A text-book of medicine : for students and practitioners.

  • Adolph Strümpell
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.

    1025/1108 page 997
    new supplies of fat. To accomplish this purpose we possess only two means—first, a limitation of the ingestion of such kinds of food as may lead to the formation of fat in the system, and, secondly, stimulation of those factors which occasion the destruction of the fat already present. All the various methods of treating obesity, without exception, aim either to diminish the supply or to increase the destruction of fat. The methods vary greatly. It must be borne in mind that the diminution of the adipose tissue must not involve injury to the body itself. The treatment should not weaken the constitution, but should invigorate the patient, or at least be innocuous. It is of prime importance, in every method of treatment, that the total quantity of ingested food should be diminished. It is a mistake to forbid the patient some particular kind of food—for instance, the cai’bohydrates or the fats—with the idea that they alone do harm, or to allow him unlimited quantities of other kinds of food, in the belief that they are harmless. Any person can eat albuminoids, fat and starch at every meal, and yet not grow fat; while, on the other hand, too much of any one of these may lead to an increase of adipose tissue. The amount of food which a person can take without increasing the amount of adipose tissue varies with the individual. It depends upon the amount of material already present in the body, and upon the various demands made upon the system, as well as other factors. This renders it difBcult to draw up a universal dietary for the obese. We can best judge of the value of any course of treatment by its results, and these are best measured by the weight and the subjective condition of the patient. Of the various elements of food, the albuminoids should be diminished least of any, because it would be sure to work injury to the system if they were supplied in too femall an amount. Of course, the albuminoids must not be eaten to such an extent that the fat into which they decompose remains intact in the body. An increase in the amount of nitrogenous tissue is, however, desirable, because this promotes the vigor of the muscles and the heart, and so leads to the oxidation of larger quantities of the non-nitrogenous tissues. The amount of fat and starch must be much more limited. The fats and starches are more potent in increasing adipose tissue and in shielding from oxida- tion the fat already stored up in the body than is nitrogenous food. It would not be at all advisable to forbid the use of either one of these two constituents of a mixed diet, allowing the other alone to be eaten. A varied diet is extremely desir- able, even for one who is corpulent; and we should exclude neither fat nor starch wholly from the dietary, but we should merely limit the amounts to be taken. As already indicated, the amount of albuminoid food remaining unchanged, a person can eat double the quantity of starchy food that he can of fat, without incx*ea.sing his adipose tissue. It is therefore irrational to allow the corpulent fat in larger proportions than starchy foods. The diet which Ebstein has recently proposed for the treatment of obesity does prove successful, but the explanation of its suc- cess lies in the comparatively small amounts of meat and fat ingested. Precisely the .same results would be attained if a corresponding amount of starch were sub- stituted for all or a portion of the fat; and in practice it is desirable, at least in most cases, to allow the patient both starches and fats. Of course, the likings and experience of the individual should be considered in each separate case. Tlie Banting treatment, introduced in 18(i4, enjoyed for a time a great rejnitation. Its inventor applied it first of all to his own case, and with success. It rests upon a rational basis, inasmuch as the albuminoids are allowed in abimdance, and the ingestion of fat and starch is limited. It lays too much stress, however, upon the exclusion of fat as compared with starch.
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