Obesity, or CORPULENCE, may be defined to be 'an accumulation of fat under the integuments or in the abdomen, or in both situations, to such an amount as to embarrass the several voluntary functions.' A certain degree of fatness is not only quite compatible with health, but, as has been shown in the article FATS, the fatty tissue is of considerable use in the animal body, partly in consequence of its physical and partly in consequence of its chemical properties; and it is only when the fatness begins to interfere with the discharge of any of the vital powers that it can be regarded as a morbid condition. Obesity may occur at any period of life, but it is most commonly after the fortieth year that the tendency to an inordinate accumulation of fat begins to show itself. After that time, in the case of men the pleasures of the table are usually more attractive than in earlier life, and much less muscular exercise is taken; while in women the cessation of the power of child-bearing induces changes which tend remarkably to the deposition of fat. The extent to which fat may accumulate in the human body is enormous. Daniel Lambert (1770-1809) weighed 739 lb.; his exact height is not recorded, but, according to the investigations of the late Dr Hutchinson (the inventor of the spirometer), the normal weight of a man 6 feet high should not exceed 178 lb. Dr Elliotson has recorded the case of a female child, a year old, who weighed 60 lb.
The predisposing causes of obesity are a peculiar habit of body, hereditarily transmitted; inactivity; sedentary occupations, &c.; while the more immediate or exciting causes are a rich diet, including fatty matters, and matters convertible in the body into fats, such as saccharine and starchy foods, and the partaking of such a diet to a greater extent than is necessary for balancing the daily waste of the tissues. 'Fat meats, butter, oily vegetable substances, milk, saccharine and farinaceous substances are the most fattening articles of food; whilst malt liquors, particularly rich and sweet ale, are, of all beverages, the most conducive in promoting obesity. The fattening effect of figs and grapes, and of the sugar-cane, upon the natives of the countries where these are abundant, is well known. In various countries in Africa and the East, where obesity is much admired in females, warm baths, indolence, and living upon saccharine and farinaceous articles, upon dates, the nuts from which palm-oil is obtained, and upon various oily seeds are the means usually employed to produce this effect' (Copland's Dictionary). The knowledge of the means of inducing obesity affords us the best clue to the rational treatment of this affection. It is a popular belief that the administration of acids—vinegar, for example, or one of the mineral acids—will check the deposition of fat; but if the desired effect is produced it is only at the cost of serious injury to the digestive, and often to the urinary organs. The employment of soap and alkalies, as advocated a century ago by Flemmyng, is less objectionable than that of acids, but the prolonged use even of these is usually prejudicial. The efficacy of one of our commonest seaweeds, sea-wrack (Fucus vesiculosus), in this affection has also been strongly advocated. It is prescribed in the form of an extract, and its value is probably dependent on the iodine contained in it.
A very interesting Letter on Corpulence, published in 1863 by Mr William Banting (1797-1878), in which he records the effect of diet in his own case, after all medicinal treatment had failed, is well worthy of the attention of those who are suffering from the affection of which this article treats. The following are the leading points in his case. He was sixty-six years of age, about 5 feet 5 inches in stature (and therefore, according to Dr Hutchinson's calculations, ought to have weighed about 142 lb.), and in August 1862 weighed 202 lb. 'Few men,' he observes, 'have led a more active life . . . so that my corpulence and subsequent obesity were not through neglect of necessary bodily activity, nor from excessive eating, drinking, or self-indulgence of any kind, except that I partook of the simple aliments of bread, milk, butter, beer, sugar, and potatoes, more freely than my aged nature required. . . . I could not stoop to tie my shoe, nor attend to the little offices humanity requires without considerable pain and difficulty; I have been compelled to go downstairs slowly backwards, to save the jar of increased weight upon the ankle and knee joints, and been obliged to puff and blow with every slight exertion.'
By the advice of a medical friend he adopted the following plan of diet: 'For breakfast I take four or five ounces of beef, mutton, kidneys, broiled fish, bacon, or cold meat of any kind except pork; a large cup of tea (without milk or sugar), a little biscuit, or one ounce of dry toast. For dinner, five or six ounces of any fish except salmon, any meat except pork, any vegetable except potato, one ounce of dry toast, fruit out of a pudding, any kind of poultry or game, and two or three glasses of good claret, sherry, or Madeira: champagne, port, or beer forbidden. For tea, two or three ounces of fruit, a rusk or two, and a cup of tea without milk or sugar. For supper, three or four ounces of meat or fish, similar to dinner, with a glass or two of claret' (p. 18). 'I breakfast between eight and nine o'clock, dine between one and two, take my slight tea meal between five and six, and sup at nine' (p. 40). Under this treatment he lost in little more than a year (between the 26th of August 1862 and the 12th of September 1863) 46 lb. of his bodily weight, while his girth round the waist was reduced 12½ inches. He reported himself as restored to health, as able to walk up and down stairs like other men; to stoop with ease and freedom; and safely to leave off knee-bandages, which he had necessarily worn for twenty years past. He made his own case widely known by the circulation of his pamphlet (which has passed through several editions), and 'numerous reports sent with thanks by strangers as well as friends' show that 'the system is a great success;' and that it is so we do not doubt, for it is based on sound physiological principles. Other more or less similar systems have since been recommended; one, with two successful cases, is recorded in the Edinburgh Medical Journal for December 1890. Such a radical change of diet, however, should not be adopted without medical advice, as in some cases it might cause disturbance of digestion or excretion, and lead to new dangers to health. See FASTING, TRAINING.