have less occasion to exert their bodies in physical labor.
Human beings acquire fat in precisely the same way that animals do. The modus operandi is identical. The stock yards at Chicago and Kansas City had their human forerunners a thousand years ago when young Hebrew girls at a very early age were put in darkened rooms and fed fattening foods so that they would acquire an extreme rotundity. Fanciful as it may sound to the flapper of today, the Hebrew girls submitted gladly to the process because rotundity was then regarded as a point of great physical attraction. In parts of Africa, women attained tremendous size by eating excessively of fresh dates and honey which should have its lesson for our sweet-eaters.
Idle Social Classes
Lady Rhondda in her effort to shake the leisure class of English women out of their baleful lethargy directed her criticism largely against the women of portly mein who enjoyed not merely high social positions but suffered in agony as the direct result of idleness and gormandizing.
The unhappy condition of these noble British ladies who rolled in fat in their wealthy homes was not unlike that of the lifer who has spent long years in prison and thus become excessively over-weight by virtue of his continued inactivity.
The prisoner’s obesity moreover is accentuated by his withdrawal from the sunlight. It is now established beyond doubt that deficiency of sun-light operating with other factors will cause an in-crease in weight. Commercial advantage has been taken of this fact with the result that animals marked for slaughter are sometimes fattened in darkened compartments.
Sweets and Drinks
Too much candy and too much drink, whether of the sweet soda-fountain variety or of the convivial alcoholic variety, are such serious causes of obesity that they must be discussed at length in another section.
There is another agency in this country which is rapidly offsetting the beneficent fat-reducing effect of prohibition and our commendable interest in sports and other outdoor activities. The automobile threatens to convert us into a nation of abdominal giants with atrophied legs.
The motor car creates congestion not only in public thoroughfares. It is the direct cause of the more sinister alimentary sluggishness. In any large city you will see at almost any hour of the day obese men and women by the hundreds sitting snugly in balloon-tired, shock-absorbing, luxuriously cushioned cars, supposedly riding for their health’s sake. How little these sadly mistaken people dream of the harm they are inviting.
The luxury of motoring is no luxury at all, nor is it a substitute for walking. Its menacing function is greatly to enhance the deposit of surplus fat.
The rôle of fluids in producing over-weight has not received the attention which its importance demands. According to the recent work of Dr. Kamm on the pituitary gland certain people have an over-production of Beta-pituitrin which controls the water balances of the body. Weight shift may be largely due to this factor. In very thin people weight increase can be quickly brought about by the injection of a very small amount of this gland extract. In the pituitary obese no antidote for this gland secretion has yet been found and so the best control of the body’s water balance lies in water restriction. All persons who find it difficult to lose weight on a low caloric diet should be tested for their reaction to water intake. It will frequently be found that a fluid intake of two liters will result in a fluid output of but one and one-half liters the half liter remaining in the tissues. For this reason it is important that in hyperpituitary types of obesity water consumption should be reduced to the amount consistent with the kidney’s excretory requirements.
When one considers the frequency with which diets are prescribed that are low in calories but high in fluids, such as soups, fruit juice and various beverages, it is no wonder there are so many failures in weight reduction. Hence the importance of a careful diagnosis in every individual undertaking a reduction cure.
Sleep is the great restorative. It is an agency which every physician welcomes in combating disease.
Nevertheless abnormal somnolence may serve to operate as a disturbing factor in increasing weight. Too much sleep may be actually harmful. Over-eating over-loads the liver and produces a congestion of the splanchnic veins and arteries.
This makes you sleepy. And metabolism is slowed down during sleep. Therefore a vicious circle virtually exists. If you eat too much you are drowsy. If you sleep too much you are in danger of growing obese.
An extraordinary phenomenon in the excessively fat is an uncontrollable tendency to sleeplike the fat boy in Pickwick. This is usually due to an accompanying intestinal toxxmia, which should be specially treated as such.