Dietetics for Nurses

by Fairfax T. Proudfit

OBESITY DIETS AND CURES

Banting Method.—This method is said to be unsuited to those with weak digestions. Following its use such individuals have been known to develop renal colic or gallstones; constipation may be present and the entire system may become so deranged as to render the patient liable to disease.[158]

Banting Diet for Obesity.—Breakfast at 9 A.M., consisting of 5-6 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. Coffee 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 derived 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.[159]

Oertel’s Method.—Oertel bases his dietetic treatment of obesity upon the heart changes and those which naturally follow in the circulation. He makes the following suggestions, taking always into consideration the condition of the patient, whether he is anemic or plethoric.

“(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 below the physiologic amount (1500 c.c.—3 pt.)

(b) Where there is obesity in anemic patients, viz. serious 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 symptoms 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	Fat	Carbohydrate	Calories
	Gm.	Gm.	Gm.
Minimum	156	25	75	1180
Maximum	170	45	120	1608

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 coffee 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 demonstrates his dietary régime:

Breakfast: Large cup of tea (no milk or sugar); 2 oz. bread with plenty of butter.

Dinner: Soup 4½ to 5½ 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 meat 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 suggested by the author: The carbohydrates and fats are restricted 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 beverages, 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 desired; fresh or stewed fruit with the exception of bananas, raisins, and dates, served without sugar; all green vegetables cooked or served without butter or fat of any description; salads, except potato or banana, served with a special dressing (no oil or sugar); water ices; watermelon and other melons served without sugar; 1 egg a day; gluten toast, no butter; brown bread or muffins made with gluten flour and prepared bran.

The following menus may be used as guides in the treatment 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 saccharin)
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 saccharin)
	1 slice of gluten bread or toast
7 A.M. or 1 hour before breakfast—	1 cup of water containing juice of ½ lemon
Breakfast—	½ grapefruit without sugar
	1 small cup black coffee or tea
	Beefsteak broiled and served without butter (lean)
	1 slice of gluten toast
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,[160] 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 abundance, but the protein foods such as meat, fish and eggs must be limited.[161] 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 prepared 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:

Reducing Diet for Obese Women[162]

Fuel value 1052 calories—ordinary requirements 2200 calories

Key:
A	Weight Oz.
B	Protein Calories
C	Total Calories

	Measure	A	B	C
Breakfast:
Apple	1 medium	4.9	2	65
Egg	1 egg	2.4	27	75
Toast	1 slice	0.5	7	50
Coffee[163]	1 cup
Skim milk	1½ tbs.	1.0	3	10
10:30 A.M.
Bouillon	½ cup	4.0	10	12
Water cracker	1 cracker	0.1	1	10
Luncheon:
Lean cold roast beef	Medium serving	3.5	97	150
Rye bread	2 thin slices	0.7	7	50
Lettuce and cottage cheese salad:
Lettuce	Ad libitum		40	85
Cheese	2½ tbs.
4:30 P.M.
Tea with lemon[163]	1 cup
Water cracker	1 cracker	0.1	1	10
Dinner:
Boiled cod with lemon	Large serving	8.2	209	225
Boiled potato	½ medium	1.8	6	50
Cauliflower (plain)	Large serving	3.0	6	25
Butter	1 tsp. (scant)	0.1		30
Water-cress and egg salad:
Water-cress	Ad libitum
Egg	1 egg		27	110
French dressing	½ tbs.
Orange	½ large	4.7	3	50
Black coffee	Demi-tasse
10:30 P.M.
Hot skim milk	½ cup	4.3	16	45
Total calories				1052

Author’s Reducing Diet

Approximate fuel value 965.5 calories

Key:
A	Protein Gm.
B	Carbohydrate Gm.
C	Fat Gm.
D	Calories

Material	Amount	A	B	C	D
Breakfast:
Orange	1 medium	1.5	17.4	0.3	78.3
Poached egg	1 egg	5.3		4.6	62.6
on Toast (gluten)	1 slice (1 oz.)	8.4	8.5	0.3	70.3
Coffee (black)	1 cup
					211.2
Luncheon:
Lettuce and cottage cheese salad:
Lettuce	Ad libitum
Cheese	2 tbs.	5.9	1.2	0.2	30.2
Dressing	1 tbs.	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 ⅛ cup	0.6	22.5	0.7	97.5
					385.9
Dinner:
Roast beef	2 thin slices (2 oz.)	11.4		4.8	88.8
Spinach	½ cup	2.3	3.6	0.3	26.3
Green peas	½ cup	4.8	11.1	0.2	65.4
Lettuce	Ad libitum
Tomato	1 medium	0.4	3.1	0.2	15.8
Dressing	1 tbs.	1.5		3.4	36.6
Orange jelly:
Orange juice	½ cup (8 tbs.)		14.2		56.8
Lemon juice	1 tbs.
Gelatin	1 tsp.	2.1			8.4
Water	1 tbs.
Saccharin	1 tablet or less
(gluten)	1 slice	8.4	8.5	0.3	70.3
Total grams		72.2	98.6	31.7	368.4
Total calories					965.5

Approximate fuel value 930.5 calories

Key:
A	Protein Gm.
B	Carbohydrate Gm.
C	Fat Gm.
D	Calories

Material	Amount	A	B	C	D
Breakfast:
Fruit	1 orange	0.850	12.050	0.150	53.0
Gluten toast	2 slices	17.800	17.000	0.600	140.0
Egg (poached or soft-cooked)	1 egg	5.300		4.600	60.0
Coffee (black)	1 cup
					253.0
Luncheon:
Oyster cocktail	6 oysters	3.500	4.200	0.680	37.0
Cold roast beef	1 slice (1 oz.)	5.700		2.400	44.0
Cold slaw:	½ cup
Cabbage	½ cup	0.002	0.001	0.034	4.5
Dressing	1 tbs.	1.500		3.400	36.0
Gluten toast	2 slices	17.800	17.000	0.600	140.0
					261.5
Dinner:
Chicken (without stuffing)	3 oz. one serving	18.200		2.100	92.0
Broiled mushrooms	6 medium size	1.500	3.000	0.180	19.0
String beans	3 oz. one serving	1.950	6.290	2.290	34.4
Pineapple salad:
Lettuce	Ad libitum
Pineapple	1 slice	4.000	31.000	0.600	129.5
Dressing	1 tbs.	1.500		2.400	37.0
Apple float:
1 apple	1 apple	0.600	22.200	0.770	98.1
½ egg white	½ egg white	1.500	0.020		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 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, however, that moderation is the keynote in the obesity régime 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 prescribed 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 the 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 accompaniment to an obesity diet and will help to prevent a sagging of the tissues which have been deprived of the supporting 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 likewise advisable, since they stimulate the body to burn up the fat.