THE EFFECTS OF OBESITY 309 



mounted a hill 165 m. high. Placed on a strict diet equivalent 

 to 2000 Cal. for three months, he lost only 1 kg. in 

 three months. On the other hand, a man who worked 7 hrs. 

 at a desk and took easy exercise on the level for 3 hrs. a day 

 lost 7 kg. in 2 months on the same diet. He also gives the 

 astonishing case of a woman, who was of spare habit up to 

 55 years, and became after this fatter and fatter. She kept herself 

 on the following diet, equal to 900-1000 Cal. : 



8 A.M., cup of black coffee. 

 10 ,, 1 egg and 1 Albert biscuit. 

 12 noon, 7 oz. apple and J pint white wine. 



2 P.M., cup of black coffee. 



4 ,, 2 oranges and 2 Albert biscuits. 



6 11. milk. 



8 ,, 1 egg, 7 oz. apple, J pint white wine. 

 10 ,, glass of seltzer water. 



And in spite of it put on \ kg. in six weeks. She showed no 

 sign of oedema, and her strength seemed unimpaired. In such a 

 case if the woman did not lie the lamp of life must burn at a 

 lower level in other words, the internal work of the body must 

 be run more economically than in most of us. 



The net available energy of the absorbed food equals the 

 gross available energy minus the work of digestion and assimila- 

 tion. It is possible that this is done more economically in some 

 than in others. Likewise in some the ratio of external work may 

 be greater in proportion to the heat produced by muscular work. 

 In the ordinary man not more than 20 per cent, of the total 

 energy appears as external work, while in the highly trained an 

 efficiency of 30 per cent, may be attained. Pregnant animals 

 when starved waste more slowly than others. It is said that 

 their metabolism runs at a lower level in the interest of the young 

 they carry ; but this requires exact confirmation. 



THE EFFECTS OF OBESITY 



The extent and rapidity of the bodily movements are lessened. 

 A man of 120 kg. mounting stairs does double the work of one 

 of 60 kg. The temperament becomes phlegmatic. Fatigue is 

 quickly induced. Fat in the belly and mediastinum may limit the 



