OBESITY - DISTRIBUTION OF MEALS.
Solid Food.—In settling upon a given diet we have to divide the solid food, without exception, into small meals or portions. The power of the heart's action and changes in the circulation connected with this power are the factors which determine the manner in which this is done, in order to avoid overdistention of the stomach, the up ward pressure of the diaphragm, the displacement of the heart out of its normal position, and an overburdening of the circulation by larger quantities of absorbed food.
The liquids are also to be taken as much as possible at separate times from the solid foods, especially at the principal meals, since meat prevails in all diets, and the stomach juices necessary to digest it must be concentrated and not diluted by much fluid. Soups may be left out altogether since they have no special nutritive value. In the case of an hydrfemic and andemic patient having but a small quantity of albumin, a nourishing breakfast is necessary, and the stomach is not to be distended beforehand or at the same time with tea, coffee, etc., which interfere with digestion, and are injurious by overburdening the circulatory apparatus. Also in plethoric patients who are gener ally large eaters, it is advisable to distribute the food into small meals, and to let the patients eat frequently in order to break them of the habit of eating too much at a time. These dietetic measures will be further supported by advice to the patient to drink little or noth ing during meals, which causes a diminution of his appetite. Instead of three meals, from five to six are ordered and the diet is adapted as set forth, according to the condition of nutrition and the decrease in the fat. According to this diminution of body fat it will be neces sary to add more fat and carbohydrates to the diet so as to avoid an undesirable burning up of the body albumin to furnish the necessary calories. If, however, the division of the meals as I have laid down in the therapy of obesity and circulatory disturbances is carried out too rigorously and the portions become too small (Schweniuger), it is possible that the fat-forming substances taken in with these small meals may not be sufficient for the momentary necessities and so may cause a burning up of some of the body fat.
Here, however, the danger is always present that not only an in sufficient quantity of fat and carbohydrates but also much too little albumin is taken in with the food. The patient finally eats too little
on account of the frequent hourly or two-hourly meals which must of necessity be as scanty as possible, or he loses his appetite froin the frequency of eating, all of which not only results in a diminution of fat but also of albumin. A considerable reduction of weight is nat urally not to be reached in this manner. This method is nothing more than a hunger cure.
The decomposition of the fat is not at all in proportion to the more or less frequent consumption or absorption of large quantities of food but altogether in proportion to the requirements of the body. If at the time it is required in the economy, too little fat-forming nourishment is taken in, some fat of the body will be consumed, but if it is not then required, even the small quantity of fat or car bohydrates introduced will entirely, or in part, be preserved and be added to the fat of the body. Only where a larger amount is ab solutely required than is furnished with the general supply of the fat-forming substance, is a permanent reduction of the fat possible; and it makes no difference whether these fat-forming substances are given and absorbed in numerous but small, or few but large meals. The conditions of weakness frequently observed during these rather stereotyped cures (though Schweninger does not wish to have them designated as cures) are caused by this kind of diet and manner of feeding, and the losses of albumin produced by it.
2. Distribution of distribution of fluids is best arranged after previously having ascertained the varying circum stances in the patient's condition. These experiments are carried out by letting the patient take as much fluid as he is used to for two days and for the following two days diminish the quantity of fluid below the physiological quantity between 750 and 1,200 grams. The fluid which is taken in and the urine secreted are both measured as care fully as possible in graduated vessels. The limit of the day is fixed by establishing a certain hour in the morning, seven to nine o'clock, at which breakfast is taken; all the urine passed immediately before this hour (i.e., before the breakfast) is considered as belonging to the previous day. All that is passed after breakfast and up to the hour of breakfast of the following day forms the amount for one day.