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HCG Fat Loss >
Dr Simeons HCG Protocol >
The Nature of Obesity >
Three Basic Causes of Obesity
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(1) The Inherited Factor
Assuming that there is a limit to
the diencephalon's fat banking
capacity, it follows that there are
three basic ways in which obesity
can become manifest. The first is
that the fat-banking capacity is
abnormally low from birth. Such a
congenitally low diencephalic
capacity would then represent the
inherited factor in obesity. When
this abnormal trait is markedly
present, obesity will develop at an
early age in spite of normal
feeding; this could explain why
among brothers and sisters eating
the same food at the same table some
become obese and others do not.
(2) Other Diencephalic Disorders
The second way in which obesity can
become established is the lowering
of a previously normal fat-banking
capacity owing to some other
diencephalic disorder. It seems to
be a general rule that when one of
the many diencephalic centers is
particularly overtaxed; it tries to
increase its capacity at the expense
of other centers.
In the menopause and after
castration the hormones previously
produced in the sex-glands no longer
circulate in the body. In the
presence of normally functioning
sex-glands their hormones act as a
brake on the secretion of the
sex-gland stimulating hormones of
the anterior pituitary. When this
brake is removed the anterior
pituitary enormously increases its
output of these sex-gland
stimulating hormones, though they
are now no longer effective. In the
absence of any response from the
non-functioning or missing sex
glands, there is nothing to stop the
anterior pituitary from producing
more and more of these hormones.
This situation causes an excessive
strain on the diencephalic center
which controls the function of the
anterior pituitary. In order to cope
with this additional burden the
center appears to draw more and more
energy away from other centers, such
as those concerned with emotional
stability, the blood circulation
(hot flushes) and other autonomous
nervous regulations, particularly
also from the not so vitally
important fat-bank.
The so-called stable type of
diabetes heavily involves the
diencephalic blood sugar regulating
center. The
diencephalon
tries to
meet this abnormal load by switching
energy destined for the fat bank
over to the sugar-regulating center,
with the result that the fat-banking
capacity is reduced to the point at
which it is forced to establish a
fixed deposit and thus initiate the
disorder we call obesity. In this
case one would have to consider the
diabetes the primary cause of the
obesity, but it is also possible
that the process is reversed in the
sense that a deficient or overworked
fat-center draws energy from the
sugar-center, in which case the
obesity would be the cause of that
type of diabetes in which the
pancreas is not primarily involved.
Finally, it is conceivable that in
Cushing's syndrome those symptoms
which resemble obesity are entirely
due to the withdrawal of energy from
the diencephalic fat-bank in order
to make it available to the highly
disturbed center which governs the
anterior pituitary adrenocortical
system.
Whether obesity is caused by a
marked inherited deficiency of the
fat-center or by some entirely
different diencephalic regulatory
disorder, its insurgence obviously
has nothing to do with overeating
and in either case obesity is
certain to develop regardless of
dietary restrictions. In these cases
any enforced food deficit is made up
from essential fat reserves and
normal structural fat, much to the
disadvantage of the patient's
general health.
(3) The Exhaustion of the Fat-bank
But there is still a third way in
which obesity can become
established, and that is when a
presumably normal fat-center is
suddenly -- the emphasis is on
suddenly -- called upon to deal with
an enormous influx of food far in
excess of momentary requirements. At
first glance it does seem that here
we have a
straight-forward case of overeating
being responsible for obesity, but
on further analysis it soon becomes
clear that the relation of cause and
effect is not so simple. In the
first place we are merely assuming
that the capacity of the fat center
is normal while it is possible and
even probable that only persons who
have some inherited trait in this
direction can become obese merely by
overeating.
Secondly, in many of these cases the
amount of food eaten remains the
same and it is only the consumption
of fuel which is suddenly decreased,
as when an athlete is confined to
bed for many weeks with a broken
bone or when a man leading a highly
active life is suddenly tied to his
desk in an office and to television
at home. Similarly, when a person,
grown up in a cold climate, is
transferred to a tropical country
and continues to eat as before, he
may develop obesity because in the
heat far less fuel is required to
maintain the normal body
temperature.
When a person suffers a long period
of privation, be it due to chronic
illness, poverty, famine or the
exigencies of war, his diencephalic
regulations adjust themselves to
some extent to the low food intake.
When then suddenly these conditions
change and he is free to eat all the
food he wants, this is liable to
overwhelm his fat-regulating center.
During the last war about 6000
grossly underfed Polish refugees who
had spent harrowing years in Russia
were transferred to a camp in India
where they were well housed, given
normal British army rations and some
cash to buy a few extras. Within
about three months, 85% were
suffering from obesity.
In a person eating coarse and
unrefined food, the digestion is
slow and only a little nourishment
at a time is assimilated from the
intestinal tract. When such a person
is suddenly able to obtain highly
refined foods such as sugar, white
flour, butter and oil these are so
rapidly digested and assimilated
that the rush of
incoming fuel which occurs at every
meal may eventually overpower the
diecenphalic regulatory mechanisms
and thus lead to obesity. This is
commonly seen in the poor man who
suddenly becomes rich enough to buy
the more expensive refined foods,
though his total caloric intake
remains the same or is even less
than before.
Psychological Aspects
Much has been written about the
psychological aspects of obesity.
Among its many functions the
diencephalon is also the seat of our
primitive animal instincts, and just
as in an emergency it can switch
energy from one center to another,
so it seems to be able to transfer
pressure from one instinct to
another. Thus, a lonely and unhappy
person deprived of all emotional
comfort and of all instinct
gratification except the stilling of
hunger and thirst can use these as
outlets for pent up instinct
pressure and so develop obesity. Yet
once that has happened, no amount of
psychotherapy or analysis,
happiness, company or the
gratification of other instincts
will correct the condition.
Compulsive Eating
No end of injustice is done to obese
patients by accusing them of
compulsive eating, which is a form
of diverted sex gratification. Most
obese patients do not suffer from
compulsive eating; they suffer
genuine hunger - real, gnawing,
torturing hunger - which has nothing
whatever to do with compulsive
eating. Even their sudden desire for
sweets is merely the result of the
experience that sweets, pastries and
alcohol will most rapidly of all
foods allay the pangs of hunger.
This has nothing to do with diverted
instincts.
On the other hand, compulsive eating
does occur in some obese patients,
particularly in girls in their late
teens or early twenties. Compulsive
eating differs fundamentally from
the obese patient’s greater need for
food. It comes on in attacks and is
never associated with real hunger, a
fact which is readily admitted by
the patients. They only feel a feral
desire to stuff. Two pounds of
chocolates may be devoured in a few
minutes; cold, greasy food from the
refrigerator, stale bread, leftovers
on stacked plates, almost anything
edible is crammed down with
terrifying speed and ferocity.
I have occasionally been able to
watch such an attack without the
patient's knowledge, and it is a
frightening, ugly spectacle to
behold, even if one does realize
that mechanisms entirely beyond the
patient's control are at work. A
careful enquiry into what may have
brought on such an attack almost
invariably reveals that it is
preceded by a strong unresolved
sex-stimulation, the higher centers
of the brain having blocked
primitive diencephalic instinct
gratification. The pressure is then
let off through another primitive
channel, which is oral
gratification. In my experience the
only thing that will cure this
condition is uninhibited sex, a
therapeutic procedure which is
hardly ever feasible, for if it
were, the patient would have adopted
it without professional prompting,
nor would this in any way correct
the associated obesity. It would
only raise new and often greater
problems if used as a therapeutic
measure.
Patients suffering from real
compulsive eating are comparatively
rare. In my practice they constitute
about 1-2%. Treating them for
obesity is a heartrending job. They
do perfectly well between attacks,
but a single bout occurring while
under treatment may annul several
weeks of therapy. Little wonder that
such patients become discouraged. In
these cases I have found that
psychotherapy may make the patient
fully understand the mechanism, but
it does nothing to stop it. Perhaps
society's
growing sexual permissiveness will
make compulsive eating even rarer.
Whether a patient is really
suffering from compulsive eating or
not is hard to decide before
treatment because many obese
patients think that their desire for
food -- to them unmotivated -- is
due to compulsive eating, while all
the time it is merely a greater need
for food. The only way to find out
is to treat such patients. Those
that suffer from real compulsive
eating continue to have such
attacks, while those who are not
compulsive eaters never get an
attack during treatment.
Reluctance to Lose Weight
Some patients are deeply attached to
their fat and cannot bear the
thought of losing it. If they are
intelligent, popular and successful
in spite of their handicap, this is
a source of pride. Some fat girls
look upon their condition as a
safeguard against erotic
involvements, of which they are
afraid. They work out a pattern of
life in which their obesity plays a
determining role and then become
reluctant to upset this pattern and
face a new kind of life which will
be entirely different after their
figure has become normal and often
very attractive. They fear that
people will like them - or be
jealous - on account of their figure
rather than be attracted by their
intelligence or character only. Some
have a feeling that reducing means
giving up an almost cherished and
intimate part of themselves. In many
of these cases psychotherapy can be
helpful, as it enables these
patients to see the whole situation
in the full light of consciousness.
An affectionate attachment to
abnormal fat is usually seen in
patients who became obese in
childhood, but this is not
necessarily so.
In all other cases the best
psychotherapy can do in the usual
treatment of obesity is to render
the burden of hunger and
never-ending dietary restrictions
slightly more tolerable. Patients
who have successfully established an
erotic transfer to their
psychiatrist are often better able
to bear their suffering as a secret
labor of love.
There are thus a large number of
ways in which obesity can be
initiated, though the disorder
itself is always due to the same
mechanism, an inadequacy of the
diencephalic fat-center and the
laying down of abnormally fixed fat
deposits in abnormal places. This
means that once obesity has become
established, it can no more be cured
by eliminating those factors which
brought it on than a fire can be
extinguished by removing the cause
of the conflagration. Thus a
discussion of the various ways in
which obesity can become established
is useful from a preventative point
of view, but it has no bearing on
the treatment of the established
condition. The elimination of
factors which are clearly hastening
the course of the disorder may slow
down its progress or even halt it,
but they can never correct it.
Not By Weight Alone
Weight alone is not a satisfactory
criterion by which to judge whether
a person is suffering from the
disorder we call obesity or not.
Every physician is familiar with the
sylphlike lady who enters the
consulting room and declares
emphatically that she is getting
horribly fat and wishes to reduce.
Many an honest and sympathetic
physician at once concludes that he
is dealing with a “nut.” If he is
busy he will give her short shrift,
but if he has time he will weigh her
and show her tables to prove that
she is actually underweight.
I have never yet seen or heard of
such a lady being convinced by
either procedure. The reason is that
in my experience the lady is nearly
always right and the doctor wrong.
When such a patient is carefully
examined one finds many signs of
potential obesity, which is just
about to become manifest as
overweight. The patient distinctly
feels that something is wrong with
her, that a subtle change is taking
place in her body, and this alarms
her.
There are a number of signs and
symptoms which are characteristic of
obesity. In manifest obesity many
and often all these signs and
symptoms are present. In latent or
just beginning cases some are always
found, and it should be a rule that
if two or more of the bodily signs
are present, the case must be
regarded as one that needs immediate
help.
Signs and Symptoms of Obesity
The bodily signs may be divided into
such as have developed before
puberty, indicating a strong
inherited factor, and those which
develop at the onset of manifest
disorder. Early signs are a
disproportionately large size of the
two upper front teeth, the first
incisor, or a dimple on both sides
of the sacral bone just above the
buttocks. When the arms are
outstretched with the palms upward,
the forearms appear sharply angled
outward from the upper arms. The
same applies to the lower
extremities. The patient cannot
bring his feet together without the
knees overlapping; he is, in fact,
knock-kneed.
The beginning accumulation of
abnormal fat shows as a little pad
just below the nape of the neck,
colloquially known as the Duchess'
Hump. There is a triangular fatty
bulge in front of the armpit when
the arm is held against the body.
When the skin is stretched by fat
rapidly accumulating under it, it
may split in the lower layers. When
large and fresh, such tears are
purple, but later they are
transformed into white scar-tissue.
Such striation, as it is called,
commonly occurs on the abdomen of
women during pregnancy, but in
obesity it is frequently found on
the breasts, the hips and
occasionally on the shoulders. In
many cases striation is so fine that
the small white lines are only just
visible. They are always a sure sign
of obesity, and though this may be
slight at the time of examination
such patients can usually remember a
period in their childhood when they
were excessively chubby.
Another typical sign is a pad of fat
on the insides of the knees, a spot
where normal fat reserves are never
stored. There may be a fold of skin
over the pubic area and another fold
may stretch round both sides of the
chest, where a loose roll of fat can
be picked up between two fingers. In
the male an excessive accumulation
of fat in the breasts is always
indicative, while in the female the
breast is usually, but not
necessarily, large. Obviously
excessive fat on the abdomen, the
hips, thighs, upper arms, chin and
shoulders are characteristic, and it
is important to remember that any
number of these signs may be present
in persons whose weight is
statistically normal; particularly
if they are dieting on their own
with iron determination.
Common clinical symptoms which are
indicative only in their association
and in the frame of the whole
clinical picture are: frequent
headaches, rheumatic pains without
detectable bony abnormality; a
feeling of laziness and lethargy,
often both physical and mental and
frequently associated with insomnia,
the patients saying that all they
want is to rest; the frightening
feeling of being famished and
sometimes weak with hunger two to
three hours after a hearty meal and
an irresistible yearning for sweets
and starchy food which often
overcomes the patient quite suddenly
and is sometimes substituted by a
desire for alcohol; constipation and
a spastic or irritable colon are
unusually common among the obese,
and so are menstrual disorders.
Returning once more to our sylphlike
lady, we can say that a combination
of some of these symptoms with a few
of the typical bodily signs is
sufficient evidence to take her case
seriously. A human figure, male or
female, can only be judged in the
nude; any opinion based on the
dressed appearance can be quite
fantastically wide off the mark, and
I feel myself driven to the
conclusion that apart from frankly
psychotic patients such as cases of
anorexia nervosa; a morbid weight
fixation does not exist. I have yet
to see a patient who continues to
complain after the figure has been
rendered normal by adequate
treatment.
The Emaciated Lady
I remember the case of a lady who
was escorted into my consulting room
while I was telephoning. She sat
down in front of my desk, and when I
looked up to greet her I saw the
typical picture of advanced
emaciation. Her dry skin hung
loosely over the bones of her face,
her neck was scrawny and collarbones
and ribs stuck out from deep
hollows. I immediately thought of
cancer and decided to which of my
colleagues at the hospital I would
refer her. Indeed, I felt a little
annoyed that my assistant had not
explained to her that her case did
not fall under my specialty. In
answer to my query as to what I
could do for her, she replied that
she wanted to reduce. I tried to
hide my surprise, but she must have
noted a fleeting expression, for she
smiled and said “I know that you
think I'm mad, but just wait.” With
that she rose and came round to my
side of the desk. Jutting out from a
tiny waist she had enormous hips and
thighs.
By using a technique which will
presently be described, the abnormal
fat on her hips was transferred to
the rest of her body which had been
emaciated by months of very severe
dieting. At the end of a treatment
lasting five weeks, she, a small
woman, had lost 8 inches round her
hips, while her face looked fresh
and
florid, the ribs were no longer
visible and her weight was the same
to the ounce as it had been at the
first consultation.
Fat but not Obese
While a person who is statistically
underweight may still be suffering
from the disorder which causes
obesity, it is also possible for a
person to be statistically
overweight without suffering from
obesity. For such persons weight is
no problem, as they can gain or lose
at will and experience no difficulty
in reducing their caloric intake.
They are masters of their weight,
which the obese are not. Moreover,
their excess fat shows no preference
for certain typical regions of the
body, as does the fat in all cases
of obesity. Thus, the decision
whether a borderline case is really
suffering from obesity or not cannot
be made merely by consulting weight
tables.
Part 4 -
The Treatment of Obesity
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