5. Facts And Fancies About Obesity
From 'Eat Fat and Grow Slim' by Richard MacKarness, M.B., B.S (1958)

THERE Is no subject, with the exception perhaps of psychiatry, on which the ignorant are more ready to expound than obesity.

Anyone who likes to keep his ears open in a pub or a restaurant can be sure of picking up some gem of misinformation on the subject.

This great tangle of modern folk-lore about food and its effects has grown up because food is really one of our main concerns from the cradle to the grave and has become very closely connected with another of our big concerns — love.

My grandmother, who was as worthy a Victorian as any of her generation, used to put the matter in its place very nicely with the slightly disapproving phrase, "Like food, love people," when we children used to goggle at the chocolate fool and say we loved it.

The food symbols of ordinary speech are clear evidence of the strong associations between food and the emotions which exist for all of us.

When we say that someone makes us sick, no further explanation is required and many common endearments make use of food symbols: honey, sweetheart, sugar.

Shakespeare, whose plays are rooted in the hidden springs of human feeling, makes Court Orsino say,

"If music be the food of love, play on."

Love and food cannot help being bound up together because, from the moment of birth, and through infancy we rely upon the one we love best for the food on which our lives depend.

Therefore, the biggest single reason for over-eating the ever-ready starchy and sugary foods and so getting fat, is a feeling of love deprivation or insecurity.

Everyone has seen or heard of cases of girls disappointed in love who either stop eating and get very thin ("I can't have love so I won't have food either") or who start to eat to excess and get very fat ("I can't have love so I'll make up on sweets instead").

Misery is the commonest cause of substantial weight loss or gain in young women. Love cures both.

This close relationship between obesity and the emotions can be seen on all sides: the mother who has no real love for her child and resents the way it curtails her freedom, who stuffs it with puddings in an unconscious attempt to make up for the love she cannot give; or the young man jilted by his girl who goes off and swills mild and bitter to drown his emotional disappointment.

Fear is also a potent cause of obesity.

Fear of illness makes a mother urge her child to eat more and more and to regard any falling off of his appetite with horror.

Fear of not getting enough leads some people who have once been hungry, to over-eat whenever there is a chance. I remember during the war when I was medical officer to a camp of Russian prisoners near Grimsby, being struck by their well-nourished appearance.

These men, mostly of Mongolian stock, had been captured working for the Todt organisation, building the "western wall" against our invasion of Europe. The Germans had kept them very short of food.

When they came to England their rations were comparatively liberal, though mainly carbohydrate, and they became quite plump through eating everything they could lay their hands on. The camp kitchen swill-buckets were always empty. They even ate the potato peelings.

People who have gone hungry in childhood never quite lose the fear of hunger and may tend to over-eat even when they have become rich. This may account for the traditional, portly figure of the self-made man.

Fear of social failure — much commoner than is generally admitted — may result in avoidance of any situation where shyness may be exposed and humiliation result. Instead of joining in the conversation at a communal meal, the bashful person over-eats silently, relying on the excuse of a full mouth for not speaking.

Gradually the over-eating which is used to compensate for the missed pleasures of social intercourse may cause obesity and then the obesity itself is used as an excuse for not competing.

Fear of failure can fatten the shy person out of the game of life.

Because obesity is so often precipitated by over-eating for emotional reasons, hypnosis has been tried in treatment, with some success.

In good subjects it has been made to work remarkably well but it is not a method to be recommended. By substituting the will of the hypnotist for the will of the patient, hypnosis has been used to ensure that a low-calorie diet shall be followed in spite of a tendency to self-indulgence.

The hypnotist works first by obtaining relaxation in his patient. He then ensures by some device—a light above eye level, for example—that he has the subject's undivided attention. Next he suggests that sleep is coming and as the patient's conscious mind dozes off, he suggests firmly to the impressionable unconscious or dreaming mind that on waking, sugar, cakes, biscuits, pastry or whatever foods the hypnotist thinks are fattening, will no longer be of interest.

Sure enough, when the patient goes home he no longer wishes to eat any of the foods on which the hypnotist has placed a taboo. The suggestions may have to be reinforced at intervals, but while they last there will be no difficulty in sticking to a diet. On the other hand, they may work too well and the patient may end up under-nourished.

Most people would agree that it is better for people to face their own problems and overcome them by their own will-power than that they should rely on the artificial support of the hypnotist, and with all hypnosis there is a danger that there may be unexpected and undesirable psychological effects.

So far, then, two big factors in the production of obesity have emerged:

  1. A defect in dealing with carbohydrates which makes a person fatten easily on an ordinary mixed diet;
  2. Over-eating especially of sugars and starches as a result of loneliness, fear or emotional dissatisfaction.

When the two factors are present, weight is gained very rapidly.

So anyone who finds himself tempted to over-eat for emotional reasons and who shows a tendency to get fat, should be careful to choose low-carbohydrate foods.

The metabolic defect in the Fatten-Easilies (their tendency to store carbohydrate as fat instead of promptly turning it into energy) is probably hereditary and may be regarded as a failure to make the adaptation to a diet based on agriculture which the Constant-Weights have achieved.

Before the cultivation of cereal crops, our ancestors, as has been said before, lived by hunting animals and subsisted on an all-meat diet of fat and protein. If they lived near woods or in forests, they may have taken a few berries, fruits and roots as well, but on the open plains they lived on meat alone and there is evidence that on this diet they were never corpulent.

With the gradual introduction of starch and sugar which followed the cultivation of the land, some people found that they could adapt themselves to the new foods and stay slim, while others must have failed to develop the biochemical mechanism for getting energy from carbohydrate and became fat instead.

These were the Fatten-Easilies.

Dr. Leonard Williams, a Harley Street physician in the 1920s, says the same thing in a more fanciful way in his book Obesity published by the Oxford University Press:

"There are a certain number of people—and they are not a few — who, in spite of the fact that they eat enormously, never grow fat. The case of such people will repay a moment's consideration. The explanation of their case is, briefly, that they are constitutionally devoid of a 'sausage machine.' They are unable so to deal with superfluous food as to render it fit for absorption and storage. A possible explanation of this is that in comparison with the fat man they represent a higher stage of evolution. . . .The reason why such people represent a higher stage in evolution is this: the deposition of fat is a provident measure taken against a lean period. In these people whose tissues have hereditarily no longer any reason for anticipating a lean period, this particular mechanism for self-preservation atrophies from disuse, and the storage of fat becomes impossible to them. Certain it is that the typical aristocrat, whose ancestors through the ages have had no necessity for hoarding fat, is always depicted as lean."

We all know that obesity runs in families and so does the power to maintain a constant weight on a large food intake.

So here is a third important factor in obesity — heredity.

So far, very little has been said about protein apart from the fact that, like fat, it gets weight off by speeding up metabolism. This class of food will be discussed next. There is much muddled thinking about protein and the role it plays in obesity. It is commonly supposed that lean meat is slimming while fat meat is not. In fact, as has been shown, fat meat gets weight off better than lean and is more palatable.

Most people now know that proteins are essential to health because they are the materials of which the body is built.

We are, each one of us, made largely of meat like other animals and it is reasonable that to keep ourselves in good repair, we should eat animal protein. In this sense, cannibals take the most logical diet of all.

Lack of protein in the diet leads to very severe disease and this has only been fully appreciated in the last twenty years or so.

In 1933, Dr. Cecily Williams first described for western medicine a condition due to protein malnutrition which is now known as kwashiorkor (from two African Gold Coast dialect words meaning a red boy). This disease is seen mainly in children, and is characterised by extreme weakness, oedema (swelling), skin eruptions and a curious reddish tinge in the hair when the sufferer is black-skinned. It has been known for years (under different names) all over Africa and Asia.

Dr. Williams showed that kwashiorkor was a deficiency disease due to a diet low in protein and high in vegetable starch. She cured the sick children by feeding them protein, in whatever form she could—milk, fish, meat, peanuts. etc.

In 1951, she and a medical team under the British Committee of the Food and Agricultural Organisation (F.A.O.) travelled across Central Africa from east to west, making a film about kwashiorkor as they went. This film was shown at the meeting held in London on 6th April, 1957, to celebrate the ninth anniversary of the founding of the World Health Organisation.

The most striking thing about the film, apart from the clinical details of kwashiorkor which are well demonstrated, is the contrast between the meat-eating and carbohydrate-eating tribes encountered: the hunting and pastoral Masai with their herds of animals, tall, well-built, slim and healthy; the agricultural Kikuyu, grinding a wretched subsistence from the soil, puny but often corpulent, disease-ridden, their children bloated with kwashiorkor, flies swarming round the sores on their faces. Fed solely on a sort of corn-starch porridge, these Kikuyu children were showing the full effects of protein deficiency at an early age.

The purpose of the film was to emphasise the wide distribution of kwashiorkor and to suggest measures for its relief: education of primitive agricultural people in the production of protein foods: ground nuts cultivation, fishing, animal husbandry and dairy farming.

But behind this obvious lesson, the film leaves the impression of a relationship between food and character: the meat-eaters, calm, friendly and self-reliant, the starch-eaters, irritable and afraid.

Political and economic considerations apart, it is impossible not to draw an unfavourable comparison between the starch-eating Kikuyu with their murderous cult of Mau-Mau, and the aloof but good-tempered, meat-eating Masai with their obvious self-respect and dignity.

Ever since Cain, the agriculturalist, killed Abel, the hunter, it has seemed that a diet of fat and protein makes for mental and physical stability while vegetarianism, with its high-carbohydrate intake, encourages the opposite.

Hitler was a vegetarian and Davy Crockett was a meat eater.

Vance Thompson has pointed out the connection between corpulence and dishonesty:

"There is a strange kinship between obesity and financial crime—almost all embezzlers are fat."

Horatio Bottomley seemed to bear this out.

Further evidence suggesting a relationship between low-protein diets and bad character comes from a study of scurvy, the disease which was the bane of mariners before its prevention by foods containing Vitamin C was established.

The early symptoms of scurvy are emotional rather than physical. They make their appearance long before the weakness, bleeding from the gums and joint pains which are so characteristic of the fully developed disease.

The victim becomes irritable, argumentative, truculent and quick to take offence. And of course it is this aspect of the disease which has come down to us in the epithet "a scurvy fellow," meaning a churlish man.

"Blackleg," the sailor's other name for scurvy, which derives from the dark haemorrhages under the skin of the legs in more advanced cases, has also come to be used as a term of abuse, particularly during industrial disputes.

What has all this to do with a low-protein diet? Just that one of the essential functions of proteins in the body is now known to be similar to that of vitamins: the supply of substances essential for the manufacture of enzymes which enter into the catalytic processes from which the body derives its energy and its life.

One authority has said that to-day, nutritionally speaking, we are emerging from the vitamin era into the age of protein.

The body cannot make certain proteins. They have to be supplied in the food. Neither can it make Vitamin C.

It is reasonable to suppose, therefore, that just as the "scurvy fellow's" churlishness is due to the withholding of a substance essential to his metabolism, so the unreliability of the high-carbohydrate, low-protein eater is similarly caused.

This might make embezzlement by a fat person a symptom of protein deficiency!

It may be his diet that makes the cowboy a better bet from the health standpoint, 'than the starch-eating city dweller.

The most extreme cases of obesity are seen, as you would expect, where a carbohydrate diet has been taken in its purest, most concentrated form — sugar.

In India many of the women, particularly in the towns, are exceedingly fat. They eat enormous quantities of sweets, like haiwa which they make themselves or buy from the mithai-wallah. Travel across India to the Burmese border and you find the Nagas, wiry, energetic, resourceful, living by hunting and on the meat of pigs and jungle bison, mithun, which they have domesticated. It is very rare to see a corpulent Naga.

Apart from the long-term effects of protein in the diet, certain biochemical aspects of protein are important for the obese. These may be summarised as follows.

Biochemical Aspects Of Protein

  1. Fat cannot be made up from protein in the body to any appreciable extent.
  2. Protein draws up the body fires (increases metabolism) and helps to burn up fat stores. This is called the specific dynamic actions (S.D.A.) of protein.
  3. Proteins are essential for health because without them the body cannot make certain hormones and enzymes (chemical regulators) concerned in energy exchange reactions, growth and repair.

These three points naturally prompt the question: why not an exclusively lean-meat diet, with no fat, for obesity?

Wouldn't that get weight off well?

The answer is that protein alone, without fat, makes a person ill, although it gets weight off quickly.

Stefansson confirmed this at the beginning of his year on an all-meat diet under medical supervision at the Bellevue Hospital. Here is his own description of what happened, from page 69 of The Fat of the Land:

"The chief purpose of placing me abruptly on exclusively lean was that there would be a sharp contrast with Anderson, who was going to be on a normal meat diet, consisting of such proportions of lean and fat as his own taste determined.
In the Arctic we had become ill during the second or third fatless week. I now became ill on the second day. The time difference between Bellevue and the Arctic was due no doubt mainly to the existence of a little fat, here and there, in our northern caribou—we had eaten the tissue from behind the eyes, we had broken the bones for marrow, and in doing everything we could to get fat we had evidently secured more than we realised. At Bellevue the meat, carefully scrutinised, was as lean as such muscle tissue well can be. Then, in the Arctic we had eaten tendons and other indigestible matter, we had chewed the soft ends of bones, getting a deal of bulk that way when we were trying to secure fat. What we ate at Bellevue contained no bulk material of this kind, so that my stomach could be compelled to hold a much larger amount of lean. Moreover, I had in New York a much larger stomach than in the Arctic: there it had been constricted in accord with the small bulk of a lean-fat diet; here in 'civilisation ' it had been expanded through the needs of a bulky mixed diet.
The symptoms brought on at Bellevue by an incomplete meat diet (this ration of lean without fat) were exactly the same as in the Arctic, except that they came on faster, diarrhoea and a feeling of general baffling discomfort.
Up North the Eskimos and I had been cured immediately when we got some fat. Dr. DuBois now cured me the same way, by giving me fat sirloin steaks, brains fried in bacon fat, and things of that sort. In two or three days I was all right, but I had lost considerable weight."

Primitive people who are forced by adverse circumstances to live on lean meat — e.g. rabbit meat — with no fat from other sources, develop diarrhoea within a week with headache, lassitude and vague discomfort. If they continue for long on lean meat they become incapable of working. They can eat until their stomaches are distended but still feel unsatisfied — they suffer from fat-hunger. Introduction of fat into their diet rapidly relieves all the unpleasant symptoms.

Fat-hunger, which is almost unknown among northern hunting people like the Eskimos, where the animals are rich in fat, becomes increasingly common towards the Equator, and it is from hot countries that most of the stories of fat-hunger come.

Sir Herbert Wilkins in his book, Undiscovered Australia, published in 1928, which describes the two year expedition he conducted for the British Museum in tropical northern Australia, gives a macabre account of fat-hunger among the aborigines.

The missionaries were having trouble in breaking the natives of cannibalism and their difficulties increased in proportion to the corpulence of the deceased.

When a thin man died, only a stern warning was needed to restrain them from cannibalism. But when a fat man was buried the missionaries had to mount guard over the grave and even then the corpse was sometimes exhumed and eaten weeks later.

Apparently the Australian cannibals did not mind their cadavers high so long as they were fat.

In Liberia where most of the wild meat is excessively lean and even domestic cattle are skinny, those animals which store fat are preserved by the natives for eating. Snakefish, the giant rat (Cricetomys Gambianos Liberiae), porcupines and warthogs are all highly prized foods because they are rich in fat.

Significantly, the literature and folk-tales of tropical people are full of the praise of fat while northern people whose meat is always fat have little to say about it. Necessities do not call for comment until they become scarce.

What is the lesson to be drawn from all this for those who wish to lose weight on a high-fat, high-protein diet?

Simply that it is essential to keep the proportion of fat to protein at about that preferred by people on an all-meat diet: one part of fat to three of lean by weight. How to do this was explained at the end of Chapter Four.

Too much protein will not do. On a low-carbohydrate intake fat is needed to supply energy as well as to furnish essential compounds for the biochemical reactions on which the proper functioning of specialised cells and tissues depend.

So much for protein in the Eat-Fat-Grow-Slim diet. It is essential and it helps to get weight off, but without fat it leaves you hungry and will soon make you feel ill.

Now to consider some other factors in obesity about which people express conflicting opinions.

Although we now live on dry land, there was a time millions of years ago when our ancestors came out of the sea inwhich they had evolved as very simple animals. To survive on land they had still to carry the sea within them and this we do to this day.

Apart from the skeleton, the tissues of the body contain from 70% to 90% water. Everything that we eat has to be dissolved in water before it can be absorbed and once absorbed it is carried in the blood — another watery solution — until it is used for energy or growth or repair by the cells of the body. These cells contain protoplasm, a semi-fluid substance, the basis of which is water.

Lack of water is much more quickly fatal to human life than lack of food and it is therefore unwise to attempt to lose weight by drastic restriction of fluid intake.

Some obese people do retain more water than they need and a reducing diet may not remove this extra water straight away. Water retention by fat people has been demonstrated experimentally by cutting cylinders of fatty tissue from obese and thin subjects and comparing the proportion of fat to water in them.

Sir Adolphe Abrahams, for many years honorary medical officer to the British Olympic athletic team, discussed this point in one of his answers to a questionnaire on slimming published in the News Chronicle on 18th March, 1956:

"One must differentiate between loss of weight and loss of fat. I have seen a man lose 9 lb. weight in running a marathon race. Of this, probably 3/4 lb. Was fat, the rest was water which was recovered in the ensuing forty-eight hours.
Similarly it sometimes happens that, on account of the dietary alteration, the onset of slimming therapy leads to retention of water, so that no loss of weight occurs. After a certain time lag there is then a rapid fall.
It may well happen that, disheartened by the experience in this early stage, the treatment is abandoned before the loss begins."

Sir Adolphe was here referring to orthodox, low-calorie diets.

Professor Kekwick and Dr. Pawan found that loss of water increased fairly rapidly on high-fat, high-protein diets and accounted for from 30% to 50% of the weight lost by the subjects under observation.

Finally, it is worth noting that some women retain water before their monthly period and become heavier at this time. This extra water is lost when the period starts and is of no significance except that if such a woman wants to slim she would find it better to weigh herself just after a period than just before.

Dr. Pennington, who has probably had more experience of high-fat, high-protein diets in the treatment of obesity than anyone else, says that alcohol checks the combustion of fat in the body.

On the other hand, there is Banting's evidence. He took six glasses of claret a day and a glass of rum or something like that most nights when he went to bed, and still he lost weight. And Dr. Pawan has mentioned to me the intriguing possibility that alcoholic drinks, by dilating the blood vessels in the skin and making it work harder, may step up metabolism to an extent which more than compensates for the calories taken in as alcohol.

This increased metabolism, coupled with increased loss of water from the skin and in the urine, could then result in weight loss. There is experimental evidence for this.

Professor Kekwick found that obese patients who were losing weight satisfactorily on a high-fat, low-calorie diet, continued to lose if alcohol was added in amounts up to 500 calories a day (equivalent to about a third of a pint of gin). But if the extra 500 calories were given as chocolate or other carbohydrate food, they stopped losing weight and started to gain.

This confirms the belief — quite widely held — that pink gins are slimming. Probably all alcoholic drinks except those like beer which contain large amounts of carbohydrate, are slimming too.

But it must be remembered that the stimulation of appetite and the removal of inhibitions by alcohol may mask the slimming effect by tempting you to overeat the fattening, carbohydrate foods which are so often provided with drinks.

Any attempt to lose weight through exercise without modifying the diet is doomed to failure. Banting put the matter in a nutshell:

"From my earliest years I had an inexpressible dread of corpulence, so, when I was between thirty and forty. years of age, finding a tendency to it creeping upon me, I consulted an eminent surgeon, now long deceased — a kind personal friend—who recommended increased bodily exertion before my ordinary daily labours began, and thought rowing an excellent plan. I had the command of a good, heavy, safe boat, lived near the river, and adopted it for a couple of hours in the early morning. It is true I gained muscular vigour, but with it a prodigious appetite, which I was compelled to indulge, and consequently increased in weight, until my kind old friend advised me to forsake the exercise."

This does not mean that all exercise is bad for the corpulent, only that suddenly plunging into unaccustomed and strenuous exertion in an effort to " sweat weight off" is valueless as a treatment for obesity.

Exercise has a definite place in the Eat-Fat-Grow-Slim regime.

It is used in two ways to help increase the metabolism and to step up the mobilisation and combustion of stored fat:

  1. By increasing calorie expenditure. If you restrict your hours in bed to eight out of the twenty-four and do not lie about in a chair during the day, you will ensure that your muscles are active all day and using fuel. This is exercise through the maintenance of posture — much more effective in getting weight off than a game of squash or a quarter-mile sprint, either of which will throw a serious strain on your locomotor system while you are over-weight and may leave you with backache or a strained foot.
  2. By helping to throw the body over to using fat. A sharp half-hour walk on an empty stomach before breakfast, by inducing a mild ketosis, will make stored fat supply the energy for the exercise.

If you have a dog and can bend and pick up a ball or a stick repeatedly on the walk, this will start your bile flowing in readiness for the digestion of the good breakfast you will eat when you get home.

Another reason for restricting the number of hours in bed is that some very recent research suggests that fat people reduce their metabolism almost to zero while they sleep. Like hibernating animals they use very little oxygen and thus conserve their calories and their weight.

With exercise, it is convenient to take the question of massage and Turkish baths.

Massage is useless when performed by somebody else. It will increase the expenditure of energy by the masseur but it will not do so for the subject lying on the couch.

Self-massage with patent rollers and gloves is good exercise and as such to be recommended, but it cannot be relied upon to perform the spot-reducing claimed for it by some people.

Turkish baths are also useless as a treatment for obesity.

They clean the skin and may remove a pound or two of water as sweat, but this is soon put back again by the long cool drinks in the rest-cubicle afterwards.

Banting's experience of Turkish baths accords closely with modern medical opinion:

"At this juncture Turkish baths became the fashion, and I was advised to adopt them as a remedy. With the first few I found immense benefit in power and elasticity for walking exercise; so, believing I had found the 'philosopher's stone,' pursued them three times a week till I had taken fifty, then less frequently (as I began to fancy, with some reason, that so many weakened my constitution) till I had taken ninety, but never succeeded in losing more than 6 lb. weight during the whole course, and I gave up the plan as worthless; though I have full belief in their cleansing properties, and their value in colds, rheumatism and many other ailments."

Now drugs
Every general practitioner is familiar with the obese patient who comes into the surgery with a request for "Something to get my weight down, doctor."

Drugs for the treatment of obesity fall into three classes:

  1. Aperients and purgatives or laxatives.
  2. Appetite-depressants like amphetamine.
  3. Hormones.

First, the laxatives: Saline aperients are the oldest drugs used for slimming, and will get weight off temporarily if they cause diarrhoea and loss of water, but the resulting thirst soon leads to drinking more.

Continual abuse of purgatives for slimming can seriously interfere with the digestion and absorption of food and will eventually cause loss of weight through malnutrition.

The advertising of such remedies as cures for obesity is unscrupulous and misleading.

Second, the amphetamine group of drugs: these are now obtainable only on a doctor's prescription but even so, enormous quantities are consumed daily. They should be used with the greatest caution.

They are supposed to destroy appetite and while doing so to increase energy and well-being.

There is no doubt that they will do this, for a time, in many cases. But they can do it only by using the whip of a stimulant on the back of a person drugged into partial starvation. Extreme irritability and sleeplessness often result and the patient becomes tired and ill-looking.

Dr. Bicknell, in his paper, "The Dietetic Treatment of Obesity," published in The Medical Press of 19th November, 1952, had this to say about the amphetamines:

"In many cases they do not reduce the appetite while they may cause a restless excitement which is most unpleasant. In other patients they do reduce the appetite though this effect often wanes in a few months. Whether any drug should be used for months to prevent such a fundamental feeling as hunger is a debatable point. But there are other clear reasons against these drugs.
With myocardial degeneration, which is a common accompaniment of obesity and a common reason for the necessity to lose weight, amphetamine is said to be a cause of tachycardia or heart block and of a raised and persistent blood pressure. The present writer in one week saw three cases of heart block in elderly men all of whom had been taking small doses of amphetamine.
Addiction, which is said to be easily cured, may cause chronic restlessness and hyper-excitability alternating with melancholia. Since it is often the menopausal woman who needs to slim, it would seem at best unwise to expose her to a drug which by giving her spurts of artificial energy may initiate her into the delights of drugs or drink at the very period in her life when such temptations are most dangerous.
The danger of death from an overdose may be slight, but mere 'slimming pills' are unlikely to be zealously kept from children. Even with normal doses adults may suffer from abdominal pain and spasm of the sphincters of the bladder and rectum: conditions which, especially in the elderly, may cause unnecessary distress and investigation before being traced to their simple origin."

Though the amphetamines are potentially bad, other drugs like the polynitrophenols, which induce wasting of the body, are very much worse and should on no account be used for slimming.

Sir Adolphe Abrahams was reported in the News Chronicle slimming series already referred to, as follows:

"No words of condemnation can be too strong for the nefarious employment of drugs to produce wasting by their poisonous effect.
At the present day amphetamines are fairly extensively employed. By reducing the appetite they reduce food consumption.
Also, by palliating the empty feeling, they relieve some of the discomfort resulting from partial starvation.To this extent their employment can be condoned, but it is by no means without danger."

Before leaving the appetite-depressant drugs, mention should be made of a range of preparations which are used for the same purpose but act in a different way. These are the expanding stomach fillers made from cellulose or other non-food substances and taken before meals to dull the appetite. While these preparations have none of the serious medical dangers associated with the polynitrophenols and amphetamines mentioned above, they act in a way which may have the long-term effect of upsetting the normal responses to hunger and the regulation of appetite in relation to metabolic needs.

In any case such preparations are unnecessary in the eat-fat-grow-slim regime, in which obesity is tackled in a more fundamental way, and partial starvation is not a prerequisite of success.

Thirdly, hormones: here we are on much safer ground and today the use of hormones opens up the most interesting possibilities in the treatment of obesity.

Hormones are complex chemical substances manufactured in the ductless glands and discharged into the blood-stream to be carried round the body to act as chemical regulators of the various organs and processes. Among other things, they are intimately concerned with regulating metabolism.

Lack of the hormone thyroxine, from the thyroid gland in the neck, leads to a condition called cretinism in child-hood, or myxoedema in adult life, in which there is a general slowing down of all the processes of the body and mind and weight may be gained.

Over-production of thyroxine, on the other hand, has the opposite effect. In this condition (thyrotoxicosis or exophthalmic goitre), there is over-activity with mental and physical agitation and considerable weight loss.

Observation of these diseases has led to the employment of thyroid hormone for the treatment of simple obesity.

Medical opinion is still divided on the results. Some doctors seem to be against the use of thyroid tablets, holding that when you give them to a person with a normal thyroid, the thyroid gland just knocks off making that much hormone and you are back where you started.

Other doctors have found thyroid tablets valuable. Dr. Bicknell is one of these. Here is what he says:

"Thyroid preparations, on the other hand, have few of the drawbacks of amphetamine and are often extremely valuable even for patients who show no definite signs of myxoedema. This is especially so if after a couple of months of dieting the loss of weight is no longer satisfactory."

Sex hormones have also been employed in obesity with varying results. Certainly, where there is evidence of male hormone deficiency — eunuchoidism — treatment with male sex hormones can bring about a change towards a more masculine physique and fat is lost from the feminine subcutaneous depots, the hips and breasts.

But generally speaking, sex hormones are disappointing in the treatment of obesity.

Of all the ductless glands, the pituitary has the best possibilities.

The pituitary has been called the master gland or conductor of the hormone orchestra. It is situated below the brain, in a bony pocket at the base of the skull, roughly at the junction of a line drawn from the bridge of the nose to the back of the head with a line joining one ear to the other.

Nature has placed this vital gland in a well-protected position and although it is only the size of a cobnut it turns out dozens of hormones which stimulate or inhibit all the other glands in the body, correlating their activities into a marvellously unified rhythm which in normal health keeps all the functions of the body running smoothly.

If a hormonal method of controlling obesity is possible, the most likely source of such a hormone would be the pituitary. This thought is not new and some fascinating work has already been done on the subject. In 1920, Dr. Leonard Williams, in the last chapter of his book already mentioned, discussed hormones which were then newly, discovered substances. On page 151 he wrote:

"Another fact which has tended to obscure the issue is the length of time which it often takes for pituitary extracts taken by mouth to produce their effects. Physicians who are accustomed to the prompt and decisive results to be expected from thyroid, seem to lack the patience which is necessary for a fair trial of pituitary. I have had to persevere for several weeks before being rewarded by any signs of the expected therapeutic action, which nevertheless eventually accomplished all that I had asked of it. One of the most annoying sides to the particular feature is the great expense of the extract; for unless people are warned at the outset that the remedy will take a long time to produce its effect, their inclination is to discontinue a costly remedy which seems to be producing no results."

In 1936, in the Journal of Physiology, C. H. Best and J. Campbell described a substance from the pituitary gland which had the specific capacity of accelerating the mobilisation of depot fat. They called it adipokinin. In 1948, two Americans, Rudolf Weil and deWitt Stetten, Jun., wrote in the December number of the Journal of Biological Chemistry:

"During fasting, under conditions in which an increase in the mobilisation of depot fat might be anticipated, there appears in the urine a material capable of provoking such an increase, which at least superficially resembles pituitary adipokinin."

In 1954, in the Canadian Journal of Physiology and Biochemistry, Collip described the isolation of a metabolism-increasing factor from the pituitary.

What all this amounts to, in untechnical language, is this: if you take a fat rabbit and inject it with a subtance obtained from the urine of a fasting rabbit, the fat rabbit will get thinner. Research into the nature and effects of this fat-mobilising substance in fasting urine is going on at the present time. Work with human volunteers is giving encouraging results similar to those in rabbits.

The urine of fasting humans contains large quantities of a material which when administered to mice will increase their utilisation of stored fat.

Constant-Weights produce this fat-mobilising substance (F.M.S.) on all types of diet. Fatten-Easilies produce quite a lot on a high-fat diet, rather less on high-protein and none at all on high-carbohydrate.

The effect of carbohydrate eating in the obese must therefore be to inhibit, probably via insulin blockage, the production of F.M.S. which is necessary for the metabolism of fat and the production of energy.

F.M.S. has recently been isolated as a pure substance (Chalmers, Pawan and Kekwick, the Lancet, July 1960). It may turn out to be a pituitary hormone and it may be the final key to the riddle of obesity. Lack of it may prevent Mr. Fatten-Easily from mobilising his excessive fat stores. It is even possible that before long doctors will be able to use it to turn the fatten-easilies into the constant-weights. When that day comes, obesity as a medical problem will be a thing of the past.