M. Dujardin Beaumetz, who professes to have given most close and careful study and attention to regimen for the obese, outlines the following, provided there is no evidence of fatty degeneration of heart.
Breakfast (at 8 a. m.)--Three-fourths of an ounce of bread "en flute"--that is abounding with crust; one and a half ounces of cold meat, ham or beef, six ounces weak black tea, sans sugar.
Lunch (at 1 p.m.)--An ounce and a half to two ounces of bread, or a ragout, or two eggs; three ounces green vegetables; one-half ounce of cheese; fruits at discretion.
Dinner (at 7 p.m.)--An ounce and a half to two ounces of bread; three to four ounces of meat, or ragout; ditto of green vegetables, salad, half an ounce of cheese, fruit ad libitum.
At meal times the patient may take only a "glass and a half" of liquid--approximately ten ounces--though a greater amount may be permitted if he abstains during the intervals.
Special alimentary regimen, however, does not constitute the sole treatment of obesity. Concurrently must be employed a number of practical adjuvants which are oftentimes of the utmost assistance. For one thing, exercise is indispensable; all authorities agree on this point. The exercise taken in the gymnasium is one of the best, notably the "wall exercise," which is more particularly suited to those afflicted with pendulous and protuberant abdomens as the result of feebleness of the hypogastric muscles, to accumulation of fat under the skin and in the omentum, and to dilation of the stomach and intestines. In the "wall exercise," the patient stands erect against an absolutely straight and plumb wall, lifts his hands (carrying a weight) straight over the head, and causes them to describe a semicircle forward. Zantz particularly insists upon arm and leg exercise for the obese, especially the former, since with the same amount of effort a larger amount of oxygen is consumed than is possible by the latter.
However, of whatever character, the exercise should be continued to the point of fatigue or dyspn#oelig;a--three thousand movements daily, gradually increased to twenty-five thousand, if the system can bear it; and under such conditions, not only is there consumption of hydrocarbons, but there is provided a veritable greed for air that augments waste. The experiments of Oertel indicate that loss of weight due to fatiguing exercise arises more particularly from dehydration, which is made good by absorption of the fluids employed as beverage; the fluids are claimed by Germain See to act as accelerants of oxidation.
During exercise there is obviously more abundant absorption of oxygen, and consequently greater elimination of carbonic acid, and as a consequence (as shown by researches of Voit), the reserve fat of the economy is attacked and diminished; in intense labor there is an average hourly consumption of about 8.2 percent. of fat. Further physical activity is useful in exercising the voluntary muscles, and thus opposing the invasion by interstitial fat of the muscle fibrils. Extreme exercise also, to a certain degree, exerts a favorable influence on the cardiac muscle, augmenting both its nutrition and its capacity for labor. With the anæmic obese, however, it is necessary to be most circumspect in prescribing forced exercise; also with the elderly obese possessed of enfeebled or fatty heart.
Hydrotherapy, especially in the form of cold douches, particularly when combined with massage, is often of considerable value in relieving obesity; the method of Harmman, of St. Germain, which has in many instances induced rapid loss of adipose, is of this class. Tepid saline baths and vapor baths have many advocates, and may afford material aid when the heart and circulation do not inhibit their employment. Hot baths elevate the temperature of the body and increase the organic exchanges, hence, as Bert and Reynard have pointed out, tend to the elimination of oxygen and carbonic acid; but when employed, the patient should be introduced while the temperature is below 130° F., when it may be gradually raised in the course of thirty or forty minutes to 140° F.
It has already been intimated, the chief feature of the treatment of obesity is acceleration of the exchanges; and this is in the main true, though it must also be borne in mind that, while there are obese who excrete little urea and have a depressed central nervous temperature, many may be azoturic, and besides eliminate phosphate in excess, when an oxidating treatment will not only fail, but prove positively injurious.