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advocate yet another fancy slimming diet it does describe a method of treatment which has
grown out of theoretical considerations based on clinical observation.
the fundamental problems of obesity, its causes, its symptoms, and its very nature. In these
many years of specialized work, thousands of cases have passed through my hands and
were carefully studied. Every new theory, every new method, every promising lead was
considered, experimentally screened and critically evaluated as soon as it became known.
But invariably the results were disappointing and lacking in uniformity.
serious students of overweight. We have grown pretty sure that the tendency to
accumulate abnormal fat is a very definite metabolic disorder, much as is, for instance,
diabetes. Yet the localization and the nature of this disorder remained a mystery. Every
new approach seemed to lead into a blind alley, and though patients were told that they are
fat because they eat too much, we believed that this is neither the whole truth nor the last
word in the matter.
held that overeating is the result of the disorder, not its cause, and that we can make little
headway until we can build for ourselves some sort of theoretical structure with which to
explain the condition. Whether such a structure represents the truth is not important at this
moment. What it must do is to give us an intellectually satisfying interpretation of what is
happening in the obese body. It must also be able to withstand the onslaught of all hitherto
known clinical facts and furnish a hard background against which the results of treatment
can be accurately assessed.
dealing with obese patients it became a habit to register and order every clinical
experience as if it were an odd looking piece of a jig-saw puzzle. And then, as in a jig saw
As the years passed these clusters grew bigger and started to amalgamate until, about
sixteen years ago, a complete picture became dimly discernible. This picture was, and still
is, dotted with gaps for which I cannot find the pieces, but I do now feel that a theoretical
structure is visible as a whole.
framework, and then, when a treatment based on such speculations showed consistently
satisfactory results, I was sure that some practical advance had been made, regardless of
whether the theoretical interpretation of these results is correct or not.
these reports have been generally well received by the profession, but the very nature of a
scientific article does not permit the full presentation of new theoretical concepts nor is
there room to discuss the finer points of technique and the reasons for observing them.
hundreds of inquiries from research institutes, doctors and patients. Hitherto I could only
refer those interested to my scientific papers, though I realized that these did not contain
sufficient information to enable doctors to conduct the new treatment satisfactorily. Those
who tried were obliged to gain their own experience through the many trials and errors
which I have long since overcome.
clinic in the Salvator Mutidi International Hospital in Rome. For some of them the time
they could spare has been too short to get a full grasp of the technique, and in any case the
number of those whom I have been able to meet personally is small compared with the
many requests for further detailed information which keep coming in. I have tried to keep
up with these demands by correspondence, but the volume of this work has become
unmanageable and that is one excuse for writing this book.
is, I believe, essential that he or she have an understanding of what is being done and why.
Only then can there be intelligent cooperation between physician and patient. In order to
avoid writing two books, one for the physician and another for the patient - a prospect
which would probably have resulted in no book at all - I have tried to meet the
requirements of both in a single book. This is a rather difficult enterprise in which I may
not have succeeded. The expert will grumble about long-windedness while the lay-reader
may occasionally have to look up an unfamiliar word in the glossary provided for him.
hedging and tentativeness with which it is customarily to express new scientific concepts
grown out of clinical experience and not as yet confirmed by clear-cut laboratory
experiments. Thus, when I make what reads like a factual statement, the professional
reader may have to translate into: clinical experience seems to suggest that such and such
an observation might be tentatively explained by such and such a working hypothesis,
requiring a vast amount of further research before the hypothesis can be considered a valid
theory. If we can from the outset establish this as a mutually accepted convention, I hope
to avoid being accused of speculative exuberance.
abnormal functioning of some part of the body and that every ounce of abnormally
accumulated fat is always the result of the same disorder of certain regulatory chanisms.
Persons suffering from this particular disorder will get fat regardless of whether they eat
excessively, normally or less than normal. A person who is free of the disorder will never
get fat, even if he frequently overeats.
moderate will gradually increase in weight and those in whom it is mild may be able to
keep their excess weight stationary for long periods. In all these cases a loss of weight
brought about by dieting, treatments with thyroid, appetite-reducing drugs, laxatives,
violent exercise, massage, or baths is only temporary and will be rapidly regained as soon
as the reducing regimen is relaxed. The reason is simply that none of these measures
corrects the basic disorder.
different forms in both sexes and at all ages as always being due to the same disorder.
Variations in form would then be partly a matter of degree, partly an inherited bodily
constitution and partly the result of a secondary involvement of endocrine glands such as
the pituitary, the thyroid, the adrenals or the sex glands. On the other hand, we postulate
that no deficiency of any of these glands can ever directly produce the common disorder
known as obesity.
equally effective in both sexes, at all ages and in all forms of obesity. Unless this is so, we
are entitled to harbor grave doubts as to whether a given treatment corrects the underlying
disorder. Moreover, any claim that the disorder has been corrected must be substantiated
by the ability of the patient to eat normally of any food he pleases without regaining
abnormal fat after treatment. Only if these conditions are fulfilled can we legitimately
speak of curing obesity rather than of reducing weight.
disorder which leads to obesity. The history of this enquiry is a long series of high hopes
and bitter disappointments.
prosperity in man and of beauty, amorousness and fecundity in women. This attitude
probably dates back to Neolithic times, about 8000 years ago; when for the first time in
the history of culture, man began to own property, domestic animals, arable land, houses,
pottery and metal tools. Before that, with the possible exception of some races such as the
Hottentots, obesity was almost non-existent, as it still is in all wild animals and most
primitive races.
disorder can be inherited. Wherever abnormal fat was regarded as an asset, sexual
selection tended to propagate the trait. It is only in very recent times that manifest obesity
has lost some of its allure, though the cult of the outsize bust - always a sign of latent
obesity - shows that the trend still lingers on.
that today nearly all inherited dispositions sooner or later develop into manifest obesity.
This change was the institution of regular meals. In pre-Neolithic times, man ate only
when he was hungry and on1y as much as he required too still the pangs of hunger.
Moreover, much of his food was raw and all of it was unrefined. He roasted his meat, but
he did not boil it, as he had no pots, and what little he may have grubbed from the Earth
and picked from the trees, he ate as he went along.
adjusted to the continual nibbling of tidbits. It is not suited to occasional gorging as is, for
instance, the intestine of the carnivorous cat family. Thus the institution of regular meals,
particularly of food rendered rapidly, placed a great burden on modern man's ability to
cope with large quantities of food suddenly pouring into his system from the intestinal
tract.
the moment of eating so as to tide him over until the next meal. Food rendered easily
digestible suddenly flooded his body with nourishment of which he was in no need at the
moment. Somehow, somewhere this surplus had to be stored.
which fills the gaps between various organs, a sort of packing material. Structural fat also
performs such important functions as bedding the kidneys in soft elastic tissue, protecting
the coronary arteries and keeping the skin smooth and taut. It also provides the springy
cushion of hard fat under the bones of the feet, without which we would be unable to
walk.
when the nutritional income from the intestinal tract is insufficient to meet the demand.
Such normal reserves are localized all over the body. Fat is a substance which packs the
highest caloric value into the smallest space so that normal reserves of fuel for muscular
activity and the maintenance of body temperature can be most economically stored in this
form. Both these types of fat, structural and reserve, are normal, and even if the body
stocks them to capacity this can never be called obesity.
fat, and of such fat only, from which the overweight patient suffers. This abnormal fat is
also a potential reserve of fuel, but unlike the normal reserves it is not available to the
body in a nutritional emergency. It is, so to speak, locked away in a fixed deposit and is
not kept in a current account, as are the normal reserves.
reserves. When these are exhausted he begins to burn up structural fat, and only as a last
resort will the body yield its abnormal reserves, though by that time the patient usually
feels so weak and hungry that the diet is abandoned. It is just for this reason that obese
patients complain that when they diet they lose the wrong fat. They feel famished and
tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper
arms show little improvement. The fat they have come to detest stays on and the fat they
need to cover their bones gets less and less. Their skin wrinkles and they look old and
miserable. And that is one of the most frustrating and depressing experiences a human
being can have.
sexual complexes, the strong become indignant and decide that modern medicine is a
fraud and its representatives fools, while the weak just give up the struggle in despair. In
either case the result is the same: a further gain in weight, resignation to an abominable
fate and the resolution at least to live tolerably the short span allotted to them - a fig for
doctors and insurance companies.
They may feel guilty, owing to the lethargy and indolence always associated with obesity.
They may feel ashamed of what they have been led to believe is a lack of control. They
may feel horrified by the appearance of their nude body and the tightness of their clothes.
But they have a primitive feeling of animal content which turns to misery and suffering as
soon as they make a resolute attempt to reduce. For this there are sound reasons.
temperature than to heat a small body. Secondly the muscular effort of moving a heavy
body is greater than in the case of a light body. The muscular effort consumes calories
which must be provided by food. Thus, all other factors being equal, a fat person requires
more food than a lean one. One might therefore reason that if a fat person eats only the
additional food his body requires he should be able to keep his weight stationary. Yet
every physician who has studied obese patients under rigorously controlled conditions
knows that this is not true. Many obese patients actually gain weight on a diet which is
calorically deficient for their basic needs. There must thus be some other mechanism at
work.
Such a connection was suggested by the fact that many juvenile obese patients show an
under-development of the sex organs. The middle-age spread in men and the tendency of
many women to put on weight in the menopause seemed to indicate a causal connection