72 



OVER-NUTRITION AND UNDER-NUTRITION 



B. THE TECHNIC OF AWTIFAT CURES 



In antifat cures the intake of nourishment must be smaller than the 

 demand, and in the obese this cannot be estimated very readily. The practi- 

 cal need will be satisfied if for an obese person the average normal require- 

 ment, amounting to about 3,500 calories, is given and is combined with slight 

 or moderate bodily exertion. On this basis I have proposed the following 



scale in antifat cures : ^ • , ■ ■. .i. 



First grade of antifat diet.— To this belong antifat cures m which the 

 diet may be reduced to about four-fifths of the normal requirement, i. e., to 

 about 2 000 calories. Success follows this only when we are treating robust 

 persons 'who are able to take sufficient bodily exercise. The action is usually 

 slow; we must not count in the beginning upon losing more than from three 

 to four pounds, and later two to three pounds, of weight per month. 



Second grade of antifat diet.— In this category the antifat cures belong 

 in which the diet is reduced to three-fifths of the usual requirement, there- 

 fore, to about 1,400 to 1,500 calories. This diet may very readily be adapted 

 to the mode of life of most patients, so that they can follow their occupations 

 without hindrance. The rapidity of cure depends upon the amount of physical 

 exercise they can take. If exercise is difficult or impossible (as in many 

 women, in very lazy persons, in certain diseases, particularly in paralysis and 

 with threatening signs of cardiac weakness), the action of diet alone is quite 

 slow (about two to three pounds a month). In vigorous persons who, besides 

 pursuing their daily occupations, can devote an hour to an hour and a half 

 daily to mountain climbing, bicycling, rowing, exercise in the gymnasium, etc., 

 at first losses in weight of four to six pounds, later of two to four pounds, a 

 month are the result. For a time, as for instance during a vacation in the 

 mountains, these losses may without excessive exertion be increased to 11 

 pounds a month or more. 



Third grade of antifat diet. — To this belong antifat cures in which the 

 diet is less than three-fifths, or even only two-fifths of the usual requirement, 

 i. e., about 1,000 to 1,400 calories. In this class belong the well-known diet- 

 aries calculated to produce decided and rapid action, those of Banting-Harvey, 

 Oertel, Ebstein, and others, as is shown by the following tables: 



Diet Scheme according to 



Calories. 



Banting 



„ , , ( Maximum 



Oertel j Minimum 



Ebstein 



Hi-Meld jKmum:::::::: 



-g. j^ i Plethoric obesity.. 

 ] Anemic obesity . . . 



V. Noorden . 



1,100 

 1,600 

 1,180 

 1,300 

 1,400 

 1,000 

 1,086 

 1,116 

 1,366 



1 V. Noorden, " Die Fettsucbt " in Nothnagel's " Handbuch der speciellen Pathologie 

 und Therapie," Wien, 1900, p. 110. 



