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What Makes SOME people Fat? PDF Print E-mail

From Eat Fat And Grow Slim by Richard MacKarness, M.B., B.S (1958)

People can be divided into two groups according to the way they deal with the excess food when they eat more than they require for their daily expenditure of energy.

In 1950 at the Royal Society of Medicine in London, Professor Sir Charles Dodds, who is in charge of the Courtauld Institute of Biochemistry at the Middlesex Hospital, described an experiment he had carried out.

He took people whose weights had been constant for many years and persuaded them to eat double or treble their normal amount of food. They did not put on weight.

He showed that this was not due to a failure to digest or assimilate the extra food and suggested that they responded to over-eating by increasing their metabolic rate (rate of food using) and thus burned up the extra calories.

He then over-fed people whose weights had not remained constant in the past and found that they showed no increase in metabolism but became fat.

So two people of the same size, doing the same work and eating the same food will react quite differently when they overeat. One will stay the same weight and the other will gain.

We all know that this is true even without scientific proof and yet the fact has not been taken into account or explained by any of the experts who write popular books and articles about slimming.
They write as though fat people and thin people deal with food in the same way.

Here is the medical correspondent of The Times (11th March, 1957) On the subject:

" It is no use saying as so many women do 'But I eat practically nothing.' The only answer to this is: No matter how little you imagine you eat, if you wish to lose weight you must eat less.' Your reserves of fat are then called on to provide the necessary energy—and you lose weight."

The doctor who wrote these rather heartless words may fairly be taken as representative of medical opinion to-day. He is applying the teachings of William Wadd, Surgeon Extraordinary to the Prince Regent, who in 1829 attributed obesity to "an over-indulgence at the table" and gave, as the first principle of treatment, "taking food that has little nutrition in it."

Fat people can certainly lose weight by this method but what do they feel like while they are doing it? Terrible!

Ask any fat person who has tried it. Many of these unfortunate people really do eat less than people of normal proportions and still they put on weight, and when they go on a strict low-calorie diet which does get weight off, they feel tired and irritable because they are subjecting themselves to starvation. Worse still, when they have reduced and feel they can eat a little more, up shoots their weight again in no time, on quite a moderate food intake.

It is all most discouraging. "Surely there must be some better way of going about it," they say. This book explains that there is. To-day a lot more is known about how fat people get fat and why. Many of the facts have been known for years, but because they have not fitted in with current theories on obesity, they have been ignored.

In the last ten years, however, atomic research has given the physiologist enormous help in unravelling the biochemical reactions which go on in the body.
Radio-active isotopes have been used to " tag " chemical substances so that their progress through the body could be followed, in the same way as birds are tagged in order to establish the paths of their migration.

By this means, details of the metabolism of fats and carbohydrates, previously shrouded in mystery, have been clarified and with the new information so gained old experimental findings have been given new interpretations and the jigsaw of seemingly contradictory facts about obesity has clicked into a recognisable picture.

The first thing to realise is that it is carbohydrate (starch and sugar) and carbohydrate only which fattens fat people.


Here is what happens when Mr. Constant-Weight has too much carbohydrate to eat:

Why does he fail to burn up the excess? The answer is the real reason for his obesity: BECAUSE HE HAS A DEFECTIVE CAPACITY FOR DEALING WITH CARBOHYDRATES

Nutritionists could not bring themselves to abandon the idea that to lose weight one must eat less. This principle derived from the law of conservation of energy (what comes out must go in) on the basis of which it was deduced that the energy intake (consumption of food) must exceed the energy expenditure when obesity is developing.

Of course this is perfectly obvious. A man can't get fat unless he eats more food than he uses up for energy. But it is beside the point.

The real question that needs answering about obesity is:

What is the cause of the fat man's failure to use up as much as he takes in as food? It could be that he is just greedy and eats more than he requires. It could also be that although he only eats a normal amount, some defect in the way his body deals with food deflects some of what he eats to his fat stores and keeps it there instead of letting him use it up for energy.

In other words, Mr. Fatten-Easily may have a defect in his metabolism which Mr. Constant-Weight has not.

Too much attention has been paid to the input side of the energy equation and not enough to possible causes of defective output. Even with a low food intake a man may get fat because his output is small. And this need not be because he is taking insufficient exercise but because something is interfering with the smooth conversion of fuel to energy in his body and encouraging its storage as fat.

It is curious that up to 1900, apart from Harvey and Banting, only one person had ever considered this alternative explanation for obesity. This was an eighteenth-century physician, Dr. Thomas Beddoes. In 1793, Beddoes applied the new theory of "pneumatic chemistry" which had originated with M. Lavoisier's experiments in France and held that during respiration the lungs took in oxygen, combined it with carbon derived from the food and expelled it in the form of carbon dioxide.

Beddoes thought that the oxygen might go deeper into the body than the lungs and that obesity might be caused by its combining insufficiently with body fat. This would lead to fat accumulating instead of being burnt up for energy.

He attempted to remedy this supposed defect of fat metabolism by introducing more oxygen into the system— but with no good result.

His theory was easily disposed of by the redoubtable William Wadd, who remarked:

"Dr. Beddoes remained so inconveniently fat during his life that a lady of Clifton used to denominate him the walking feather bed."

So the views of William Wadd prevailed and, apart from the Banting interlude, starvation has been the basis of the treatment of obesity in this country right up to the present day. Only the words have changed.

"Calorie restriction" has now replaced Wadd's "taking food that has little nutrition in it."

Within the principle of total food restriction, most reducing diets gave a high proportion of protein up to the year 1900. Then the American physiologist, Russell Henry Chittenden, published an indictment of protein, purporting to show that it was the cause of many diseases and from that time obese patients were generally kept short of this most vital food in their already short rations. (Lately, protein has been coming back into favour, and most of the current, popular, "Women's Page" slimming diets follow Niemeyer's modification of Banting. That is to say, they are high-protein and low-calorie, with fat and carbohydrate both restricted.)

There was the start of a break away towards more rational thinking on obesity with von Bergmann and the "lipophilia" school. He, like Beddoes, suggested a diminished oxidation of fat and explored the metabolism of the obese for evidence of abnormality which could account for a special affinity for fat and an excess of storage over use.

The snag again—as with Beddoes — the lack of any effective treatment to fit in with the theory.

So as the twentieth century ran on into the thirties the view became more and more widely accepted that obesity was caused by an inflow of energy greater than the outflow, caused simply by careless over-eating and gluttony.

Popular books on slimming became mainly concerned with tricks for persuading people to eat less while seeming to allow them to eat more.

In 1930, Newburgh and Johnson summed the matter up thus in the Journal of Clinical Investigation:

"Obesity is never directly caused by abnormal metabolism but is always due to food habits not adjusted to the metabolic requirements "; i.e. over-weight never comes from a defective ability to mobilise fat from the fat stores but always from over-eating.

This appeared to be the last word and doctors and slimming "experts" all over the world settled down to trying to persuade their obese patients to eat less.

With the "obesity comes from over-eating" dogma enshrined in history and hallowed by the blessing of the high priests of modern physiological research, imagine the impact on the medical world of the news in 1944, that cases of obesity were being treated effectively at the New York City Hospital with diets in which more than 24 ounces of fat meat was allowed a day. Patients were encouraged to eat to the limit of their appetites and some who were sceptical of the diet ate very copiously indeed. But they still lost weight.

The man in charge of this treatment was Dr. Blake F. Donaldson.

At that time, Great Britain was still in the grip of severe war-time rationing and minimal amounts of fat and protein foods were obtainable. So this American revival of Bantingism was for the time being of academic interest only over here.

But from that time onwards, unrestricted-calorie high-fat, high-protein, low-carbohydrate diets for obesity were on the map again and in the United States at any rate they gradually gained in popularity. Research workers in Britain were not idle, however. Many of them had been to America, and Donaldson's work and later Dr. Alfred Pennington's caused great interest.

Then in July 1956, in the Lancet, Professor Alan Kekwick and Dr. G. L. S. Pawan published the results of a scientific evaluation of Banting's diet undertaken in their wards at the Middlesex Hospital in London. They proved that Banting was right.

Here is their conclusion:

"The composition of the diet can alter the expenditure of calories in obese persons, increasing it when fat and proteins are given and decreasing it when carbohydrates are given."

Today this work is being quoted in medical journals all over the world. Here is a quotation from the February 1957 number of the American journal, Antibiotic Medicine and Clinical Therapy:

"Kekwick and Pawan, from the Middlesex Hospital, London, report some news for the obese. All of the obese subjects studied lost weight immediately after admission to hospital and therefore a period of stabilisation was required before commencing investigation.

If the proportions of fat, carbohydrate and protein were kept constant, the rate of weight loss was then proportional to the calorie intake.

If the calorie intake was kept constant, however, at 1,000 per day, the most rapid weight loss was noted with high fat diets . . . But when the calorie intake was raised to 2,600 daily in these patients, weight loss would still occur provided that this intake was given mainly in the form of fat and protein.

It is concluded that from 30 to 50 per cent of weight loss is derived from the total body water and the remaining 50 to 70 per cent from the body fat."

In other words, doctors now have scientific justification for basing diets for obesity on reduction of carbohydrate rather than on reduction of calories and fat.

Before going on it should be explained that Banting did in fact take some carbohydrate. Kekwick and Pawan and other investigators have shown that up to 6o grammes (just under 2 ounces) of carbohydrate a day are compatible with effective weight reduction on a high-fat, high-protein diet, although in some subjects even this amount will slow down the rate of weight loss. In such cases further restriction of carbohydrate with stricter adherence to the high-fat, high-protein foods results in satisfactory weight loss again.

Summary of the argument so far (1958)

  1. There are two kinds of people: the Fatten-Easilies and the Constant-Weights.
  2. If a Constant-Weight eats more carbohydrate than he needs, he automatically pushes up his metabolic rate (turns the bellows on his body fires) until the excess has been consumed.
  3. A Fatten-Easily cannot do this because of a defect in his body chemistry. Excess carbohydrate is laid down as fat.
  4. It is carbohydrate which makes a fat person fat.
  5. Medical research has now proved that Banting was right and that diets for obesity may be based successfully on reduction of carbohydrate rather than on restriction of calories and fat.