OBESITY DIETS AND CURES
Banting Method. — This method is said to be unsuited
to those with weak digestions. Following its use such in-
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GOUT, OBESITY, EMACIATION 427
dividuals have been known to develop renal colic or gall-
stones; constipation may be present and the entire system
may become so deranged as to render the patient liable to
disease.^
Banting Diet for Obesity. — Breakfast at 9 a.m., con-
sisting of 5-^ ounces of animal food, meat or boiled fish
(except pork or veal), 1 small biscuit or 1 ounce dry toast.
Total solids, 5-6 ounces. Coflfee or tea (without milk or
sugar), 9 ounces.
2 P.M. — Dinner: Fish or meat (salmon, eels, herring,
pork, and veal excepted), poultry or game; any vegetable
except potatoes, parsnips, carrots, turnips, or beet roots; dry
toast, 1 ounce; fruit cooked and unsweetened; good claret,
sherry, or Madeira, 10 ounces. Total solids, 10-12 ounces.
6 P.M. — Tea: 2-3 ounces cooked fruit; 1-2 ounces
rusks; 2-4 ounces solids; 9 ounces tea, without milk or sugar.
7 P.M. — Supper: Meat or fish as at dinner; claret or
sherry and water, 7 ounces.
Total daily solids, 21-27 ounces.
Total fluids, 35 ounces.
Oertel pointed out the great benefits which might be de-
rived by those individuals suffering from certain types of
heart disease which are accompanied by obesity. He made
it distinctly understood that while the treatment in no
way affected the heart lesion, — that is, in so far as altering
the character of the disease, — it greatly reduced the work
imposed upon the circulatory organ and permitted a more
complete oxidation of the blood.*
OerteFs Method. — Owtel bases his dietetic treatment
of obesity upon the heart changes and those which naturally
follow in the circulation. He makes the following sugges-
tions, taking always into consideration the condition of the
patient, whether he is anemic or plethoric.
' ''Diet in Health and Disease," by Fr^idenwald and Ruhrab.
*/6id., p. 544, ^
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DIETETICS FOR NURSES
" (a) Where there is an abnormally increased amount of
fat in plethoric patients with unimpaired or only beginning
changes in the heart action, the diet should aim at:
(1) An increased supply of protein.
(2) A decrease in the fat-forming substances.
(3) Little or no diminution in the supply of liquids be-
low the physiologic amount (1500 c.c.-3 pt.)
(6) Where there is obesity in anemic patients, viz. seri-
ous plethora, the diet should aim at:
(1) An increase in the quantity of proteins.
(2) A diminution in amount of fat-forming substances
and eventually
(3) A decrease in the amount of fluid.
(c) Where there is obesity in adults with anemic symp-
toms in whom not only the amount of protein but also the
abnormally increased amount of fat is slowly wasting away,
they require:
(1) An increase in the amount of protein taken.
(2) A sufficient amount of fat and carbohydrates or
even an increase of same to prevent the falling off of fat.
(3) A diminution in the amount of fluid taken."
Oertel claims that the simplest method of reducing the
fat-forming elements in a diet is to decrease the amount of
fat and allow a certain amount of carbohydrates, regulating
the diet according to the individual. The following table is
given by him as showing the minimum and maximum
amount of the different food constituents constituting the
obesity diet:
Protein
Om.
Fat
Om.
Carbo-
hydrate
Om.
Calories
Minimum . . .
Maximum . • .
156
170
25
45
75
120
1180
1608
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GOUT, OBESITY, EMACIATION 429
In instituting a treatment for obesity Oertel insists upon
a certain amount of exercise daily in the open air, the
amount to be regulated by the physician according to the
individual case. He suggests that five or six small meals a
day be given rather than a few large meals. He eliminates
soups, tea, and coflfee while the cure is being given.
Ebstein suggests a diet in which the carbohydrates and
fluids are reduced but in which the fats are allowed to a
considerable extent. The diet consists of meat, eggs, fish,
vegetables (green) and fruits. The following menu (dem-
onstrates his dietary regime:
Breakfast: Large cup of tea (no milk or sugar); 2 02.
bread with plenty of butter.
Dinner: Soup 4V^ to 5% oz.; meat with fat sauce; green
vegetables; fresh fruit; 2-3 glasses light wine.
Afternoon : Tea as at breakfast.
Supper: Tea, 1 egg, fat roast mfeat or ham, smoked fish;
about 1 oz. bread with plenty of butter; a little cheese and
fresh fruit; potatoes, sweets and sugars forbidden.
Dietetic Treatment. — The following menus are sug-
gested by the author: The carbohydrates and fats are re-
stricted and the fluids reduced to a minimum. The meals
as far as possible are kept " dry " ; soups, milk, cocoa are
avoided; water is not permitted at meals; alcoholic bever-
ages, white bread, butter, potatoes, sugar, candy, pastry,
cakes, puddings, gravies, sauces, bread dressings, griddle
cakes, sirups, molasses, honey, ice cream, cereals, pork of
all sorts, ham, bacon pork chops, etc., olive oil, spaghetti,
macaroni, and noodles are prohibited.
Allowable Foods. — The following foods are allowed:
Black coffee or tea, small cup twice daily without milk,
cream, or sugar — saccharin may be used to sweeten if de-
sired ; fresh or stewed fruit with the exception of bananas,
raisins, and dates, served without sugar; aU green vegetables
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430 DIETETICS FOR NURSES
cooked or served without butter or fat of any description ;
salads, except potato or banana, served with a special dress-
ing (no oil or sugar); water ices; watermelon and other
melons served without sugar; 1 egg a day; gluten toast, no
butter; brown bread or muflins made with gluten flour and
prepared bran.
The following menus may be used as guides in the treat-
ment of obesity:
Breakfast — 1 sliced orange (no sugar)
1 small cup coffee or tea without cream, milk,
or sugar (sweeten with saccharin if desired)
1 poached egg on
1 slice of gluten toast (no butter)
Lunch — Cottage cheese and lettuce salad with special
dressing
2 broiled lamb chops.
1 slice gluten bread; 3 ounces (1 serving) apple
sauce (sweetened if necessary with sac-
charin)
Dinner — Roast beef
Spinach or greens (cooked without fat meat)
Green peas
Tomato and lettuce salad with special dressing
Orange or wine jelly (sweetened with sac-
charin)
1 slice of gluten bread or toast
7 A.M. or 1 hour before breakfast — 1 cup of water con-
taining juice of y^ lenion
Breakfast — V^ grapefruit without sugar
1 small cup black coffee or tea
Beefsteak broiled and served without butter
(lean)
1 slice of gluten toast
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GOUT, OBESITY, EMACIATION 431
Lunch — Tuna fish salad (no olive oil in dressing)
1 bran muffin or 1 slice (1 oz.) gluten toast
1 baked apple (without cream or sugar)
Dinner — Roast or boiled chicken (no gravy or bread
dressing)
Green vegetables (peas, string beans, cabbage,*
turnips, artichokes (without butter).
Fruit salad (special dressing)
Lemon ice
Amount of Food. — The amount of food is limited to a
certain extent. Green vegetables may be eaten in abun-
dance, but the protein foods such as meat, fish and eggs
must be limited.* The bread (even gluten and bran breads)
must be limited to 1-2 slices at each meal. All meals are
eaten without fluids except breakfast, when one small cup
of coffee or tea without milk, cream, or sugar is allowed.
If fruit juice is to be served instead of fruit, it must be pre-
pared with little if any water and no sugar. The juice may
be poured over cracked ice, if desired.
The following reducing diet is suggested by Dr. Rose
for the use of over-fat women:
* Boiled vegetable dinners must be prepared without fat meat and
potatoes.
* Scientific investigation has proved that both carbohydrates and fats
may be formed in the body from protein. Hence any excess above that
required to keep the bodv in nitrogen equilibrium is utilised by the
organism for fuel or stored as fat.
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DIETETICS FOR NURSES
Beducinq Diet for Obese Women'
Fuel value 1062 calories — ordinary requirements 2200 calories
Measure
Weight
Oz.
Protein
Calories
Total
Calories
Breakfast:
Apple . .
Egg . .
Toast . .
Coffee'
Skim milk
10:30 a.m.
Bouillon . .
Water cracker
Luncheon :
Lean cold roast beef
Bye bread ....
Lettuce and cottage
cheese salad :
Lettuce .
Oneese • • •
4:30 P.M.
Tea with lemon* .
Water cracker
Dinner :
Boiled cod with lemon
Boiled potato .
Cauliflower (plain) .
Butter
Watercress and egg
salad :
Watercress
Egg . .
French dressing
Orange . .
Black coffee •
10:30 P.M.
Hot skim milk
Total calories
1 medium
legg
1 slice
Icup
n tbs.
J cup
1 cracker
Medium serving
2 thin slices
Ad libitum
2i tbs.
icup
1 cracker
Large serving
i medium
Large serving
1 tsp. (scant)
Ad libitum
legg
itbs.
i large
Demi-tasse
icup
4.9
2.4
0.5
1.0
4.0
0.1
3.5
0.7
0.1
8.2
1.8
3.0
0.1
4.7
4.3
27
7
10
1
97
7
40
209
6
6
27
16
65
75
50
10
12
10
150
50
85
10
225
50
25
30
110
50
45
1052
'"Feeding the Family," p. 84, by Mary Swarta Rose.
"Saccharin may be used to sweeten.
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GOUT, OBESITY, EMACIATION
433
Author's Beducino Diet
Approximate fuel value 966.6
Material
Amount
Protein
Om.
Carbo-
hydrate
Gm.
Fat
Gm.
Calories
Breakfast :
Orange . . .
1 medium
1.5
17.4
0.3
78.8
Poached egg . .
legg
5.3
4.6
62.6
on
Toast (gluten) .
1 slice (1
(oz.)
8.4
8.5
0.3
70.3
CofFee (black) .
Icup
211.2
Luncheon :
Lettuce and cot-
tage cheese salad:
Lettuce . . .
Ad libitum
Cheese . . .
2tbs.
5.9
1.2
0.2
30.2
Dressing . .
Itbs.
1.5
3.4
36.6
Lamb chop . .
1 chop
9.2
12.7
151.3
Gluten bread or
toast . . .
1 slice
8.9
8.5
0.3
70.3
Apple sauce . .
1 serving,
about 1
cup
0.6
22.5
.7
97.5
385.9
Dinner:
Roast beef . .
2 thin slices
(2oz.)
11.4
4.8
88.8
Spinach . . .
icup
2.3
3.6
0.3
26.3
Green peas . .
icup
4.8
11.1
0.2
65.4
Lettuce . . .
Ad libitum
Tomato . . .
1 medium
0.4
3.1
0.2
15.8
Dressing . . .
Itbs.
1.5
3.4
36.6
Orange jelly:
Orange juice .
i cup (8
tbs.)
14.2
56.8
Lemon juice .
Itbs.
Gelatin . . .
Itsp.
2.1
8.4
Water . . .
Itbs.
Saccharin . .
1 tablet or
less
Bread (gluten) .
1 slice
8.4
72.2
8.5
98.6
0.3
31.7
70.3
Total grams . .
868.4
Total calories . .
905.5
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DIETETICS FOR NURSES
Author's Beducing Diet — Continued
Approximate fuel value 9S0.6
Material
Amount
Protein
Om.
Carbo-
hydrate
Om.
Fat
Om.
Calories
Breakfast:
Fruit ....
1 orange
0.85
12.05
0.15
53.0
Gluten toast .
2 slices
17.8
17.0
0.6
140.0
^Sg (poached or
soft cooked)
legg
5.3
4.6
60.0
CofFee ....
1 cup
253.0
Luncheon :
Oyster cocktail .
6 oysters
3.5
4.20
0.68
37.0
Cold roast beef .
1 slice (1
oz.)
6.7
2.4
44.0
Cold slaw:
icup
Cabbage . .
icup
0.002
0.001
0.034
4.5
Dressing . .
Itbs.
1.5
3.4
36.0
Gluten toast . .
2 slices
17.8
17.0
0.6
140.0
261.5
Dinner :
Chicken (without
stuffing) . .
3 oz. one
serving
18.2
2.1
92.0
Broiled mushrooms
6 medium
size
1.5
3.0
0.18
19.0
String beans . .
3 oz. one
serving
1.95
6.29
2.29
34.4
Pineapple salad:
Lettuce . . .
Ad libitum
Pineapple . .
1 slice
4.0
31.0
0.6
129.5
Dressing
Itbs.
1.5
2.4
37.0
Apple float:
1 apple . .
1 apple
0.6
22.2
0.77
98.1
i egg white . .
i egg white
1.5
0.02
6.0
Saccharin to
sweeten
Total grams . .
416.0
Total calories . .
930.5
Rules and Regulations. — The following directions and
menus are given to be used when a reduction in weight is
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GOUT, OBESITY, EMACIATION 435
necessary. Care must be taken not to allow large amounts
of even the non-fat-forming foods in the dietary, since under
certain conditions the body will manufacture adipose tissue
of any surplus organic material ingested. Breakfast must
be limited as demonstrated in the tabulated diet sheet.
Keeping the Weight Down. — After the individual has
been reduced to approximately the desired weight the diet
may be made a trifle more liberal, keeping in mind, how-
ever, that moderation is the keynote in the obesity regime
and will have to be practised to a certain extent always. It
is wise to continue the dry meals and to limit the amount
of butter, cream, and other "fatty foods," to a certain
extent. Pork, with the exception of crisp bacon several
times a week at breakfast, had best be avoided, and alcoholic
beverages should be omitted entirely except when pre-
scribed by the physician. The outdoor exercise should be
continued and only the amount of sleep requisite to health
indulged in. If the individual will faithfully carry out
these directions, there is no reason why tiie weight should
continue to be a burden. It must be remembered that it
is never safe to diet indiscriminately and without the advice
of a physician, since much harm may come of so doing.
Value of Massage. — Massage is an advisable accom-
paniment to an obesity diet and will help to prevent a sag-
ging of the tissues which have been deprived of the support-
ting fat. The tissues of the face, neck, and breast are
especially apt to wrinkle unless given the exercise and
stimulation from massage. Cold baths are hkewise advis-
able, since they stimulate the body to bum up the fat.
OBESITY MENUS
Lunch — Tuna fish salad
Cauliflower
Baked apple
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436 DIETETICS FOR NURSES
Dinner — Sofl^shell crabs
Roast lamb
Spinach
Tomato jelly
Grapefruit
Lunch — Corned beef and cabbage
Stewed pears
Dinner — Clam cocktail
Roast chicken
Asparagus
Fruit salad
Lunch — Broiled oysters; cold lamb
Boiled turnips
Water-cress salad
Dinner — Roast-beef
Stewed tomatoes
String beans
Lettuce and tomato salad
Sliced peaches
Lunch — Broiled calves' liver
Greens (mustard, turnip, beet tops, or dande-
lion)
Orange jelly
Dinner — Crab-flake cocktail
Broiled squab
Artichokes
Stewed celery
Lettuce, Russian dressing
Lunch — Kippered herring
Veal croquettes (baked instead of fried, with
tomato sauce; this dressing is made by add-
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GOUT, OBESITY, EMACIATION 437
ing 1 teaspoonful of cshili sauce to the r^-
ular dressing used in obesity diets)
Asparagus
Apple sauce
Dinner — Baked halibut steak, stuflFed with ojrsters
Boiled onions
Boiled carrots
Pineapple and grapefruit salad
Lunch — Broiled calves' brains
Vegetable salad
Melon
Dinner — Broiled chicken
Boiled beets
String beans
Cucumber and young onion salad
Raspberry ice
Lunch — Stuffed ^gs
Sliced tongue with spinach or greens
Carrots or beets
Fruit
Dinner — Roast turkey, cranberry sauce
Cauliflower
Tomatoes stuflFed with celery, green peppers
and onion dressing
Peach whip
Lunch — Hashed beef
Boiled onions
Stewed prunes
Dinner — Oysters
Baked rabbit
Eggplant (baked)
Spinach
Fruit jelly
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438 DIETETICS FOR NURSES
EMACIATION
Emaciation as a rule is a sjonptom of an abnormal con-
dition rather than a disease in itself. Certain individuals
are said to be "constitutionally thin" and upon investiga-
tion it is often found that this thinness extends back in
many cases for generations, many members of a family
being thin no matter what measures are taken to overcome
the condition. However, constitutional emaciation is not so
prevalent as constitutional obesity and, as has already been
stated, is more often a symptom of some metabolic disturb-
ance or pathological condition.
Causes of Emaciation. — Errors in diet — insufficient
or improper food — are accountable for most of the cases
seen in infants and children. Over-exercise, that is, when
the amount of exercise taken is not commensurate with the
intake of food, is accountable for other cases. This type of
emaciation is found especially in growing children.
Disease as a Cause. — Wasting diseases, such as tuber-
culosis and anemia, bring about a loss of weight, while in
fevers in general and tj^jhoid fever especially not only the
febrile condition hastens the metabolic processes but also
the activities of the bacteria act together and break down
the tissues of the body, causing a falhng off from the nor-
mal body weight. Loss of sleep, unhygienic or unsanitary
surroundings, and capricious appetites probably cause some
of the cases of excessive thinness.
Thinness in Children. — Parents are to blame for much
of the thinness seen in children, especially the nervous high-
strung children whose energies outweigh their desire for
food or, as is more often the case, tiieir willingness to eat
the proper foods. It is a mistaken kindness to cater to the
whims and fancies of a child's appetite, and much harm is
wrought by allowing the "trash" to overbalance the neces-
sary building or repair food in the dietary. Not that sugar
is not necessary, for it is particularly so at the age when
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GOUT, OBESITY, EMACIATION 439
the metabolic processes are faster tiian later in life, but it
must be remembered that the body is being built up both
in height and breadth.
The Need for Building Foods. — The skeleton and the
muscular tissues cannot be constructed from sugar, hence
the diet which consists chiefly of this food constituent is
unbalanced and will sooner or later bring about disturb-
ances which are very apt to result in emaciation. The
causes of emaciation may be summarized as follows:
(1) Those cases which are due to pathological conditions
such as tuberculosis, anemia, typhoid fever, etc.;
(2) Those induced by errors in diet and bad habits
such as insufficient or improper food, loss of sleep, over-
exercise, lack of ventilation in the sleeping apartment,
which destroys the appetite;
(3) Malformation or deformities of mouth, throat, or
stomach which make it impossible for the individual to
partake of sufficient food to cover the needs of the body;
(4) Heredity ("constitutional thinness'').
Regulating the Diet. — As has been stated in a former
chapter, any persistent loss of weight or failure to gain on
the part of an infant whose chief business in life should be
to grow, should be given immediate and careful attention.
As a rule the diet is to blame; it is either improperly bal-
anced, insufficient in amount, or poorly prepared, any of
which might readily cause a disturbance to the delicate
apparatus of the child.
Diet and Habits. — In adults, the diet and habits of
life are in many cases to blame for the excessive thinness
seen in many individuals. If the trouble can be traced to
some abnormal condition, it can only be removed by reliev-
ing or checking the disease which induced it. The older
methods of treating typhoid fever, for example, did nothing
to prevent the progressive emaciation which was the result
not only of the accelerated metabolism from the fever but
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440 DIETETICS FOR NURSES
also from the invasion of the intestinal tract by the specific
bacteria which brou^t about a like result. In tuberculosis
a similar breaking down of the tissues occurs, as is likewise
the case in anemia and other diseases in which the functions
of the blood-making organs are interfered with. Any of the
above diseases may cause emaciation, and the treatment
in most of the cases resolves itself in removing the cause as
far as possible and in adjusting the diet.
Selection of Food. — The dietetic treatment for emacia-
tion is practically the only one which will materially change
the weight of the individual, since by food alone is the
body built. Certain foods are more capable of being readily
converted into adipose tissue than others, and these must
have a prominent place in the dietary.
Rules and Regulations. — In obesity it was found that
it was necessary to curtail the sleep and rest, increase the
amount of exercise and decrease the amount of food. In
emaciation practically an opposite regime is adopted. The
patient is urged to eat plenteously, drink copiously of
water and nutrient beverages, soup, etc., avoid worry and
excitement, over-exertion and indigestion, to take one or
two naps every day, to retire early, to avoid hot baths and
take a warm cleansing bath followed by a cold shower or
sponge bath. Exercise must be of a mild character; the
patient must be warned against becoming exhausted, since
this condition precludes a gain in weight.
Dietetic Treatment. — The meals must be carefully se-
lected, well prepared and daintily served, that all of the
psychical benefits from such efforts may be attained. A
nutrient beverage such as cream, egg, and vichy, reen-
forced fruit beverages, malted milk, with egg and chocolate,
cereal and milk gruels, etc., may be given between breakfast
and lunch, lunch and dinner and before retiring. The meals
must consist of the simplest foods that the digestion may
not be overtaxed by the quantity ingested.
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GOUT, OBESITY, EMACIATION 441
Allowable Foods. — The following foods may be used
in the treatment of emaciation: All dairy products, milk,
cream, butter and cheese, eggs cooked in various ways,
soups of all kinds, meats in moderation, vegetables, espe-
cially potatoes, olive oil, and the various salad oils, cereals,
tapioca, macaroni, spa^etti, noodles, rice, bread of every
description, fruit including bananas, grapes, dates, raisins,
prunes, etc., ice creams, farinaceous puddings, sauces, ex-
cept those containing vinegar, grape juice and other fruit
juices sweetened with sugar, cocoa and chocolate, malted
milk and proprietary infant foods, honey, molasses and
sirups, cakes, cookies and pastry in moderation. It is ad-
visable to make milk the chief fluid food ; to this is added
cream, malted milk, lactose, ^gs, and other reenforcing
agents.
Milk Cure. — Certain physicians advise milk alone, giv-
ing from one to two gallons a day for three weeks or longer.
Many individuals complain that "milk makes them bilious"
but, as a rule, this is because the amount taken is small and
the solids insufficient to lend the necessary bulk to the
feces, consequently the peristaltic action becomes sluggish
and the passage of the food mass delayed in the intestinal
tract, furnishing a medium for bacterial growth and activity.
When larger quantities are ingested such is not the case
and the fluid so high in nutrient qualities is utilized by the
body for the building up of the depleted tissues. When
the emaciation is the result of disease the diet is necessarily
adjusted to meet the condition. At times it is most difficult
to overcome the anemia and accompanying emaxjip^tion on
account of the disease precluding the giving of" the foods
especially designed by nature to produce flesh. This is
especially the case in the progressive emaciation in dia-
betes. However, in this case the Allen starvation treatment,
with. the. reeducation of the organs to a toleration for carr
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442
DIETETICS FOR NURSES
bohydrates, has gone far toward overcoming this distressing
condition.
Readjusting the Habits. — When the loss of wei^t is
found to be the result of close application to work, lack of
fresh air and sleep, or from errors in diet, a change of cli-
mate and occupation should be made, together with a read-
justment of the daily habits, such as substituting a cool
bath for the regular hot one, and sleeping out of doors or