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
eat 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, or 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 disorder.
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 in 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 too still the pangs of
hunger. Moreover, much of his food was raw and all of it was unrefined. He roasted his meat, but he did not boil it,
as he had no pots, and what little he may have grubbed from the Earth and picked from the trees, he 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, 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.
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