Weight and see
MEDICINE JOHN ROWAN WILSON
Most men have some secret demon inside them which they find themselves condemned to fight throughout the years of their adult life—lust, envy, covetousness, religious doubts. In my case it has been adipose tissue.
In a struggle lasting over twenty years one gets to know one's enemy. I am aware by now that he is a tireless, resourceful fellow, with a natural talent for guerrilla operations. I have tried active and passive methods, crash offensives and long-term re-educational pro- grammes. I have even used smoke and drugs as a desperate attempt to obtain a decision. I know now that complete victory is impossible. The best I can hope for is a policy of con- tainment.
A sizeable proportion of the human race is affected in this way. Nobody knows why it should be that some people can eat huge amounts and never put on weight at all, while others, it seems, hardly need to get a cream bun into their mouths before the waistband begins to tighten and the scales start moving ominously upwards. Nobody knows why appe- tites vary so widely from person to person. It
has been suggested that it may be environ- mental in origin, due to differences in the training of children, but certainly this cannot
be the whole story. Dogs of the same breed, trained in the same way, can vary markedly in their attitude towards food. Some are selec- tive and moderate in what they eat—others never seem to be satisfied.
A psychological explanation has been ad- vanced, with some plausibility. Whether or not one is prepared to accept theories going back to oral gratification, sucking at the mother's breast, and so on. it is a matter of general ob- servation that some people have a tendency to eat more in times of tension and depression, turning to food as others turn to drink. They eat to forget. as it were. But only some people —others tend to go off their food. A more physiological conception is that of the so-called 'appestat.' This theory postulates that there is a central mechanism in the brain which regu- lates the appetite according to how much food a person really needs to fuel his body. If the mechanism is slightly inaccurate the indi- vidual will tend to take in too many calories and put on fat.
While there is disagreement about the cause, there is none about the potential danger of obesity. There is an impressive volume of evi- dence that obesity shortens life, predisposes towards various chronic diseases of the heart, lungs and joints, and greatly increases the risk of operations. It is also, of course, uncom- fortable and unsivhtly. The question is—what does one do about it?
The first thing to be clear about is that there is no real answer apart from the reduc- tion of calories in the diet. The reason one has to emphasise this fact is that so many people find it difficult to accept its implications in practice. When it is explained to them that they are fat because they have been eating too much they are prone to swear that they eat practically nothing—'no more than a bird, doctor.' If they fail to lose weight on a 1,000- calorie regime they indignantly repudiate any suggestion that they are failing to keep to the
diet. One physician grew so tired of this argu- ment that he asked a number of these patients to put down on paper all the things they ate each day. Then he took them into hospital and fed them on precisely that. They com- plained that he was starving them.
Everyone loses weight if the calories are re- duced enough—there were no fat men in Belsen. Weight loss is, however, usually irregu- lar. The usual pattern is a very gratifying loss, of perhaps as much as live pounds, in the first week of dieting. The patient is cock-a-hoop. Then, in the next week, he keeps to the same vying regime and is hungry all the time. yet he loses hardly any weight at all. If he persists he will find that he begins to get results again round about the third week, but very often he becomes discouraged and weakens. Gradually, the diet goes by the board. Then one day, to his horror, that first five pounds has come back again, as quickly as it went.
Aids to will-power are available in the forms of certain drugs, such as amphetamine, which reduce appetite. But there is a risk of un- pleasant side-effects and the reduction of appe- tite is temporary--drugs do not attack the long-term problem. Nor do the patent foods which arc sold in enormous quantities as aids to slimming. There is no fundamental advan- tage in taking your 300 calories at lunch-time in the form of a biscuit which tastes like com- pressed sawdust, instead of a chunk of lean beef with a green salad. There are, unhappily, no short cuts to the solution of this problem. It is possible for any overweight person to take off up to a stone in a couple of months, if he goes at it with determination. That's the easy part. The difficult part is to maintain the weight loss. This means the acceptance of a less self-indulgent diet on a permanent basis. How- ever, the diet needn't be too dreary, since it is really only sugar and starch which cause the trouble. You can eat plenty of protein and fat, bacon and eggs, steak, cheese, as well as fruit, salad and farm vegetables. But sugar, jam, cakes, potatoes and nice thick chunks of bread are out for you.
You may get fairly well adjusted to this modified food intake, though it would be rash to think you will easily get over the desire for fattening foods. Is it ever lost? The only answer I can give is that of the French courtesan who was asked in her seventies at what age one became free from the torment of sexual desire. She said she didn't know.