POUNDS AND INCHES Little Choices Everyday

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This book discusses a new interpretation of the nature of obesity and while it does not advocate yet another. fancy slimming diet it does describe a method of treatment which has grown out of theoretical considerations. based on clinical observation, What I have to say is an essence of views distilled out of forty years of grappling with the fundamental. problems of obesity its causes its symptoms its very nature In these many years of specialized work. thousands of cases have passed through my hands and were carefully studied Every new theory every new. method every promising lead was considered experimentally screened and critically evaluated as soon as it. became known But invariably the results were disappointing and lacking in uniformity. I felt that we were merely nibbling at the fringe of a great problem as indeed do most serious students of. overweight We have grown pretty sure that the tendency to accumulate abnormal fat is a very definite. metabolic disorder much as is for instance diabetes Yet the localization and the nature of this disorder. remained a mystery Every new approach seemed to lead into a blind alley and though patients were told that. they are fat because they eat too much we believed that this is neither the whole truth nor the last word in the. Refusing to be side tracked by an all too facile interpretation of obesity I have always held that overeating is. the result of the disorder not its cause and that we can make little headway until we can build for ourselves. some sort of theoretical structure with which to explain the condition Whether such a structure represents the. truth is not important at this moment What it must do is to give us an intellectually satisfying interpretation of. what is happening in the obese body It must also be able to withstand the onslaught of all hitherto known. clinical facts and furnish a hard background against which the results of treatment can be accurately assessed. To me this requirement seems basic and it has always been the center of my interest In dealing with obese. patients it became a habit to register and order every clinical experience as if it were an odd looking piece of a. jig saw puzzle And then as in a jig saw puzzle little clusters of fragments began to form though they seemed. to fit in nowhere As the years passed these clusters grew bigger and started to amalgamate until about sixteen. years ago a complete picture became dimly discernible This picture was and still is dotted with gaps for which. I cannot find the pieces but I do now feel that a theoretical structure is visible as a whole. With mounting experience more and more facts seemed to fit snugly into the new framework and when then a. treatment based on such speculations showed consistently satisfactory results I was sure that some practical. advance had been made regardless of whether the theoretical interpretation of these results is correct or not. The clinical results of the new treatment have been published in scientific journal and these reports have been. generally well received by the profession but the very nature of a scientific article does not permit the full. presentation of new theoretical concepts nor is there room to discuss the finer points of technique and the. reasons for observing them, During the 16 years that have elapsed since 1 first published my findings I have had many hundreds of. enquiries from research institutes doctors and patients Hitherto I could only refer those interested to my. scientific papers though I realized that these did not contain sufficient information to enable doctors to conduct. the new treatment satisfactorily Those who tried were obliged to gain their own experience through the many. trials and errors which I have long since overcome. Doctors from all over the world have come to Italy to study tire method at first hand in my clinic in the Salvator. Mutidi International Hospital in Rome For some of them the time they could spate has been too short to get a. full grasp of the technique and in any case the number of those whom I have been able to meet personally is. small compared with the many requests for further detailed information which keep coming in I have tried to. keep up with these demands by correspondence but the volume of this work has become unmanageable and. that is one excuse for writing this book, In dealing with a disorder in which the patient must take an active part in the treatment it is I believe essential. that he or she have an understanding of what is being done and why Only then can there be intelligent. cooperation between physician and patient In order to avoid writing two books one for the physician and. another for the patient a prospect which would probably have resulted in no book at all 1 have tried to meet the. requirements of both in a single book This is a rather difficult enterprise in which I may not have succeeded. The expert will grumble about longwinded while the Jay reader may occasionally have to look up an unfamiliar. word in the glossary provided for him, To make the text more readable I shall be unashamedly authoritative and avoid all the hedging and tentativeness. with which it is customarily to express new scientific concepts grown out of clinical experience and not as yet. Confirmed by clear cut laboratory experiments Thus when I make what reads like a factual statement the. professional reader may have to translate into clinical experience seems to suggest that such and such an. observation might he tentatively explained by such and such a working hypothesis requiring a vast amount of. further research before the hypothesis can be considered a valid theory If we can from the outset establish this. as a mutually accepted convention I hope to avoid being accused of speculative exuberance. THE NATURE OF OBESITY,Obesity a Disorder, As a basis for our discussion we postulate that obesity in all its many forms is due to an abnormal functioning of.
some part of the body and that every ounce of abnormally accumulated fat is always the result of the same. disorder of certain regulatory chanisms Persons suffering from this particular disorder will get fat regardless of. whether they cat excessively normally or less than normal A person who is free of the disorder will never get. fat even if he frequently overeats, Those in whom the disorder is severe will accumulate fat very rapidly those in whom it is moderate will. gradually increase in weight and those in whom it is mild may be able to keep their excess weight stationary for. long periods in all these cases a loss of weight brought about by dieting treatments with thyroid appetite. reducing drugs laxatives violent exercise massage baths is only temporary and will be rapidly regained as. soon as the reducing regimen is relaxed The reason is simply that none of these measures corrects the basic. While there are great variations in the severity of obesity we shall consider all the different forms in both sexes. and at all ages as always being due to the same disorder Variations in form would then be partly a matter of. degree partly an inherited bodily constitution and partly the result of a secondary involvement of endocrine. glands such as the pituitary the thyroid the adrenals or the sex glands On the other hand we postulate that no. deficiency of any of these glands can ever directly produce the common disorder known as obesity. If this reasoning is correct it follows that a treatment aimed at curing the disorder must be equally effective iii. both sexes at all ages and in all forms of obesity Unless this is so we are entitled to harbor grave doubts as to. whether a given treatment corrects the underlying disorder Moreover any claim that the disorder has been. corrected must be substantiated by the ability of the patient to eat normally of any food he pleases without. regaining abnormal fat after treatment Only if these conditions are fulfilled can we legitimately speak of curing. obesity rather than of reducing weight, Our problem thus presents itself as an enquiry into the localization and the nature of the disorder which leads to. obesity The history of this enquiry is a long series of high hopes and bitter disappointments. The History of Obesity, There was a time not so long ago when obesity was considered a sign of health and prosperity in man and of. beauty amorousness and fecundity in women This attitude probably dates back to Neolithic times about 8000. years ago when for the first time in the history of culture man began to own property domestic animals arable. land houses pottery and metal tools Before that with the possible exception of some races such as the. Hottentots obesity was almost non existent as it still is in all wild animals and most primitive races. Today obesity is extremely common among all civilized races because a disposition to the disorder can be. inherited Wherever abnormal fat was regarded as an asset sexual selection tended to propagate the trait It is. only in very recent times that manifest obesity has lost some of its allure though the cult of the outsize bust. always a sign of latent obesity shows that the trend still lingers on. The Significance of Regular Meals, In the early Neolithic times another change took place which may well account for the fact that today nearly all. inherited dispositions sooner or later develop into manifest obesity This change was the institution of regular. meals In pre Neolithic times man ate only when he was hungry and on1y as much as he required to still the. pangs of hunger Moreover much of his I food was raw and all of it was unrefined lie roasted his meat but lie. did not boil it as he had no pots and what little be may have grubbed Iron the earth and picked from the trees. be ate as he went along, The whole structure of man s omnivorous digestive tract is like that of an ape rat or pig adjusted to the.
continual nibbling of tidbits It is not suited to occasional gorging as is for instance the intestine of the. carnivorous cat family Thus the institution of regular meals particularly of food rendered rapidly assirni1. placed a great burden on modern man s ability to cope with large quantities of food suddenly pouring into his. system from the intestinal tract, The institution of regular meals meant that man had to eat more than his body required at the moment of eating. so as to tide him over until the next meal Food rendered easily digestible suddenly flooded his body with. nourishment of which he was in no need at the moment Somehow somewhere this surplus had to be stored. Three Kinds of Fat, In the human body we can distinguish three kinds of fat The first is the structural fat which fills the gaps. between various organs a sort of packing material Structural fat also performs such important functions as. bedding the kidneys in soft elastic tissue protecting the coronary arteries and keeping the skin smooth and taut. it also provides the springy cushion of hard fat under the bones of the feet without which we would be unable. The second type of fat is a normal reserve of fuel upon which the body can freely draw when the nutritional. income from the intestinal tract is insufficient to meet the demand Such normal reserves are localized all over. the body Fat is a substance which packs the highest caloric value into the smallest space so that normal reserves. of fuel for muscular activity and the maintenance of body temperature can be most economically stored in this. form Both these types of fat structural and reserve are normal and even if the body stocks them to capacity. this can never be called obesity, But there is a third type of fat which is entirely abnormal It is the accumulation of such fat and of such fat. only from which the overweight patient suffers This abnormal fat is also a potential reserve of fuel but unlike. the normal reserves it is not available to the body in a nutritional emergency It is so to speak locked away in a. fixed deposit and is not kept in a current account as are the normal reserves. When an obese patient tries to reduce by starving himself he will first lose his normal fat reserves When these. are exhausted he begins to burn up structural fat and only as a last resort will the body yield its abnormal. reserves though by that time the patient usually feels so weak and hungry that the diet is abandoned It is just. for this reason that obese patients complain that when they diet they lose the wrong fat They feel famished and. tired and their face becomes drawn and haggard but their belly hips thighs and upper arms show little. improvement The fat they have come to detest stays on and the fat they need to cover their bones gets less and. less Their skin wrinkles and they look old and miserable And that is one of the most frustrating and depressing. experiences a human being can have,Injustice to the Obese. When then obese patients are accused of cheating gluttony lack of will power greed and sexual complexes the. strong become indignant and decide that modern medicine is a fraud and its representatives fools while the. weak just give up the struggle in despair In either case the result is the same a further gain in weight. resignation to an abominable fate and the resolution at least to live tolerably the short span allotted to them a fig. for doctors and insurance companies, Obese patients only feel physically well as long as they are stationary or gaining weight They may feel guilty.
owing to the lethargy and indolence always associated with obesity They may feel ashamed of what they have. POUNDS AND INCHES A NEW APPROACH TO OBESITY BY A T W SIMEONS M D SALVATOR MUNDI INTERNATIONAL HOSPITAL 00152 ROME VIALE MURA GIANICOLENSI 77 FOREWORD This book discusses a new interpretation of the nature of obesity and while it does not advocate yet another fancy slimming diet it does describe a method of treatment which has grown out of theoretical considerations based on clinical

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