Dietetic Treatment.—The older plans were erroneously based upon the theory that fat was only formed out of certain articles of food, as hydro carbons (fats) and carbohydrates (starch and sugar), whilst it is a well known fact especially seen in hereditary obesity that proteids also contri bute to the formation of fat. Some individuals manufacture and store up their fat chiefly from some one of these classes of food, whilst others may chiefly store up their fat from another class, and hence no one system can be expected to suit all the cases of obesity. By a careful study of each case the physician can soon find out which plan is best suited to it. Often the most suitable treatment will not lie in hard and fast adherence to any recognised plan, but in such modifications of it as may be rationally decided upon after frequently weighing the patient and watching which class of food best nourishes the body and maintains a high state of vigour without adding to the deposition of adipose tissue. Unless there are special reasons for the contrary, it will be desirable to make the changes slowly and gradually at first. Sudden and marked reductions in the body weight cannot be safely made, and, moreover, the attempt often leads to the disarrangement of both appetite and digestion. As a rule a reduc tion of more than S oz. daily in body weight should not be permitted in the early stages of treatment, and about t lb. per week in the later months.
Witting's diet consists of 13reakfast--1 to 5 us. of animal food, consisting of beef, mutton, kidney, bacon, boiled fish, or hot or cold meat of ally kind, veal and pork. A little biscuit, or f oz. dry toast. A large cup of tea ur coffee, without sugar and milk. Dinner-5 to 6 oz. of any fish, except salmon, eels, or herrings, or of any meat, except pork or veal, or of any poultry or game. Any vegetables, except potatoes, parsnips, carrots, beet root, or turnips. t oz. dry toast. Cooked fruit out of a pudding and un sweetened. to oz. claret, weak sherry (,r madeira. Tea-2 to 3 oz. cooked fruit and ;i rusk or two, and o oz. tea without milk or sugar. supper-3 or 4 oz. 11611 or meat, as at dinner, with 7 oz. claret or sherry and water.
The normal amount of calories is calculated at 3,000; the Banting diet contains only ',too, and is not capable of maintaining life for any con siderable period without inducing dyspepsia and gout, and, it is stated, also renal disease. There is often unconquerable abhorrence of animal food induced, and the patient feels compelled to abandon the system. Gutman's diet, like the above, contains only t,roo calories; the meat is reduced to to/ oz. and the bread increased to 4ir oz. Salad, fresh vege tables, fruit and potatoes are permitted to the extent in all of 19 oz. daily.
Ebstein recognises that fat is formed from albuminous foods, especially if carbohydrates are freely administered at the same time, and that this transformation takes place independent of the administration of fats. The presence of fats in the food he believes tends to prevent its deposition in the body, and hence fatty substances enter into this dietary; their use prevents the craving for hydrocarbons and they give a feeling of satiety which is never experienced under the Banting system, in which fats, starch and sugar are omitted. The diet is made up of the following: Breakfast—i•76 oz. white bread (toasted) with plenty of butter, and 8.8 oz. tea without sugar or milk. Dinner—Fatty soup made from a beef marrow-bone. 4 to 5 oz. fat meat with some cabbage, asparagus, spinach, peas or beans in moderate quantity, and 2 or 3 glasses of light wine, and a little stewed fruit without sugar. Late in the afternoon—A cup of tea without milk or sugar. Supper—A large cup of tea without milk or sugar, oz. each of bread and butter, one egg, or a corresponding bulk of fat ham, fat roast meat or cheese, with fresh fruit. No alcohol.
This diet gives good results in many instances, but as it contains carbohydrates in quantity insufficient to sustain life, it cannot be continued except for short periods. Wood, contrasting it with the Ranting diet, points out that the food of an average healthy man should contain 3o drs. proteids, 25 drs. fat and 92 drs. starchy carbohydrates, whilst the Banting diet supplies 43 drs. proteids, 2 drs. fat and 51 drs. starchy carbohydrates, and the Ebstein system gives 25 drs. proteids, 211 drs. fat and r t drs. starchy carbohydrates.
Oertel's system provides for a moderate reduction of carbohydrates and a great diminution of fluids; it was at first introduced for the treat ment of corpulency associated with valvular lesions. Though now practically discarded for the treatment of heart affections, this dietary is often used in simple obesity. The amounts are varied according to circumstances, there being a maximum and minimum; the average figures give a good working mean. It differs from the Banting system in the increase of fat and carbohydrates and from the Ebstein by the diminution of the fat and the doubling of the carbohydrates and proteids.
The amount of water is not to exceed 35 oz., but a vital element in the Oertel plan is the mountain climbing, by which there is rapid elimination of water from the blood. He calculated that 4o oz. were eliminated in an ascent of r,000 feet during four hours' walking, the skin and lungs getting rid of the most of this, the urine being but slightly augmented.