166 OBESITY 



amount. Of course, under such circumstances, the diet loses its significance, 

 which, after all, consists in the large amount of albumin which the patient 

 is supposed to consume. 



The shortcomings of the " no-fat " cures, especially the fact that at best 

 they admit of but temporary employment, caused me to propose in the year 

 1882 a method for the treatment of obesity which is free from the objection- 

 able features of those previously mentioned, and which, without losing its 

 distinguishing characteristics, may be variously modified from time to time 

 according to whatever conditions may arise. My method, which is by no 

 means a modification of the Banting cure, permits a manner of life which 

 differs but little from that of other plain and sensible persons. My plan can 

 be continued indefinitely by the person in question without the exercise of 

 too great self-denial. By this means alone is it possible to retain perma- 

 nently what has once been achieved. The treatment of obesity is a rational 

 one only when we endeavor to bring about a lasting cure, and not only a rapid 

 transitory result. We can never succeed permanently with any method of 

 treatment if the patient follows it only for a certain length of time and then 

 returns to his former mode of life; that which has shown itself as curative 

 must form a permanent and integral constituent of his future manner 

 of life. 



The conceptions which led me to propose for obese persons a diet which 

 should be curative, and, in its main principles, could be maintained during 

 life were chiefly the following: It is sufficiently proven by experience that 

 even in fat persons the ingestion of a measured quantity of fat under certain 

 circumstances fails to produce any accumulation of fat, and that the person 

 in question may even rid himself of his superfluous fat provided that the 

 carbohydrates are properly limited and that his manner of living is otherwise 

 normal and in accordance with the fundamental laws of the modern phys- 

 iology of nutrition. I have, therefore, abjured the fat-depletion cures and 

 assigned to fat the place which it should occupy in the diet of the obese. The 

 prohibition of fat is entirely opposed to the physiological laws of normal nutri- 

 tion. Fat is a necessary food. No less prominent a physiologist than Bon- 

 ders refers to this as follows : " Too little fat undermines the organism, and 

 lays a foundation for faulty nutrition, a poor admixture of the nutritive juices 

 and of the tissues." That this law is not operative for the obese can neither 

 be proven by scientific reasoning nor inferred from professional experience. 

 Even Hippocrates advised for the obese the ingestion of foods prepared with 

 fat, as, in this manner, the appetite was most rapidly satisfled. This obser- 

 vation of Hippocrates is perfectly correct. 



_ It is, therefore, an ancient law of experience that by the addition of a cer- 

 tam amount of fat to the food the sensation of hunger is more lastingly re- 

 moved than by food very deficient in fat, or by an equivalent amount of carbo- 

 hydrates or of albumin. Fatty foods act in this way not because they spoil 

 the appetite nor (as has been maintained by some) because- they produce dys- 

 peptic symptoms. On the contrary we see that dyspeptic symptoms appear 

 frequently after the ingestion of too large quantities of meat. That one may 

 eat enormously of meat without a sensation of satiety is well known. Quite 



