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Pounds & Inches

A NEW APPROACH TO OBESITY

BY: A.T.W. SIMEONS, M.D.

SEVENTH EDITION1971

__________ ALL RIGHTS RESERVED

__________

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Tabe o! Con"en"s

Forward 4The Nature of Obe!t" #Obe!t" a D!order #G$a%du$ar Theor!e &

Three 'a!( )aue of Obe!t" 1*+1, The I%her!ted Fa(tor 1*+*, Other D!e%(e-ha$!( D!order 1*+., The E/haut!o% of the Fat0ba% 1.2"(ho$o3!(a$ A-e(t 1.)o-u$!5e Eat!%3 14Re$u(ta%(e to Loe 6e!3ht 1Not b" 6e!3ht A$o%e 1S!3% a%d S"-to of Obe!t" 1#The Ea(!ated Lad" 17Fat 'ut Not Obee 17

The Treate%t Of Obe!t" 1& A )ur!ou Ober5at!o% 1&Fat o% the 8o5e 192re3%a%(" a%d Obe!t" 19The Nature of Hua% )hor!o%!( Go%adotro-!% *The Rea$ Go%adotro-h!% *1H)G %o Se/ Horo%e *1I-orta%(e a%d 2ote%(" of H)G **)o-$!(at!%3 D!order **D!abete **Rheuat! *.)ho$etero$ *.Gout *4'$ood 2reure *42e-t!( :$(er *2or!a!; F!%3er%a!$; Ha!r Var!(oe :$(er *The <2re3%a%t= 8a$e *Te(h%!>ue *#6ar%!%3 *#H!tor" ta!%3 *#The Durat!o% of Treate%t *7Iu%!t" to H)G *&8e%trua!o% *&Further )oure *9)o%d!t!o% that ut be a((e-ted before treate%t *9E/a!%!%3 the 2at!e%t .Ga!% 'efore Lo .Start!%3 Treate%t .1The D!et .*8a!%3 u- the )a$or!e .4

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Ve3etar!a% .Fau$t" D!et!%3 .V!ta!% a%d A%e!a .The F!rt Da" of Treate%t .F$u(tuat!o% !% 6e!3ht Lo .#I%terru-t!o% of 6e!3ht Lo .7

The 2$ateau +A--$e Da", .7Rea(h!%3 a Forer Le5e$ .78e%trua$ I%terru-t!o% .&D!etar" Error .&Sa$t a%d Redu(!%3 .96ater .9)o%t!-at!o% .9I%5et!3at!%3 D!etar" Error .9L!ar a%d Foo$ 4)oet!( 41The Vo!(e 4*Other Reao% for a Ga!% 4*

A--et!te0redu(!%3 Dru3 4*:%foreee% I%terru-t!o% of Treate%t 4.8u(u$ar Fat!3ue 4.8aa3e 4.'$ood Su3ar 44The Rat!o of 2ou%d to I%(he 42re-ar!%3 the So$ut!o% 4I%?e(t!%3 4#F!bro!d 4#Ga$$to%e 47The Heart 47)oro%ar" O(($u!o% 47Teeth a%d V!ta!% 47

A$(oho$ 4&Tuber(u$o! 4&The 2a!%fu$ Hee$ 4&The Se-t!(a$ 2at!e%t 49)o%($ud!%3 a )oure 49S!--!%3 a 8ea$ +Stea Da", Lo!%3 ore 6e!3ht Troub$e After Treate%t 'eware of O5er0e%thu!a 12rote!% Def!(!e%(" 1Re$a-e *2$a% of a Nora$ )oure *)ON)L:SION *GLOSSAR@ 4

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#OREWORD

Th! boo d!(ue a %ew !%ter-retat!o% of the %ature of obe!t"; a%d wh!$e !t doe %otad5o(ate "et a%other fa%(" $!!%3 d!et !t doe de(r!be a ethod of treate%t wh!(h ha3row% out of theoret!(a$ (o%!derat!o% baed o% ($!%!(a$ ober5at!o%

6hat I ha5e to a" ! a% ee%(e of 5!ew d!t!$$ed out of fort" "ear of 3ra--$!%3 w!th thefu%dae%ta$ -rob$e of obe!t"; !t (aue; !t "-to; a%d !t 5er" %ature I% thee a%""ear of -e(!a$!Bed wor; thoua%d of (ae ha5e -aed throu3h " ha%d a%d were(arefu$$" tud!ed E5er" %ew theor"; e5er" %ew ethod; e5er" -ro!!%3 $ead wa (o%!dered;e/-er!e%ta$$" (ree%ed a%d (r!t!(a$$" e5a$uated a oo% a !t be(ae %ow% 'ut !%5ar!ab$"the reu$t were d!a--o!%t!%3 a%d $a(!%3 !% u%!for!t"

I fe$t that we were ere$" %!bb$!%3 at the fr!%3e of a 3reat -rob$e; a; !%deed; do oter!ou tude%t of o5erwe!3ht 6e ha5e 3row% -rett" ure that the te%de%(" to a((uu$ateab%ora$ fat ! a 5er" def!%!te etabo$!( d!order; u(h a !; for !%ta%(e; d!abete @et the$o(a$!Bat!o% a%d the %ature of th! d!order rea!%ed a "ter" E5er" %ew a--roa(h eeedto $ead !%to a b$!%d a$$e"; a%d thou3h -at!e%t were to$d that the" are fat be(aue the" eat toou(h; we be$!e5ed that th! ! %e!ther the who$e truth %or the $at word !% the atter

Refu!%3 to be !de0tra(ed b" a% a$$ too fa(!$e !%ter-retat!o% of obe!t"; I ha5e a$wa" he$dthat o5ereat!%3 ! the reu$t of the d!order; %ot !t (aue; a%d that we (a% ae $!tt$e headwa"u%t!$ we (a% bu!$d for oure$5e oe ort of theoret!(a$ tru(ture w!th wh!(h to e/-$a!% the(o%d!t!o% 6hether u(h a tru(ture re-ree%t the truth ! %ot !-orta%t at th! oe%t 6hat!t ut do ! to 3!5e u a% !%te$$e(tua$$" at!f"!%3 !%ter-retat!o% of what ! ha--e%!%3 !% theobee bod" It ut a$o be ab$e to w!thta%d the o%$au3ht of a$$ h!therto %ow% ($!%!(a$ fa(ta%d fur%!h a hard ba(3rou%d a3a!%t wh!(h the reu$t of treate%t (a% be a((urate$"aeed

To e th! re>u!ree%t ee ba!(; a%d !t ha a$wa" bee% the (e%ter of " !%teret I%dea$!%3 w!th obee -at!e%t !t be(ae a hab!t to re3!ter a%d order e5er" ($!%!(a$ e/-er!e%(ea !f !t were a% odd $oo!%3 -!e(e of a ?!30aw -uBB$e A%d the%; a !% a ?!30aw -uBB$e; $!tt$e($uter of fra3e%t be3a% to for; thou3h the" eeed to f!t !% %owhere A the "ear-aed thee ($uter 3rew b!33er a%d tarted to aa$3aate u%t!$; about !/tee% "ear a3o;a (o-$ete -!(ture be(ae d!$" d!(er%!b$e Th! -!(ture wa; a%d t!$$ !; dotted w!th 3a-for wh!(h I (a%%ot f!%d the -!e(e; but I do %ow fee$ that a theoret!(a$ tru(ture ! 5!!b$e a awho$e

6!th ou%t!%3 e/-er!e%(e ore a%d ore fa(t eeed to f!t %u3$" !%to the %ew fraewor;a%d whe% the% a treate%t baed o% u(h -e(u$at!o% howed (o%!te%t$" at!fa(tor"reu$t; I wa ure that oe -ra(t!(a$ ad5a%(e had bee% ade; re3ard$e of whether thetheoret!(a$ !%ter-retat!o% of thee reu$t ! (orre(t or %ot

The ($!%!(a$ reu$t of the %ew treate%t ha5e bee% -ub$!hed !% (!e%t!f!( ?our%a$ C a%d theere-ort ha5e bee% 3e%era$$" we$$ re(e!5ed b" the -rofe!o%; but the 5er" %ature of a (!e%t!f!(art!($e doe %ot -er!t the fu$$ -ree%tat!o% of %ew theoret!(a$ (o%(e-t %or ! there roo tod!(u the f!%er -o!%t of te(h%!>ue a%d the reao% for ober5!%3 the

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Dur!%3 the 1# "ear that ha5e e$a-ed !%(e I f!rt -ub$!hed " f!%d!%3; I ha5e had a%"hu%dred of !%>u!r!e fro reear(h !%t!tute; do(tor a%d -at!e%t H!therto I (ou$d o%$" referthoe !%tereted to " (!e%t!f!( -a-er; thou3h I rea$!Bed that thee d!d %ot (o%ta!% uff!(!e%t!%forat!o% to e%ab$e do(tor to (o%du(t the %ew treate%t at!fa(tor!$" Thoe who tr!edwere ob$!3ed to 3a!% the!r ow% e/-er!e%(e throu3h the a%" tr!a$ a%d error wh!(h I ha5e$o%3 !%(e o5er(oe

Do(tor fro a$$ o5er the wor$d ha5e (oe to Ita$" to tud" the ethod; f!rt ha%d !% " ($!%!(!% the Sa$5ator 8u%d! I%ter%at!o%a$ Ho-!ta$ !% Roe For oe of the the t!e the" (ou$d-are ha bee% too hort to 3et a fu$$ 3ra- of the te(h%!>ue; a%d !% a%" (ae the %uber ofthoe who I ha5e bee% ab$e to eet -ero%a$$" ! a$$ (o-ared w!th the a%" re>uetfor further deta!$ed !%forat!o% wh!(h ee- (o!%3 !% I ha5e tr!ed to ee- u- w!th theedea%d b" (orre-o%de%(e; but the 5o$ue of th! wor ha be(oe u%a%a3eab$e a%dthat ! o%e e/(ue for wr!t!%3 th! boo

I% dea$!%3 w!th a d!order !% wh!(h the -at!e%t ut tae a% a(t!5e -art !% the treate%t; !t !; Ibe$!e5e; ee%t!a$ that he or he ha5e a% u%derta%d!%3 of what ! be!%3 do%e a%d wh" O%$"the% (a% there be !%te$$!3e%t (oo-erat!o% betwee% -h"!(!a% a%d -at!e%t I% order to a5o!d

wr!t!%3 two boo; o%e for the -h"!(!a% a%d a%other for the -at!e%t 0 a -ro-e(t wh!(h wou$d-robab$" ha5e reu$ted !% %o boo at a$$ 0 I ha5e tr!ed to eet the re>u!ree%t of both !% a!%3$e boo Th! ! a rather d!ff!(u$t e%ter-r!e !% wh!(h I a" %ot ha5e u((eeded The e/-ertw!$$ 3rub$e about $o%30w!%ded%e; wh!$e the $a"0reader a" o((a!o%a$$" ha5e to $oo u- a%u%fa!$!ar word !% the 3$oar" -ro5!ded for h!

To ae the te/t ore readab$e I ha$$ be u%ahaed$" author!tat!5e a%d a5o!d a$$ thehed3!%3 a%d te%tat!5e%e w!th wh!(h !t ! (utoar" to e/-re %ew (!e%t!f!( (o%(e-t3row% out of ($!%!(a$ e/-er!e%(e a%d %ot a "et (o%f!red b" ($ear0(ut $aborator" e/-er!e%tThu whe% I ae what read $!e a fa(tua$ tatee%t; the -rofe!o%a$ reader a" ha5e totra%$ate !%to clinical experience seems to suggest that such and such an observation might

be tentatively explained by such and such a working hypothesis, requiring a vast amount offurther research before the hypothesis can be considered a valid theory If we (a% fro theoutet etab$!h th! a a utua$$" a((e-ted (o%5e%t!o%; I ho-e to a5o!d be!%3 a((ued of-e(u$at!5e e/ubera%(e

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THE NAT$RE O# OBESITY

Obesity a Disorder

A a ba! for our d!(u!o% we -otu$ate that obe!t" !% a$$ !t a%" for ! due to a%ab%ora$ fu%(t!o%!%3 of oe -art of the bod" a%d that e5er" ou%(e of ab%ora$$"

a((uu$ated fat ! a$wa" the reu$t of the ae d!order of (erta!% re3u$ator" e(ha%!2ero% uffer!%3 fro th! -art!(u$ar d!order w!$$ 3et fat re3ard$e of whether the" eate/(e!5e$"; %ora$$" or $e tha% %ora$ A -ero% who ! free of the d!order w!$$ %e5er 3etfat; e5e% !f he fre>ue%t$" o5ereat

Thoe !% who the d!order ! e5ere w!$$ a((uu$ate fat 5er" ra-!d$"; thoe !% who !t !oderate w!$$ 3radua$$" !%(reae !% we!3ht a%d thoe !% who !t ! !$d a" be ab$e to ee-the!r e/(e we!3ht tat!o%ar" for $o%3 -er!od I% a$$ thee (ae a $o of we!3ht brou3htabout b" d!et!%3; treate%t w!th th"ro!d; a--et!te0redu(!%3 dru3; $a/at!5e; 5!o$e%t e/er(!e;aa3e; bath; et(; ! o%$" te-orar" a%d w!$$ be ra-!d$" re3a!%ed a oo% a the redu(!%3re3!e% ! re$a/ed The reao% ! !-$" that %o%e of thee eaure (orre(t the ba!(

d!order

6h!$e there are 3reat 5ar!at!o% !% the e5er!t" of obe!t"; we ha$$ (o%!der a$$ the d!ffere%tfor !% both e/e a%d at a$$ a3e a a$wa" be!%3 due to the ae d!order Var!at!o% !%for wou$d the% be -art$" a atter of de3ree; -art$" a% !%her!ted bod!$" (o%t!tut!o% a%d -art$"the reu$t of a e(o%dar" !%5o$5ee%t of e%do(r!%e 3$a%d u(h a the -!tu!tar"; the th"ro!d;the adre%a$ or the e/ 3$a%d O% the other ha%d; we -otu$ate that %o def!(!e%(" of a%" ofthee 3$a%d (a% e5er d!re(t$" -rodu(e the (oo% d!order %ow% a obe!t"

If th! reao%!%3 ! (orre(t; !t fo$$ow that a treate%t a!ed at (ur!%3 the d!order ut bee>ua$$" effe(t!5e !% both e/e; at a$$ a3e a%d !% a$$ for of obe!t" :%$e th! ! o; we aree%t!t$ed to harbor 3ra5e doubt a to whether a 3!5e% treate%t (orre(t the u%der$"!%3

d!order 8oreo5er; a%" ($a! that the d!order ha bee% (orre(ted ut be ubta%t!ated b"the ab!$!t" of the -at!e%t to eat %ora$$" of a%" food he -$eae w!thout re3a!%!%3 ab%ora$ fatafter treate%t O%$" !f thee (o%d!t!o% are fu$f!$$ed (a% we $e3!t!ate$" -ea of (ur!%3obe!t" rather tha% of redu(!%3 we!3ht

Our -rob$e thu -ree%t !te$f a a% e%>u!r" !%to the $o(a$!Bat!o% a%d the %ature of thed!order wh!(h $ead to obe!t" The h!tor" of th! e%>u!r" ! a $o%3 er!e of h!3h ho-e a%db!tter d!a--o!%te%t

The History of Obesity

There wa a t!e; %ot o $o%3 a3o; whe% obe!t" wa (o%!dered a !3% of hea$th a%d

-ro-er!t" !% a% a%d of beaut"; aorou%e a%d fe(u%d!t" !% woe% Th! att!tude -robab$"date ba( to Neo$!th!( t!e; about & "ear a3o whe% for the f!rt t!e !% the h!tor" of(u$ture; a% be3a% to ow% -ro-ert"; doet!( a%!a$; arab$e $a%d; houe; -otter" a%d eta$too$ 'efore that; w!th the -o!b$e e/(e-t!o% of oe ra(e u(h a the Hotte%tot; obe!t"wa a$ot %o%0e/!te%t; a !t t!$$ ! !% a$$ w!$d a%!a$ a%d ot -r!!t!5e ra(e

Toda" obe!t" ! e/tree$" (oo% ao%3 a$$ (!5!$!Bed ra(e; be(aue a d!-o!t!o% to the

6



d!order (a% be !%her!ted 6here5er ab%ora$ fat wa re3arded a a% aet; e/ua$ e$e(t!o%te%ded to -ro-a3ate the tra!t It ! o%$" !% 5er" re(e%t t!e that a%!fet obe!t" ha $otoe of !t a$$ure; thou3h the (u$t of the out!Be but 0 a$wa" a !3% of $ate%t obe!t" 0 howthat the tre%d t!$$ $!%3er o%

The Significance of Regular Meals

I% the ear$" Neo$!th!( t!e a%other (ha%3e too -$a(e wh!(h a" we$$ a((ou%t for the fa(t thattoda" %ear$" a$$ !%her!ted d!-o!t!o% oo%er or $ater de5e$o- !%to a%!fet obe!t" Th!(ha%3e wa the !%t!tut!o% of re3u$ar ea$ I% -re0Neo$!th!( t!e; a% ate o%$" whe% he wahu%3r" a%d o%1" a u(h a he re>u!red too t!$$ the -a%3 of hu%3er 8oreo5er; u(h of h!food wa raw a%d a$$ of !t wa u%ref!%ed He roated h! eat; but he d!d %ot bo!$ !t; a he had%o -ot; a%d what $!tt$e he a" ha5e 3rubbed fro the Earth a%d -!(ed fro the tree; he atea he we%t a$o%3

The who$e tru(ture of a% o%!5orou d!3et!5e tra(t !; $!e that of a% a-e; rat or -!3;ad?uted to the (o%t!%ua$ %!bb$!%3 of t!db!t It ! %ot u!ted to o((a!o%a$ 3or3!%3 a !; for!%ta%(e; the !%tet!%e of the (ar%!5orou (at fa!$" Thu the !%t!tut!o% of re3u$ar ea$;

-art!(u$ar$" of food re%dered ra-!d$" a!!$ab$e; -$a(ed a 3reat burde% o% oder% a%ab!$!t" to (o-e w!th $ar3e >ua%t!t!e of food udde%$" -our!%3 !%to h! "te fro the !%tet!%a$tra(t

The !%t!tut!o% of re3u$ar ea$ ea%t that a% had to eat ore tha% h! bod" re>u!red at theoe%t of eat!%3 o a to t!de h! o5er u%t!$ the %e/t ea$ Food re%dered ea!$" d!3et!b$eudde%$" f$ooded h! bod" w!th %our!he%t of wh!(h he wa !% %o %eed at the oe%tSoehow; oewhere th! ur-$u had to be tored

Three Kinds of Fat

I% the hua% bod" we (a% d!t!%3u!h three !%d of fat The f!rt ! the tru(tura$ fat wh!(h

f!$$ the 3a- betwee% 5ar!ou or3a%; a ort of -a(!%3 ater!a$ Stru(tura$ fat a$o -erforu(h !-orta%t fu%(t!o% a bedd!%3 the !d%e" !% oft e$at!( t!ue; -rote(t!%3 the (oro%ar"arter!e a%d ee-!%3 the !% ooth a%d taut It a$o -ro5!de the -r!%3" (uh!o% of hard fatu%der the bo%e of the feet; w!thout wh!(h we wou$d be u%ab$e to wa$

The e(o%d t"-e of fat ! a %ora$ reer5e of fue$ u-o% wh!(h the bod" (a% free$" draw whe%the %utr!t!o%a$ !%(oe fro the !%tet!%a$ tra(t ! !%uff!(!e%t to eet the dea%d Su(h %ora$reer5e are $o(a$!Bed a$$ o5er the bod" Fat ! a ubta%(e wh!(h -a( the h!3het (a$or!(5a$ue !%to the a$$et -a(e o that %ora$ reer5e of fue$ for u(u$ar a(t!5!t" a%d thea!%te%a%(e of bod" te-erature (a% be ot e(o%o!(a$$" tored !% th! for 'oth theet"-e of fat; tru(tura$ a%d reer5e; are %ora$; a%d e5e% !f the bod" to( the to (a-a(!t"th! (a% %e5er be (a$$ed obe!t"

'ut there ! a th!rd t"-e of fat wh!(h ! e%t!re$" ab%ora$ It ! the a((uu$at!o% of u(h fat;a%d of u(h fat o%$"; fro wh!(h the o5erwe!3ht -at!e%t uffer Th! ab%ora$ fat ! a$o a-ote%t!a$ reer5e of fue$; but u%$!e the %ora$ reer5e !t ! %ot a5a!$ab$e to the bod" !% a%utr!t!o%a$ eer3e%(" It !; o to -ea; $o(ed awa" !% a f!/ed de-o!t a%d ! %ot e-t !% a(urre%t a((ou%t; a are the %ora$ reer5e

7



6he% a% obee -at!e%t tr!e to redu(e b" tar5!%3 h!e$f; he w!$$ f!rt $oe h! %ora$ fatreer5e 6he% thee are e/hauted he be3!% to bur% u- tru(tura$ fat; a%d o%$" a a $atreort w!$$ the bod" "!e$d !t ab%ora$ reer5e; thou3h b" that t!e the -at!e%t uua$$" fee$o wea a%d hu%3r" that the d!et ! aba%do%ed It ! ?ut for th! reao% that obee -at!e%t(o-$a!% that whe% the" d!et the" $oe the wro%3 fat The" fee$ fa!hed a%d t!red a%d the!rfa(e be(oe draw% a%d ha33ard; but the!r be$$"; h!-; th!3h a%d u--er ar how $!tt$e

!-ro5ee%t The fat the" ha5e (oe to detet ta" o% a%d the fat the" %eed to (o5er the!rbo%e 3et $e a%d $e The!r !% wr!%$e a%d the" $oo o$d a%d !erab$e A%d that ! o%eof the ot frutrat!%3 a%d de-re!%3 e/-er!e%(e a hua% be!%3 (a% ha5e

Injustice to the Obese

6he% the% obee -at!e%t are a((ued of (heat!%3; 3$utto%"; $a( of w!$$ -ower; 3reed a%de/ua$ (o-$e/e; the tro%3 be(oe !%d!3%a%t a%d de(!de that oder% ed!(!%e ! a frauda%d !t re-ree%tat!5e foo$; wh!$e the wea ?ut 3!5e u- the tru33$e !% de-a!r I% e!ther (aethe reu$t ! the ae a further 3a!% !% we!3ht; re!3%at!o% to a% abo!%ab$e fate a%d thereo$ut!o% at $eat to $!5e to$erab$" the hort -a% a$$otted to the 0 a f!3 for do(tor a%d!%ura%(e (o-a%!e

Obee -at!e%t o%$" fee$ -h"!(a$$" we$$ a $o%3 a the" are tat!o%ar" or 3a!%!%3 we!3ht The"a" fee$ 3u!$t"; ow!%3 to the $ethar3" a%d !%do$e%(e a$wa" ao(!ated w!th obe!t" The" a"fee$ ahaed of what the" ha5e bee% $ed to be$!e5e ! a $a( of (o%tro$ The" a" fee$horr!f!ed b" the a--eara%(e of the!r %ude bod" a%d the t!3ht%e of the!r ($othe 'ut the"ha5e a -r!!t!5e fee$!%3 of a%!a$ (o%te%t wh!(h tur% to !er" a%d uffer!%3 a oo% a the"ae a reo$ute atte-t to redu(e For th! there are ou%d reao%

I% the f!rt -$a(e; ore (a$or!( e%er3" ! re>u!red to ee- a $ar3e bod" at a (erta!%te-erature tha% to heat a a$$ bod" Se(o%d$" the u(u$ar effort of o5!%3 a hea5" bod"! 3reater tha% !% the (ae of a $!3ht bod" The u(u$ar effort (o%ue )a$or!e wh!(h utbe -ro5!ded b" food Thu; a$$ other fa(tor be!%3 e>ua$; a fat -ero% re>u!re ore food tha%

a $ea% o%e O%e !3ht therefore reao% that !f a fat -ero% eat o%$" the add!t!o%a$ food h!bod" re>u!re he hou$d be ab$e to ee- h! we!3ht tat!o%ar" @et e5er" -h"!(!a% who hatud!ed obee -at!e%t u%der r!3orou$" (o%tro$$ed (o%d!t!o% %ow that th! ! %ot true 8a%"obee -at!e%t a(tua$$" 3a!% we!3ht o% a d!et wh!(h ! (a$or!(a$$" def!(!e%t for the!r ba!(%eed There ut thu be oe other e(ha%! at wor

Glandular Theories

At o%e t!e !t wa thou3ht that th! e(ha%! !3ht be (o%(er%ed w!th the e/ 3$a%d Su(ha (o%%e(t!o% wa u33eted b" the fa(t that a%" ?u5e%!$e obee -at!e%t how a% u%der0de5e$o-e%t of the e/ or3a% The !dd$e0a3e -read !% e% a%d the te%de%(" of a%"

woe% to -ut o% we!3ht !% the e%o-aue eeed to !%d!(ate a (aua$ (o%%e(t!o% betwee%d!!%!h!%3 e/ fu%(t!o% a%d o5erwe!3ht @et; whe% h!3h$" a(t!5e e/ horo%e be(aea5a!$ab$e; !t wa fou%d that the!r ad!%!trat!o% had %o effe(t whatoe5er o% obe!t" The e/3$a%d (ou$d therefore %ot be the eat of the d!order

8



The Thyroid Gland

6he% !t wa d!(o5ered that the th"ro!d 3$a%d (o%tro$ the rate at wh!(h bod"0fue$ !(o%ued; !t wa thou3ht that b" ad!%!ter!%3 th"ro!d 3$a%d to obee -at!e%t the!r ab%ora$fat de-o!t (ou$d be bur%ed u- ore ra-!d$" Th! too -ro5ed to be e%t!re$" d!a--o!%t!%3;be(aue a we %ow %ow; thee ab%ora$ de-o!t tae %o -art !% the bod" e%er3"0tur%o5er 0 the" are !%a((e!b$" $o(ed awa" Th"ro!d ed!(at!o% ere$" for(e the bod" to

(o%ue !t %ora$ fat reer5e; wh!(h are a$read" de-$eted !% obee -at!e%t; a%d the% tobrea dow% tru(tura$$" ee%t!a$ fat w!thout tou(h!%3 the ab%ora$ de-o!t I% th! wa" a-at!e%t a" be brou3ht to the br!% of tar5at!o% !% -!te of ha5!%3 a hu%dred -ou%d of fat to-are Thu a%" we!3ht $o brou3ht about b" th"ro!d ed!(at!o% ! a$wa" at the e/-e%e offat of wh!(h the bod" ! !% d!re %eed

6h!$e the a?or!t" of obee -at!e%t ha5e a -erfe(t$" %ora$ th"ro!d 3$a%d a%d oe e5e%ha5e a% o5era(t!5e th"ro!d; o%e a$o o((a!o%a$$" ee a (ae w!th a rea$ th"ro!d def!(!e%(" I%u(h (ae; treate%t w!th th"ro!d br!%3 about a a$$ $o of we!3ht; but th! ! %ot due tothe $o of a%" ab%ora$ fat It ! e%t!re$" the reu$t of the e$!!%at!o% of a u(o!d ubta%(e;(a$$ed "/edea; wh!(h the bod" a((uu$ate whe% there ! a ared -r!ar" th"ro!d

def!(!e%(" 8oreo5er; -at!e%t uffer!%3 o%$" fro a e5ere $a( of th"ro!d horo%e %e5erbe(oe obee !% the true e%e 2o!b$" a$o the ober5at!o% that %ora$ -ero% 0 thou3h%ot the obee 0 $oe we!3ht ra-!d$" whe% the!r th"ro!d be(oe o5era(t!5e a" ha5e(o%tr!buted to the fa$e %ot!o% that th"ro!d def!(!e%(" a%d obe!t" are (o%%e(ted 8u(h!u%derta%d!%3 about the u--oed ro$e of the th"ro!d 3$a%d !% obe!t" ! t!$$ et w!th; a%d!t ! %ow rea$$" h!3h t!e that th"ro!d -re-arat!o% be o%(e a%d for a$$ tru( off the $!t ofreed!e for obe!t" Th! ! -art!(u$ar$" o be(aue 3!5!%3 th"ro!d 3$a%d to a% obee -at!e%twhoe th"ro!d ! e!ther %ora$ or o5era(t!5e; be!de be!%3 ue$e; ! de(!ded$" da%3erou

The Pituitary Gland

The %e/t 3$a%d to be fa$e$" !%(r!!%ated wa the a%ter!or $obe of the -!tu!tar" or h"-o-h"!

Th! ot !-orta%t 3$a%d $!e we$$ -rote(ted !% a bo%" (a-u$e at the bae of the u$$ It haa 5at %uber of fu%(t!o% !% the bod"; ao%3 wh!(h ! the re3u$at!o% of a$$ the other!-orta%t e%do(r!%e 3$a%d The fa(t that 5ar!ou !3% of a%ter!or -!tu!tar" def!(!e%(" areofte% ao(!ated w!th obe!t" ra!ed the ho-e that the eat of the d!order !3ht be !% th!3$a%d 'ut a$thou3h a $ar3e %uber of -!tu!tar" horo%e ha5e bee% !o$ated a%d a%"e/tra(t of the 3$a%d -re-ared; %ot a !%3$e o%e or a%" (ob!%at!o% of u(h fa(tor -ro5ed tobe of a%" 5a$ue !% the treate%t of obe!t" u!te re(e%t$"; howe5er; a fat0ob!$!B!%3 fa(tor habee% fou%d !% -!tu!tar" 3$a%d; but !t ! t!$$ too ear$" to a" whether th! fa(tor ! det!%ed to-$a" a ro$e !% the treate%t of obe!t"

The drenals

Re(e%t$"; a $o%3 er!e of br!$$!a%t d!(o5er!e (o%(er%!%3 the wor!%3 of the adre%a$ oru-rare%a$ 3$a%d; a$$ bod!e wh!(h !t ato- the !d%e"; ha5e (reated tree%dou !%teretTh! !%teret a$o tur%ed to the -rob$e of obe!t" whe% !t wa d!(o5ered that a (o%d!t!o%wh!(h !% oe re-e(t reeb$e a e5ere (ae of obe!t" 0 the o0(a$$ed )uh!%3S"%droe 0 wa (aued b" a 3$a%du$ar %ew03rowth of the adre%a$ or b" the!r e/(e!5et!u$at!o% w!th A)TH; wh!(h ! the -!tu!tar" horo%e 3o5er%!%3 the a(t!5!t" of the outer r!%d

9



or (orte/ of the adre%a$

6he% we $ear%ed that a% ab%ora$ t!u$at!o% of the adre%a$ (orte/ (ou$d -rodu(e !3% thatreeb$e true obe!t"; th! %ow$ed3e fur%!hed %o -ra(t!(a$ ea% of treat!%3 obe!t" b"de(rea!%3 the a(t!5!t" of the adre%a$ (orte/ There ! %o e5!de%(e to u33et that !% obe!t"there ! a%" e/(e of adre%o(ort!(a$ a(t!5!t" !% fa(t; a$$ the e5!de%(e -o!%t to the (o%trar"There ee to be rather a $a( of adre%o(ort!(a$ fu%(t!o% a%d a de(reae !% the e(ret!o% of

A)TH fro the a%ter!or -!tu!tar" $obe C

So here a3a!% our ear(h for the e(ha%! wh!(h -rodu(e obe!t" $ed u !%to a b$!%d a$$e"Re(e%t$"; a%" tude%t of obe!t" ha5e re5erted to the %!h!$!t!( att!tude that obe!t" !(aued !-$" b" o5ereat!%3 a%d that !t (a% o%$" be (ured b" u%der eat!%3

The Dience!halon or Hy!othala"us

For thoe of u who refued to be d!(oura3ed there rea!%ed o%e $!3ht ho-e 'ur!ed dee-dow% !% the a!5e hua% bra!% there ! a -art wh!(h we ha5e !% (oo% w!th a$$ 5ertebratea%!a$; the o0(a$$ed d!e%(e-ha$o% It ! a 5er" -r!!t!5e -art of the bra!% a%d ha !% a%bee% a$ot othered b" the hu3e ae of %er5ou t!ue w!th wh!(h we th!%; reao%a%d 5o$u%tar!$" o5e our bod" The d!e%(e-ha$o% ! the -art fro wh!(h the (e%tra$ %er5ou"te (o%tro$ a$$ the autoat!( a%!a$ fu%(t!o% of the bod"; u(h a breath!%3; the heartbeat; d!3et!o%; $ee-; e/; the ur!%ar" "te; the auto%oou or 5e3etat!5e %er5ou "tea%d 5!a the -!tu!tar" the who$e !%ter-$a" of the e%do(r!%e 3$a%d

It wa therefore %ot u%reao%ab$e to u--oe that the (o-$e/ o-erat!o% of tor!%3 a%d!u!%3 fue$ to the bod" !3ht a$o be (o%tro$$ed b" the d!e%(e-ha$o% It ha $o%3 bee% %ow%that the (o%te%t of u3ar 0 a%other for of fue$ 0 !% the b$ood de-e%d o% a (erta!% %er5ou(e%ter !% the d!e%(e-ha$o% 6he% th! (e%ter ! detro"ed !% $aborator" a%!a$; the" de5e$o-a (o%d!t!o% rather !!$ar to hua% tab$e d!abete It ha a$o $o%3 bee% %ow% that thedetru(t!o% of a%other d!e%(e-ha$!( (e%ter -rodu(e a 5ora(!ou a--et!te a%d a ra-!d 3a!% !%

we!3ht !% a%!a$ wh!(h %e5er 3et fat -o%ta%eou$"

C There ! oe ($!%!(a$ e5!de%(e to u33et that thoe "-to of )uh!%3 S"%droewh!(h reeb$e true obe!t" are (aued b" the ae e(ha%! wh!(h (aue (oo%obe!t"; wh!$e the other "-to of the "%droe are d!re(t$" due to adre%o(ort!(a$d"fu%(t!o%

10



The Fat#ban$

Au!%3 that !% a% u(h a (e%ter (o%tro$$!%3 the o5ee%t of fat doe e/!t; !t fu%(t!o%wou$d ha5e to be u(h $!e that of a ba% 6he% the bod" a!!$ate fro the !%tet!%a$ tra(tore fue$ tha% !t %eed at the oe%t; th! ur-$u ! de-o!ted !% what a" be (o-aredw!th a (urre%t a((ou%t Out of th! a((ou%t !t (a% a$wa" be w!thdraw% a re>u!red A$$ %ora$fat reer5e are !% u(h a (urre%t a((ou%t; a%d !t ! -robab$e that a d!e%(e-ha$!( (e%ter

a%a3e the de-o!t a%d w!thdrawa$

6he% %ow; for reao% wh!(h w!$$ be d!(ued $ater; the de-o!t 3row ra-!d$" wh!$e a$$w!thdrawa$ be(oe ore fre>ue%t; a -o!%t a" be rea(hed wh!(h 3oe be"o%d thed!e%(e-ha$o% ba%!%3 (a-a(!t" ut a a ba%er !3ht u33et to a wea$th" ($!e%t that!%tead of a((uu$at!%3 a $ar3e a%d u%a%a3eab$e (urre%t a((ou%t he hou$d !%5et h!ur-$u (a-!ta$; the bod" a--ear to etab$!h a f!/ed de-o!t !%to wh!(h a$$ ur-$u fu%d 3obut fro wh!(h the" (a% %o $o%3er be w!thdraw% b" the -ro(edure ued !% a (urre%t a((ou%tI% th! wa" the d!e%(e-ha$!( =fat0ba%= free !te$f fro a$$ wor wh!(h 3oe be"o%d !t %ora$ba%!%3 (a-a(!t" The o%et of obe!t" date fro the oe%t the d!e%(e-ha$o% ado-t th!$abor0a5!%3 rue O%(e a f!/ed de-o!t ha bee% etab$!hed the %ora$ fat reer5e are he$d

at a !%!u; wh!$e e5er" a5a!$ab$e ur-$u ! $o(ed awa" !% the f!/ed de-o!t a%d !therefore tae% out of %ora$ (!r(u$at!o%

11



THREE BASIC CA$SES O# OBESITY:

%&' The Inherited Factor

Au!%3 that there ! a $!!t to the d!e%(e-ha$o% fat ba%!%3 (a-a(!t"; !t fo$$ow that thereare three ba!( wa" !% wh!(h obe!t" (a% be(oe a%!fet The f!rt ! that the fat0ba%!%3

(a-a(!t" ! ab%ora$$" $ow fro b!rth Su(h a (o%3e%!ta$$" $ow d!e%(e-ha$!( (a-a(!t" wou$dthe% re-ree%t the !%her!ted fa(tor !% obe!t" 6he% th! ab%ora$ tra!t ! ared$" -ree%t;obe!t" w!$$ de5e$o- at a% ear$" a3e !% -!te of %ora$ feed!%3 th! (ou$d e/-$a!% wh" ao%3brother a%d !ter eat!%3 the ae food at the ae tab$e oe be(oe obee a%d otherdo %ot

%(' Other Dience!halic Disorders

The e(o%d wa" !% wh!(h obe!t" (a% be(oe etab$!hed ! the $ower!%3 of a -re5!ou$"%ora$ fat0ba%!%3 (a-a(!t" ow!%3 to oe other d!e%(e-ha$!( d!order It ee to be a3e%era$ ru$e that whe% o%e of the a%" d!e%(e-ha$!( (e%ter ! -art!(u$ar$" o5erta/ed !t tr!e

to !%(reae !t (a-a(!t" at the e/-e%e of other (e%ter

I% the e%o-aue a%d after (atrat!o% the horo%e -re5!ou$" -rodu(ed !% the e/ 3$a%d%o $o%3er (!r(u$ate !% the bod" I% the -ree%(e of %ora$$" fu%(t!o%!%3 e/ 3$a%d the!rhoro%e a(t a a brae o% the e(ret!o% of the e/ 3$a%d t!u$at!%3 horo%e of thea%ter!or -!tu!tar" 6he% th! brae ! reo5ed the a%ter!or -!tu!tar" e%orou$" !%(reae !tout-ut of thee e/ 3$a%d t!u$at!%3 horo%e; thou3h the" are %ow %o $o%3er effe(t!5e I%the abe%(e of a%" re-o%e fro the %o%0fu%(t!o%!%3 or !!%3 e/ 3$a%d; there ! %oth!%3to to- the a%ter!or -!tu!tar" fro -rodu(!%3 ore a%d ore of thee horo%e Th! !tuat!o%(aue a% e/(e!5e tra!% o% the d!e%(e-ha$!( (e%ter wh!(h (o%tro$ the fu%(t!o% of thea%ter!or -!tu!tar" I% order to (o-e w!th th! add!t!o%a$ burde% the (e%ter a--ear to draw orea%d ore e%er3" awa" fro other (e%ter; u(h a thoe (o%(er%ed w!th eot!o%a$ tab!$!t";the b$ood (!r(u$at!o% +hot f$uhe, a%d other auto%oou %er5ou re3u$at!o%; -art!(u$ar$" a$ofro the %ot o 5!ta$$" !-orta%t fat0ba%

The o0(a$$ed tab$e t"-e of d!abete hea5!$" !%5o$5e the d!e%(e-ha$!( b$ood u3ar re3u$at!%3(e%ter The d!e%(e-ha$o% tr!e to eet th! ab%ora$ $oad b" w!t(h!%3 e%er3" det!%ed forthe fat0ba% o5er to the u3ar0re3u$at!%3 (e%ter; w!th the reu$t that the fat0ba%!%3 (a-a(!t" !redu(ed to the -o!%t at wh!(h !t ! for(ed to etab$!h a f!/ed de-o!t a%d thu !%!t!ate thed!order we (a$$ obe!t" I% th! (ae o%e wou$d ha5e to (o%!der the d!abete the -r!ar"(aue of the obe!t"; but !t ! a$o -o!b$e that the -ro(e ! re5ered !% the e%e that adef!(!e%t or o5erwored fat0(e%ter draw e%er3" fro the u3ar0(e%ter; !% wh!(h (ae theobe!t" wou$d be the (aue of that t"-e of d!abete !% wh!(h the -a%(rea ! %ot -r!ar!$"

!%5o$5ed F!%a$$"; !t ! (o%(e!5ab$e that !% )uh!%3 "%droe thoe "-to wh!(hreeb$e obe!t" are e%t!re$" due to the w!thdrawa$ of e%er3" fro the d!e%(e-ha$!( fat0ba%!% order to ae !t a5a!$ab$e to the h!3h$" d!turbed (e%ter wh!(h 3o5er% the a%ter!or -!tu!tar"0adre%o(ort!(a$ "te

6hether obe!t" ! (aued b" a ared !%her!ted def!(!e%(" of the fat0(e%ter or b" oee%t!re$" d!ffere%t d!e%(e-ha$!( re3u$ator" d!order; !t !%ur3e%(e ob5!ou$" ha %oth!%3 to do

12



w!th o5ereat!%3 a%d !% e!ther (ae obe!t" ! (erta!% to de5e$o- re3ard$e of d!etar"retr!(t!o% I% thee (ae a%" e%for(ed food def!(!t ! ade u- fro ee%t!a$ fat reer5ea%d %ora$ tru(tura$ fat; u(h to the d!ad5a%ta3e of the -at!e%t 3e%era$ hea$th

%)' The *+haustion of the Fat#ban$

'ut there ! t!$$ a th!rd wa" !% wh!(h obe!t" (a% be(oe etab$!hed; a%d that ! whe% a-reuab$" %ora$ fat0(e%ter ! udde%$" 0 the e-ha! ! o% udde%$" 0 (a$$ed u-o% to dea$w!th a% e%orou !%f$u/ of food far !% e/(e of oe%tar" re>u!ree%t At f!rt 3$a%(e !tdoe ee that here we ha5e a tra!3ht0forward (ae of o5ereat!%3 be!%3 re-o%!b$e forobe!t"; but o% further a%a$"! !t oo% be(oe ($ear that the re$at!o% of (aue a%d effe(t !%ot o !-$e I% the f!rt -$a(e we are ere$" au!%3 that the (a-a(!t" of the fat0(e%ter !%ora$ wh!$e !t ! -o!b$e a%d e5e% -robab$e that o%$" -ero% who ha5e oe !%her!ted tra!t!% th! d!re(t!o% (a% be(oe obee ere$" b" o5ereat!%3

Se(o%d$"; !% a%" of thee (ae the aou%t of food eate% rea!% the ae a%d !t ! o%$"the (o%u-t!o% of fue$ wh!(h ! udde%$" de(reaed; a whe% a% ath$ete ! (o%f!%ed to bedfor a%" wee w!th a broe% bo%e or whe% a a% $ead!%3 a h!3h$" a(t!5e $!fe ! udde%$" t!ed

to h! de !% a% off!(e a%d to te$e5!!o% at hoe S!!$ar$"; whe% a -ero%; 3row% u- !% a (o$d($!ate; ! tra%ferred to a tro-!(a$ (ou%tr" a%d (o%t!%ue to eat a before; he a" de5e$o-obe!t" be(aue !% the heat far $e fue$ ! re>u!red to a!%ta!% the %ora$ bod" te-erature

6he% a -ero% uffer a $o%3 -er!od of -r!5at!o%; be !t due to (hro%!( !$$%e; -o5ert"; fa!%eor the e/!3e%(!e of war; h! d!e%(e-ha$!( re3u$at!o% ad?ut thee$5e to oe e/te%t to the$ow food !%tae 6he% the% udde%$" thee (o%d!t!o% (ha%3e a%d he ! free to eat a$$ thefood he wa%t; th! ! $!ab$e to o5erwhe$ h! fat0re3u$at!%3 (e%ter Dur!%3 the $at war about# 3ro$" u%derfed 2o$!h refu3ee who had -e%t harrow!%3 "ear !% Ru!a weretra%ferred to a (a- !% I%d!a where the" were we$$ houed; 3!5e% %ora$ 'r!t!h ar" rat!o%a%d oe (ah to bu" a few e/tra 6!th!% about three o%th; &J were uffer!%3 fro

obe!t"

I% a -ero% eat!%3 (oare a%d u%ref!%ed food; the d!3et!o% ! $ow a%d o%$" a $!tt$e%our!he%t at a t!e ! a!!$ated fro the !%tet!%a$ tra(t 6he% u(h a -ero% ! udde%$"ab$e to obta!% h!3h$" ref!%ed food u(h a u3ar; wh!te f$our; butter a%d o!$ thee are ora-!d$" d!3eted a%d a!!$ated that the ruh of !%(o!%3 fue$ wh!(h o((ur at e5er" ea$a" e5e%tua$$" o5er-ower the d!e(e%-ha$!( re3u$ator" e(ha%! a%d thu $ead to obe!t"Th! ! (oo%$" ee% !% the -oor a% who udde%$" be(oe r!(h e%ou3h to bu" the oree/-e%!5e ref!%ed food; thou3h h! tota$ (a$or!( !%tae rea!% the ae or ! e5e% $e tha%before

Psychological s!ects8u(h ha bee% wr!tte% about the -"(ho$o3!(a$ a-e(t of obe!t" Ao%3 !t a%" fu%(t!o%the d!e%(e-ha$o% ! a$o the eat of our -r!!t!5e a%!a$ !%t!%(t; a%d ?ut a !% a%eer3e%(" !t (a% w!t(h e%er3" fro o%e (e%ter to a%other; o !t ee to be ab$e to tra%fer-reure fro o%e !%t!%(t to a%other Thu; a $o%e$" a%d u%ha--" -ero% de-r!5ed of a$$eot!o%a$ (ofort a%d of a$$ !%t!%(t 3rat!f!(at!o% e/(e-t the t!$$!%3 of hu%3er a%d th!rt (a%ue thee a out$et for -e%t u- !%t!%(t -reure a%d o de5e$o- obe!t" @et o%(e that ha

13



ha--e%ed; %o aou%t of -"(hothera-" or a%a$"!; ha--!%e; (o-a%" or the 3rat!f!(at!o%of other !%t!%(t w!$$ (orre(t the (o%d!t!o%

,o"!ulsi-e *ating

No e%d of !%?ut!(e ! do%e to obee -at!e%t b" a((u!%3 the of (o-u$!5e eat!%3; wh!(h !a for of d!5erted e/03rat!f!(at!o% 8ot obee -at!e%t do %ot uffer fro (o-u$!5e eat!%3the" uffer 3e%u!%e hu%3er 0 rea$; 3%aw!%3; tortur!%3 hu%3er 0 wh!(h ha %oth!%3 whate5er todo w!th (o-u$!5e eat!%3 E5e% the!r udde% de!re for weet ! ere$" the reu$t of thee/-er!e%(e that weet; -atr!e a%d a$(oho$ w!$$ ot ra-!d$" of a$$ food a$$a" the -a%3 ofhu%3er Th! ha %oth!%3 to do w!th d!5erted !%t!%(t

O% the other ha%d; (o-u$!5e eat!%3 doe o((ur !% oe obee -at!e%t; -art!(u$ar$" !% 3!r$!% the!r $ate tee% or ear$" twe%t!e )o-u$!5e eat!%3 d!ffer fu%dae%ta$$" fro the obee-at!e%t 3reater %eed for food It (oe o% !% atta( a%d ! %e5er ao(!ated w!th rea$hu%3er; a fa(t wh!(h ! read!$" ad!tted b" the -at!e%t The" o%$" fee$ a fera$ de!re to tuffTwo -ou%d of (ho(o$ate a" be de5oured !% a few !%ute (o$d; 3rea" food fro therefr!3erator; ta$e bread; $efto5er o% ta(ed -$ate; a$ot a%"th!%3 ed!b$e ! (raed dow%

w!th terr!f"!%3 -eed a%d fero(!t"

I ha5e o((a!o%a$$" bee% ab$e to wat(h u(h a% atta( w!thout the -at!e%t %ow$ed3e; a%d !t! a fr!3hte%!%3; u3$" -e(ta($e to beho$d; e5e% !f o%e doe rea$!Be that e(ha%! e%t!re$"be"o%d the -at!e%t (o%tro$ are at wor A (arefu$ e%>u!r" !%to what a" ha5e brou3ht o%u(h a% atta( a$ot !%5ar!ab$" re5ea$ that !t ! -re(eded b" a tro%3 u%reo$5ed e/0t!u$at!o%; the h!3her (e%ter of the bra!% ha5!%3 b$o(ed -r!!t!5e d!e%(e-ha$!( !%t!%(t3rat!f!(at!o% The -reure ! the% $et off throu3h a%other -r!!t!5e (ha%%e$; wh!(h ! ora$3rat!f!(at!o% I% " e/-er!e%(e the o%$" th!%3 that w!$$ (ure th! (o%d!t!o% ! u%!%h!b!ted e/; athera-eut!( -ro(edure wh!(h ! hard$" e5er fea!b$e; for !f !t were; the -at!e%t wou$d ha5eado-ted !t w!thout -rofe!o%a$ -ro-t!%3; %or wou$d th! !% a%" wa" (orre(t the ao(!ated

obe!t" It wou$d o%$" ra!e %ew a%d ofte% 3reater -rob$e !f ued a a thera-eut!( eaure

2at!e%t uffer!%3 fro rea$ (o-u$!5e eat!%3 are (o-arat!5e$" rare I% " -ra(t!(e the"(o%t!tute about 10*J Treat!%3 the for obe!t" ! a heartre%d!%3 ?ob The" do -erfe(t$" we$$betwee% atta(; but a !%3$e bout o((urr!%3 wh!$e u%der treate%t a" a%%u$ e5era$ weeof thera-" L!tt$e wo%der that u(h -at!e%t be(oe d!(oura3ed I% thee (ae I ha5e fou%dthat -"(hothera-" a" ae the -at!e%t fu$$" u%derta%d the e(ha%!; but !t doe %oth!%3to to- !t 2erha- o(!et" 3row!%3 e/ua$ -er!!5e%e w!$$ ae (o-u$!5e eat!%3 e5e%rarer

6hether a -at!e%t ! rea$$" uffer!%3 fro (o-u$!5e eat!%3 or %ot ! hard to de(!de beforetreate%t be(aue a%" obee -at!e%t th!% that the!r de!re for food 0 to the u%ot!5ated

0 ! due to (o-u$!5e eat!%3; wh!$e a$$ the t!e !t ! ere$" a 3reater %eed for food The o%$"wa" to f!%d out ! to treat u(h -at!e%t Thoe that uffer fro rea$ (o-u$!5e eat!%3(o%t!%ue to ha5e u(h atta(; wh!$e thoe who are %ot (o-u$!5e eater %e5er 3et a% atta(dur!%3 treate%t

14



Reluctance to .ose /eight

Soe -at!e%t are dee-$" atta(hed to the!r fat a%d (a%%ot bear the thou3ht of $o!%3 !t If the"are !%te$$!3e%t; -o-u$ar a%d u((efu$ !% -!te of the!r ha%d!(a-; th! ! a our(e of -r!deSoe fat 3!r$ $oo u-o% the!r (o%d!t!o% a a afe3uard a3a!%t erot!( !%5o$5ee%t; of wh!(hthe" are afra!d The" wor out a -atter% of $!fe !% wh!(h the!r obe!t" -$a" a deter!%!%3 ro$ea%d the% be(oe re$u(ta%t to u-et th! -atter% a%d fa(e a %ew !%d of $!fe wh!(h w!$$ be

e%t!re$" d!ffere%t after the!r f!3ure ha be(oe %ora$ a%d ofte% 5er" attra(t!5e The" fear that-eo-$e w!$$ $!e the 0 or be ?ea$ou 0 o% a((ou%t of the!r f!3ure rather tha% be attra(ted b"the!r !%te$$!3e%(e or (hara(ter o%$" Soe ha5e a fee$!%3 that redu(!%3 ea% 3!5!%3 u- a%a$ot (her!hed a%d !%t!ate -art of thee$5e I% a%" of thee (ae -"(hothera-" (a%be he$-fu$; a !t e%ab$e thee -at!e%t to ee the who$e !tuat!o% !% the fu$$ $!3ht of(o%(!ou%e A% affe(t!o%ate atta(he%t to ab%ora$ fat ! uua$$" ee% !% -at!e%t whobe(ae obee !% (h!$dhood; but th! ! %ot %e(ear!$" o

I% a$$ other (ae the bet -"(hothera-" (a% do !% the uua$ treate%t of obe!t" ! to re%derthe burde% of hu%3er a%d %e5er0e%d!%3 d!etar" retr!(t!o% $!3ht$" ore to$erab$e 2at!e%twho ha5e u((efu$$" etab$!hed a% erot!( tra%fer to the!r -"(h!atr!t are ofte% better ab$e

to bear the!r uffer!%3 a a e(ret $abor of $o5e

There are thu a $ar3e %uber of wa" !% wh!(h obe!t" (a% be !%!t!ated; thou3h the d!order!te$f ! a$wa" due to the ae e(ha%!; a% !%ade>ua(" of the d!e%(e-ha$!( fat0(e%ter a%dthe $a"!%3 dow% of ab%ora$$" f!/ed fat de-o!t !% ab%ora$ -$a(e Th! ea% that o%(eobe!t" ha be(oe etab$!hed; !t (a% %o ore be (ured b" e$!!%at!%3 thoe fa(tor wh!(hbrou3ht !t o% tha% a f!re (a% be e/t!%3u!hed b" reo5!%3 the (aue of the (o%f$a3rat!o% Thua d!(u!o% of the 5ar!ou wa" !% wh!(h obe!t" (a% be(oe etab$!hed ! uefu$ fro a-re5e%tat!5e -o!%t of 5!ew; but !t ha %o bear!%3 o% the treate%t of the etab$!hed (o%d!t!o%The e$!!%at!o% of fa(tor wh!(h are ($ear$" hate%!%3 the (oure of the d!order a" $owdow% !t -ro3re or e5e% ha$t !t; but the" (a% %e5er (orre(t !t

0ot by /eight alone1

6e!3ht a$o%e ! %ot a at!fa(tor" (r!ter!o% b" wh!(h to ?ud3e whether a -ero% ! uffer!%3fro the d!order we (a$$ obe!t" or %ot E5er" -h"!(!a% ! fa!$!ar w!th the "$-h$!e $ad" whoe%ter the (o%u$t!%3 roo a%d de($are e-hat!(a$$" that he ! 3ett!%3 horr!b$" fat a%dw!he to redu(e 8a%" a% ho%et a%d "-athet!( -h"!(!a% at o%(e (o%($ude that he !dea$!%3 w!th a <%utK If he ! bu" he w!$$ 3!5e her hort hr!ft; but !f he ha t!e he w!$$ we!3hher a%d how her tab$e to -ro5e that he ! a(tua$$" u%derwe!3ht

I ha5e %e5er "et ee% or heard of u(h a $ad" be!%3 (o%5!%(ed b" e!ther -ro(edure Thereao% ! that !% " e/-er!e%(e the $ad" ! %ear$" a$wa" r!3ht a%d the do(tor wro%3 6he%

u(h a -at!e%t ! (arefu$$" e/a!%ed o%e f!%d a%" !3% of -ote%t!a$ obe!t"; wh!(h ! ?utabout to be(oe a%!fet a o5erwe!3ht The -at!e%t d!t!%(t$" fee$ that oeth!%3 ! wro%3w!th her; that a ubt$e (ha%3e ! ta!%3 -$a(e !% her bod"; a%d th! a$ar her

There are a %uber of !3% a%d "-to wh!(h are (hara(ter!t!( of obe!t" I% a%!fetobe!t" a%" a%d ofte% a$$ thee !3% a%d "-to are -ree%t I% $ate%t or ?ut be3!%%!%3(ae oe are a$wa" fou%d; a%d !t hou$d be a ru$e that !f two or ore of the bod!$" !3%

15



are -ree%t; the (ae ut be re3arded a o%e that %eed !ed!ate he$-

Signs and sy"!to"s of obesity

The bod!$" !3% a" be d!5!ded !%to u(h a ha5e de5e$o-ed before -ubert"; !%d!(at!%3 atro%3 !%her!ted fa(tor; a%d thoe wh!(h de5e$o- at the o%et of a%!fet d!order Ear$" !3%are a d!-ro-ort!o%ate$" $ar3e !Be of the two u--er fro%t teeth; the f!rt !%(!or; or a d!-$e o%both !de of the a(ra$ bo%e ?ut abo5e the butto( 6he% the ar are outtret(hed w!ththe -a$ u-ward; the forear a--ear har-$" a%3$ed outward fro the u--er ar Theae a--$!e to the $ower e/tre!t!e The -at!e%t (a%%ot br!%3 h! feet to3ether w!thout the%ee o5er$a--!%3 he !; !% fa(t; %o(0%eed

The be3!%%!%3 a((uu$at!o% of ab%ora$ fat how a a $!tt$e -ad ?ut be$ow the %a-e of the%e(; (o$$o>u!a$$" %ow% a the Du(he Hu- There ! a tr!a%3u$ar fatt" bu$3e !% fro%t of thear-!t whe% the ar ! he$d a3a!%t the bod" 6he% the !% ! tret(hed b" fat ra-!d$"a((uu$at!%3 u%der !t; !t a" -$!t !% the $ower $a"er 6he% $ar3e a%d freh; u(h tear are-ur-$e; but $ater the" are tra%fored !%to wh!te (ar0t!ue Su(h tr!at!o%; a !t ! (a$$ed;(oo%$" o((ur o% the abdoe% of woe% dur!%3 -re3%a%("; but !% obe!t" !t ! fre>ue%t$"

fou%d o% the breat; the h!- a%d o((a!o%a$$" o% the hou$der I% a%" (ae tr!at!o% !o f!%e that the a$$ wh!te $!%e are o%$" ?ut 5!!b$e The" are a$wa" a ure !3% of obe!t";a%d thou3h th! a" be $!3ht at the t!e of e/a!%at!o% u(h -at!e%t (a% uua$$" reebera -er!od !% the!r (h!$dhood whe% the" were e/(e!5e$" (hubb"

A%other t"-!(a$ !3% ! a -ad of fat o% the !%!de of the %ee; a -ot where %ora$ fatreer5e are %e5er tored There a" be a fo$d of !% o5er the -ub!( area a%d a%other fo$da" tret(h rou%d both !de of the (het; where a $ooe ro$$ of fat (a% be -!(ed u- betwee%two f!%3er I% the a$e a% e/(e!5e a((uu$at!o% of fat !% the breat ! a$wa" !%d!(at!5e;wh!$e !% the fea$e the breat ! uua$$"; but %ot %e(ear!$"; $ar3e Ob5!ou$" e/(e!5e fat o%the abdoe%; the h!-; th!3h; u--er ar; (h!% a%d hou$der are (hara(ter!t!(; a%d !t !!-orta%t to reeber that a%" %uber of thee !3% a" be -ree%t !% -ero% whoe

we!3ht ! tat!t!(a$$" %ora$ -art!(u$ar$" !f the" are d!et!%3 o% the!r ow% w!th !ro%deter!%at!o%

)oo% ($!%!(a$ "-to wh!(h are !%d!(at!5e o%$" !% the!r ao(!at!o% a%d !% the frae ofthe who$e ($!%!(a$ -!(ture are fre>ue%t heada(he; rheuat!( -a!% w!thout dete(tab$e bo%"ab%ora$!t" a fee$!%3 of $aB!%e a%d $ethar3"; ofte% both -h"!(a$ a%d e%ta$ a%d fre>ue%t$"ao(!ated w!th !%o%!a; the -at!e%t a"!%3 that a$$ the" wa%t ! to ret the fr!3hte%!%3fee$!%3 of be!%3 fa!hed a%d oet!e wea w!th hu%3er two to three hour after a heart"ea$ a%d a% !rre!t!b$e "ear%!%3 for weet a%d tar(h" food wh!(h ofte% o5er(oe the-at!e%t >u!te udde%$" a%d ! oet!e ubt!tuted b" a de!re for a$(oho$ (o%t!-at!o% a%da -at!( or !rr!tab$e (o$o% are u%uua$$" (oo% ao%3 the obee; a%d o are e%trua$

d!orderRetur%!%3 o%(e ore to our "$-h$!e $ad"; we (a% a" that a (ob!%at!o% of oe of thee"-to w!th a few of the t"-!(a$ bod!$" !3% ! uff!(!e%t e5!de%(e to tae her (aeer!ou$" A hua% f!3ure; a$e or fea$e; (a% o%$" be ?ud3ed !% the %ude a%" o-!%!o% baedo% the dreed a--eara%(e (a% be >u!te fa%tat!(a$$" w!de off the ar; a%d I fee$ "e$fdr!5e% to the (o%($u!o% that a-art fro fra%$" -"(hot!( -at!e%t u(h a (ae of a%ore/!a%er5oa a <orb!d we!3ht f!/at!o%K doe %ot e/!t I ha5e "et to ee a -at!e%t who (o%t!%ue to

16



(o-$a!% after the f!3ure ha bee% re%dered %ora$ b" ade>uate treate%t

The *"aciated .ady

I reeber the (ae of a $ad" who wa e(orted !%to " (o%u$t!%3 roo wh!$e I wate$e-ho%!%3 She at dow% !% fro%t of " de; a%d whe% I $ooed u- to 3reet her I aw thet"-!(a$ -!(ture of ad5a%(ed ea(!at!o% Her dr" !% hu%3 $ooe$" o5er the bo%e of her fa(e;her %e( wa (raw%" a%d (o$$arbo%e a%d r!b tu( out fro dee- ho$$ow I !ed!ate$"thou3ht of (a%(er a%d de(!ded to wh!(h of " (o$$ea3ue at the ho-!ta$ I wou$d refer herI%deed; I fe$t a $!tt$e a%%o"ed that " a!ta%t had %ot e/-$a!%ed to her that her (ae d!d %otfa$$ u%der " -e(!a$t" I% a%wer to " >uer" a to what I (ou$d do for her; he re-$!ed thathe wa%ted to redu(e I tr!ed to h!de " ur-r!e; but he ut ha5e %oted a f$eet!%3e/-re!o%; for he !$ed a%d a!d <I %ow that "ou th!% I ad; but ?ut wa!tK 6!th thathe roe a%d (ae rou%d to " !de of the de utt!%3 out fro a t!%" wa!t he hade%orou h!- a%d th!3h

'" u!%3 a te(h%!>ue wh!(h w!$$ -ree%t$" be de(r!bed; the ab%ora$ fat o% her h!- watra%ferred to the ret of her bod" wh!(h had bee% ea(!ated b" o%th of 5er" e5ere

d!et!%3 At the e%d of a treate%t $at!%3 f!5e wee; he; a a$$ woa%; had $ot & !%(herou%d her h!-; wh!$e her fa(e $ooed freh a%d f$or!d; the r!b were %o $o%3er 5!!b$e a%d herwe!3ht wa the ae to the ou%(e a !t had bee% at the f!rt (o%u$tat!o%

Fat but not Obese

6h!$e a -ero% who ! tat!t!(a$$" u%derwe!3ht a" t!$$ be uffer!%3 fro the d!order wh!(h(aue obe!t"; !t ! a$o -o!b$e for a -ero% to be tat!t!(a$$" o5erwe!3ht w!thout uffer!%3fro obe!t" For u(h -ero% we!3ht ! %o -rob$e; a the" (a% 3a!% or $oe at w!$$ a%de/-er!e%(e %o d!ff!(u$t" !% redu(!%3 the!r (a$or!( !%tae The" are ater of the!r we!3ht;wh!(h the obee are %ot 8oreo5er; the!r e/(e fat how %o -refere%(e for (erta!% t"-!(a$

re3!o% of the bod"; a doe the fat !% a$$ (ae of obe!t" Thu; the de(!!o% whether aborder$!%e (ae ! rea$$" uffer!%3 fro obe!t" or %ot (a%%ot be ade ere$" b" (o%u$t!%3we!3ht tab$e

17







tra%ferred ba( !%to the %ora$ (urre%t a((ou%t a%d free$" draw% u-o% to ae u- for a%"%utr!t!o%a$ def!(!t Dur!%3 -re3%a%("; e5er" ou%(e of reer5e fat ! -$a(ed at the d!-oa$ of the3row!%3 fetu 6ere th! %ot o; a% obee woa%; whoe %ora$ reer5e are a$read"de-$eted; wou$d ha5e the 3reatet d!ff!(u$t!e !% br!%3!%3 her -re3%a%(" to fu$$ ter There !(o%!derab$e e5!de%(e to u33et that !t ! the H)G -rodu(ed !% $ar3e >ua%t!t!e !% the-$a(e%ta wh!(h br!%3 about th! d!e%(e-ha$!( (ha%3e

Thou3h we a" be ab$e to !%(reae the d!e%ee-ha$!( fat0ba%!%3 (a-a(!t" b" !%?e(t!%3 H)G;th! doe %ot !% !te$f affe(t the we!3ht; ?ut a tra%ferr!%3 o%etar" fu%d fro a f!/edde-o!t !%to a (urre%t a((ou%t doe %ot ae a a% a%" -oorer to be(oe -oorer !t ! a$o%e(ear" that he free$" -e%d the o%e" wh!(h thu be(oe a5a!$ab$e I% -re3%a%(" the%eed of the 3row!%3 ebr"o tae (are of th! to oe e/te%t; but !% the treate%t of obe!t"there ! %o ebr"o; a%d o a 5er" e5ere d!etar" retr!(t!o% ut tae !t -$a(e for thedurat!o% of treate%t

O%$" whe% the fat wh!(h ! !% tra%!t u%der the effe(t of H)G ! a(tua$$" (o%ued (a% orefat be w!thdraw% fro the f!/ed de-o!t I% -re3%a%(" !t wou$d be ot u%de!rab$e !f thefetu were offered a-$e food o%$" whe% there ! a h!3h !%f$u/ fro the !%tet!%a$ tra(t Idea$

%utr!t!o%a$ (o%d!t!o% for the fetu (a% o%$" be a(h!e5ed whe% the other b$ood ! (o%t!%ua$$"aturated w!th food; re3ard$e of whether he eat or %ot; a otherw!e a -er!od of tar5at!o%!3ht ha-er the tead" 3rowth of the ebr"o It ee that H)G br!%3 about th! (o%t!%ua$aturat!o% of the b$ood; wh!(h ! the reao% wh" obee -at!e%t u%der treate%t w!th H)G%e5er fee$ hu%3r" !% -!te of the!r drat!(a$$" redu(ed food !%tae

The Na"u%e o! Hu*an Cho%onc +onado"%on

H)G ! %e5er fou%d !% the hua% bod" e/(e-t dur!%3 -re3%a%(" a%d !% thoe rare (ae !%wh!(h a re!due of -$a(e%ta$ t!ue (o%t!%ue to 3row !% the wob !% what ! %ow% a a(hor!o%!( e-!the$!oa It ! %e5er fou%d !% the a$e The hua% t"-e of (hor!o%!(

3o%adotro-h!% ! fou%d o%$" dur!%3 the -re3%a%(" of woe% a%d the 3reat a-e It !-rodu(ed !% e%orou >ua%t!t!e; o that dur!%3 (erta!% -hae of her -re3%a%(" a woa%a" e/(rete a u(h a o%e !$$!o% I%ter%at!o%a$ :%!t -er da" !% her ur!%e 0 e%ou3h tore%der a !$$!o% !%fa%t!$e rat -re(o(!ou$" ature Other aa$ ae ue of a d!ffere%thoro%e; wh!(h (a% be e/tra(ted fro the!r b$ood eru but %ot fro the!r ur!%e The!r-$a(e%ta d!ffer !% th! a%d other re-e(t fro that of a% a%d the 3reat a-e Th! a%!a$(hor!o%!( 3o%adotro-h!% ! u(h $e ra-!d$" broe% dow% !% the hua% bod" tha% H)G; a%d!t ! a$o $e u!tab$e for the treate%t of obe!t"

A ofte% ha--e% !% ed!(!%e; u(h (o%fu!o% ha bee% (aued b" 3!5!%3 H)G !t %aebefore !t true ode of a(t!o% wa u%dertood It ha bee% e/-$a!%ed that gonadotrophin$!tera$$" ea% a e/ 3$a%d d!re(ted ubta%(e or horo%e; a%d th! ! >u!te !$ead!%3 Itdate fro the ear$" da" whe% !t wa f!rt fou%d that H)G ! ab$e to re%der !%fa%t!$e e/3$a%d ature; whereb" !t wa e%t!re$" o5er$ooed that !t ha %o t!u$at!%3 effe(t whatoe5ero% %ora$$" de5e$o-ed a%d %ora$$" fu%(t!o%!%3 e/ 3$a%d No aou%t of H)G ! e5er ab$eto !%(reae a %ora$ e/ fu%(t!o% !t (a% o%$" !-ro5e a% ab%ora$ o%e a%d !% the "ou%3hate% the o%et of -ubert" Howe5er; th! ! %o d!re(t effe(t H)G a(t e/($u!5e$" at ad!e%(e-ha$!( $e5e$ a%d there br!%3 about a (o%!derab$e !%(reae !% the fu%(t!o%a$ (a-a(!t" ofa$$ thoe (e%ter wh!(h are wor!%3 at a/!u (a-a(!t"

20



The Rea +onado"%ohns

Two horo%e %ow% !% the fea$e a fo$$!($e t!u$at!%3 horo%e +FSH, a%d (or-u $uteut!u$at!%3 horo%e +LSH, are e(reted b" the a%ter!or $obe of the -!tu!tar" 3$a%d Theehoro%e are rea$ 3o%adotro-h!% be(aue the" d!re(t$" 3o5er% the fu%(t!o% of the o5ar!eThe a%ter!or -!tu!tar" ! !% tur% 3o5er%ed b" the d!e%(e-ha$o%; a%d o whe% there ! a%o5ar!a% def!(!e%(" the d!e%(e-ha$!( (e%ter (o%(er%ed ! hard -ut to (orre(t atter b"

!%(rea!%3 the e(ret!o% fro the a%ter!or -!tu!tar" of FSH or LSH; a the (ae a" be 6he%e/ua$ def!(!e%(" ! ($!%!(a$$" -ree%t; th! ! a !3% that the d!e%(e-ha$!( (e%ter (o%(er%ed !u%ab$e; !% -!te of a/!a$ e/ert!o%; to (o-e w!th the dea%d for a%ter!or -!tu!tar" t!u$at!o%C 6he% the% the ad!%!trat!o% of H)G !%(reae the fu%(t!o%a$ (a-a(!t" of the d!e%(e-ha$o%;a$$ dea%d (a% be fu$$" at!f!ed a%d the e/ def!(!e%(" ! (orre(ted

That th! ! the true e(ha%! u%der$"!%3 the -reued 3o%adotro-h!( a(t!o% of H)G !(o%f!red b" the fa(t that whe% the -!tu!tar" 3$a%d of !%fa%t!$e rat ! reo5ed before the" are3!5e% H)G; the $atter ha %o effe(t o% the!r e/ 3$a%d H)G (a%%ot therefore ha5e a d!re(te/ 3$a%d t!u$at!%3 a(t!o% $!e that of the a%ter!or -!tu!tar" 3o%adotro-h!%; a FSH a%d LSHare ?ut$" (a$$ed The $atter are e%t!re$" d!ffere%t ubta%(e fro that wh!(h (a% be e/tra(ted

fro -re3%a%(" ur!%e a%d wh!(h; u%fortu%ate$"; ! (a$$ed (hor!o%!( 3o%adotro-h!% It wou$d be%o ore ($u"; a%d (erta!%$" far ore a--ro-r!ate; !f H)G were he%(eforth (a$$ed (hor!o%!(d!e%(e-ha$otro-h!%

HC+ no Se- Ho%*one

It (a%%ot be uff!(!e%t$" e-ha!Bed that H)G ! %ot a e/ horo%e; that !t a(t!o% ! !de%t!(a$!% e%; woe%; (h!$dre% a%d !% thoe (ae !% wh!(h the e/ 3$a%d %o $o%3er fu%(t!o% ow!%3to o$d a3e or the!r ur3!(a$ reo5a$ The o%$" e/ua$ (ha%3e !t (a% br!%3 about after -ubert" !a% !-ro5ee%t of a -re0e/!t!%3 def!(!e%("; but %e5er a t!u$at!o% be"o%d the %ora$ I% a%!%d!re(t wa" 5!a the a%ter!or -!tu!tar"; H)G re3u$ate e%truat!o% a%d fa(!$!tate (o%(e-t!o%;

but !t %e5er 5!r!$!Be a woa% or fe!%!Be a a% It %e!ther ae e% 3row breat %ordoe !t !%terfere w!th the!r 5!r!$!t"; thou3h where th! wa def!(!e%t !t a" !-ro5e !t It %e5erae woe% 3row a beard or de5e$o- a 3ruff 5o!(e I ha5e treed th! -o!%t o%$" for theae of " $a" reader; be(aue !t ! our da!$" e/-er!e%(e that whe% -at!e%t hear the wordhoro%e the" !ed!ate$" ?u- to the (o%($u!o% that th! ut ha5e oeth!%3 to do w!ththe e/0 -here The" are %ot a((utoed a we are; to th!% th"ro!d; !%u$!%; (ort!o%e;adre%a$!% et(; a horo%e

C A we are -ea!%3 of -ure$" re3u$ator" d!order; we ob5!ou$" e/($ude a$$ u(h (ae !%wh!(h there are 3ro or3a%!( $e!o% of the -!tu!tar" or the e/ 3$a%d thee$5e

21



I*o%"ance and Po"enc) o! HC+

Ow!%3 to the fa(t that H)G ha %o d!re(t a(t!o% o% a%" e%do(r!%e 3$a%d; !t e%orou!-orta%(e !% -re3%a%(" ha bee% o5er$ooed a%d !t -ote%(" u%deret!ated Thou3h a-re3%a%t woa% (a% -rodu(e a u(h a o%e !$$!o% u%!t -er da"; we f!%d that the doe ofo%$" 1* u%!t -er da" ! a-$e to redu(e we!3ht at the rate of rou3h$" o%e -ou%d -er da";e5e% !% a (o$ou we!3h!%3 4 -ou%d; whe% ao(!ated w!th a 0)a$or!e d!et It ! %o

e/a33erat!o% to a" that the f$ood!%3 of the fea$e bod" w!th H)G ! b" far the ot-e(ta(u$ar horo%a$ e5e%t !% -re3%a%(" It ha a% e%orou -rote(t!5e !-orta%(e forother a%d (h!$d; a%d I e5e% 3o o far a to a" that %o woa%; a%d (erta!%$" %ot a% obeeo%e; (ou$d (arr" her -re3%a%(" to ter w!thout !t

If I (a% be for3!5e% for (o-ar!%3 " fe$$ow0e%do(r!%o$o3!t w!th w!(ed Godother; H)Gha (erta!%$" bee% the!r )!%dere$$a; a%d I (a% o%$" roa%t!(a$$" ho-e that !t e/traord!%ar"effe(t o% ab%ora$ fat w!$$ -ro5e to be !t Fa!r" Godother

H)G ha bee% %ow% for o5er ha$f a (e%tur" It ! the ubta%(e wh!(h A(hhe! a%d o%deo br!$$!a%t$" ued to d!a3%oe ear$" -re3%a%(" out of the ur!%e A-art fro that; the o%$" th!%3!t d!d !% the e/-er!e%ta$ $aborator" wa to -rodu(e -re(o(!ou rat; a%d that wa %ot-art!(u$ar$" t!u$at!%3 to further reear(h at a t!e whe% u(h ore thr!$$!%3 e%do(r!%o$o3!(a$d!(o5er!e were -our!%3 !% fro a$$ !de; wee-!%3 H)G !%to the t!$$er ba( water

,o"!licating Disorders

Soe (o-$!(at!%3 d!order are ofte% ao(!ated w!th obe!t"; a%d thee we ut br!ef$"d!(u The ot !-orta%t ao(!ated d!order a%d the o%e !% wh!(h obe!t" ee to-$a" a -re(!-!tat!%3 or at $eat a% a33ra5at!%3 ro$e are the fo$$ow!%3 the tab$e t"-e ofd!abete; 3out; rheuat! a%d arthr!t!; h!3h b$ood -reure a%d harde%!%3 of the arter!e;(oro%ar" d!eae a%d (erebra$ heorrha3e

A-art fro the fa(t that the" are ofte% 0 thou3h %ot %e(ear!$" 0 ao(!ated w!th obe!t";thee d!order ha5e two th!%3 !% (oo% I% a$$ of the; oder% reear(h ! be(o!%3ore a%d ore !%($!%ed to be$!e5e that d!e%(e-ha$!( re3u$at!o% -$a" a do!%a%t ro$e !% the!r(auat!o% The other (oo% fa(tor ! that the" e!ther !-ro5e or do %ot o((ur dur!%3-re3%a%(" I% the $atter re-e(t the" are ?o!%ed b" a%" other d!order %ot %e(ear!$"ao(!ated w!th obe!t" Su(h d!order are; for !%ta%(e; (o$!t!; duode%a$ or 3atr!( u$(er;(erta!% a$$er3!e; -or!a!; $o of ha!r; br!tt$e f!%3er%a!$; !3ra!%e; et(

If H)G M d!et doe !% the obee br!%3 about thoe d!e%(e-ha$!( (ha%3e wh!(h are(hara(ter!t!( of -re3%a%("; o%e wou$d e/-e(t to ee a% !-ro5ee%t !% a$$ thee (o%d!t!o%(o-arab$e to that ee% !% rea$ -re3%a%(" The ad!%!trat!o% of H)G doe !% fa(t do th! !% a

rearab$e wa"

Dabe"es

I% a% obee -at!e%t uffer!%3 fro a fa!r$" ad5a%(ed (ae of tab$e d!abete of a%" "eardurat!o% !% wh!(h the b$ood u3ar a" ra%3e fro .04 3J; !t ! ofte% -o!b$e to to- a$$a%t!d!abet!( ed!(at!o% after the f!rt few da" of treate%t The b$ood u3ar (o%t!%ue todro- fro da" to da" a%d ofte% rea(he %ora$ 5a$ue !% *0. wee A !% -re3%a%("; th!

22



-he%oe%o% ! %ot ober5ed !% the br!tt$e t"-e of d!abete; a%d a oe (ae that are-redo!%a%t$" tab$e a" ha5e a a$$ br!tt$e fa(tor !% the!r ($!%!(a$ aeu-; a$$ obeed!abet!( ha5e to be e-t u%der a 5er" (arefu$ a%d e/-ert wat(h

A br!tt$e (ae of d!abete ! -r!ar!$" due to the !%ab!$!t" of the -a%(rea to -rodu(e uff!(!e%t!%u$!%; wh!$e !% the tab$e t"-e; d!e%(e-ha$!( re3u$at!o% ee to be of 3reater !-orta%(eThat ! -o!b$" the reao% wh" the tab$e for re-o%d o we$$ to the H)G ethod of

treat!%3 obe!t"; wherea the br!tt$e t"-e doe %ot Obee -at!e%t are 3e%era$$" uffer!%3 frothe tab$e t"-e; but a tab$e t"-e a" 3radua$$" (ha%3e !%to a br!tt$e o%e; wh!(h ! uua$$"ao(!ated w!th a $o of we!3ht Thu; whe% a% obee d!abet!( f!%d that he ! $o!%3 we!3htw!thout d!et or treate%t; he hou$d at o%(e ha5e h! d!abete e/-ert$" atte%ded to There !oe e5!de%(e to u33et that the (ha%3e fro tab$e to br!tt$e ! ore $!ab$e to o((ur !%-at!e%t who are ta!%3 !%u$!% for the!r tab$e d!abete

Rheu*a"s*

A$$ rheuat!( -a!%; e5e% thoe ao(!ated w!th deo%trab$e bo%" $e!o%; !-ro5eub?e(t!5e$" w!th!% a few da" of treate%t; a%d ofte% re>u!re %e!ther (ort!o%e %or a$!("$ate

A3a!% th! ! a we$$ %ow% -he%oe%o% !% -re3%a%("; a%d wh!$e u%der treate%t w!th H)G Md!et the effe(t ! %o $e draat!( A !t doe after -re3%a%("; the -a!% of defored ?o!%tretur% after treate%t; but a$$er doe of -a!%0re$!e5!%3 dru3 ee ab$e to (o%tro$ !tat!fa(tor!$" after we!3ht redu(t!o% I% a%" (ae; the H)G ethod ae !t -o!b$e !% obeearthr!t!( -at!e%t to !%terru-t -ro$o%3ed (ort!o%e treate%t w!thout a re(urre%(e of -a!% Th!!% !te$f ! ot we$(oe; but there ! the added ad5a%ta3e that the treate%t t!u$ate thee(ret!o% of A)TH !% a -h"!o$o3!(a$ a%%er a%d that th! re3e%erate the adre%a$ (orte/;wh!(h ! a-t to uffer u%der -ro$o%3ed (ort!o%e treate%t

Choes"e%o

The e/a(t e/te%t to wh!(h the b$ood (ho$etero$ ! !%5o$5ed !% harde%!%3 of the arter!e; h!3hb$ood -reure a%d (oro%ar" d!eae ! %ot a "et %ow%; but !t ! %ow w!de$" ad!tted thatthe b$ood (ho$etero$ $e5e$ ! 3o5er%ed b" d!e%(e-ha$!( e(ha%! The beha5!or of(!r(u$at!%3 (ho$etero$ ! therefore of -art!(u$ar !%teret dur!%3 the treate%t of obe!t" w!thH)G )ho$etero$ (!r(u$ate !% two for; wh!(h we (a$$ free a%d eter!f!ed Nora$$" theefra(t!o% are -ree%t !% a -ro-ort!o% of about *J free to 7J eter!f!ed (ho$etero$; a%d !t !the $atter fra(t!o% wh!(h daa3e the wa$$ of the arter!e I% -re3%a%(" th! -ro-ort!o% !re5ered a%d !t a" he tae% for 3ra%ted that arter!o($ero! %e5er 3et wore dur!%3-re3%a%(" for th! 5er" reao%

To " %ow$ed3e; the o%$" other (o%d!t!o% !% wh!(h the -ro-ort!o% of free to eter!f!ed(ho$etero$ ! re5ered ! dur!%3 the treate%t of obe!t" w!th H)G M d!et; whe% e/a(t$" theae -he%oe%o% tae -$a(e Th! ee a% !-orta%t !%d!(at!o% of how ($oe$" a -at!e%tu%der H)G treate%t reeb$e a -re3%a%t woa% !% d!e%(e-ha$!( beha5!or

6he% the tota$ aou%t of (!r(u$at!%3 (ho$etero$ ! %ora$ before treate%t; th! abo$uteaou%t ! %e!ther !3%!f!(a%t$" !%(reaed %or de(reaed 'ut whe% a% obee -at!e%t w!th a%ab%ora$$" h!3h (ho$etero$ a%d a$read" how!%3 !3% of arter!o($ero! ! treated w!thH)G; h! b$ood -reure dro- a%d h! (oro%ar" (!r(u$at!o% ee to !-ro5e; a%d "et h!

23



tota$ b$ood (ho$etero$ a" oar to he!3ht %e5er before rea(hed

At f!rt th! 3reat$" a$ared u 'ut the% we aw that the -at!e%t (ae to %o har e5e% !ftreate%t wa (o%t!%ued a%d we fou%d !% fo$$ow0u- e/a!%at!o% u%dertae% oe o%thafter treate%t that the (ho$etero$ wa u(h better tha% !t had bee% before treate%t A the!%(reae ! ot$" !% the for of the %ot da%3erou free (ho$etero$; we 3radua$$" (ae towe$(oe the -he%oe%o% Toda" we be$!e5e that the r!e ! e%t!re$" due to the $!berat!o% of

re(e%t (ho$etero$ de-o!t that ha5e %ot "et u%der3o%e (a$(!f!(at!o% !% the arter!a$ wa$$ a%dtherefore h!3h$" be%ef!(!a$

+ou"

A% !de%t!(a$ beha5!or ! fou%d !% the b$ood ur!( a(!d $e5e$ of -at!e%t uffer!%3 fro 3out2red!(tab$" u(h -at!e%t 3et a% a(ute a%d ofte% e5ere atta( after the f!rt few da" of H)Gtreate%t but the% rea!% e%t!re$" free of -a!%; !% -!te of the fa(t that the!r b$ood ur!( a(!dofte% how a ared !%(reae wh!(h a" -er!t for e5era$ o%th after treate%t Thoe-at!e%t who ha5e re3a!%ed the!r %ora$ we!3ht rea!% free of "-to re3ard$e of whatthe" eat; wh!$e thoe that re>u!re a e(o%d (oure of treate%t 3et a%other atta( of 3out a

oo% a the e(o%d (oure ! !%!t!ated 6e do %ot "et %ow what d!e%(e-ha$!( e(ha%!are !%5o$5ed !% 3out -o!b$" eot!o%a$ fa(tor -$a" a ro$e; a%d !t ! worth reeber!%3 thatthe d!eae doe %ot o((ur !% woe% of (h!$dbear!%3 a3e 6e %ow 3!5e * tab$et da!$" of@LORI) to a$$ -at!e%t who 3!5e a h!tor" of 3out a%d ha5e a h!3h b$ood ur!( a(!d $e5e$ I%th! wa" we (a% (o-$ete$" a5o!d atta( dur!%3 treate%t

Bood P%essu%e

2at!e%t who ha5e brou3ht thee$5e to the br!% of a$%utr!t!o% b" e/a33erated d!et!%3;$a/at!5e et(; ofte% ha5e a% ab%ora$$" $ow b$ood -reure I% thee (ae the b$ood -reurer!e to %ora$ 5a$ue at the be3!%%!%3 of treate%t a%d the% 5er" 3radua$$" dro-; a !t

a$wa" doe !% -at!e%t w!th a %ora$ b$ood -reure Nora$ 5a$ue are a$wa" re3a!%ed afew da" after the treate%t ! o5er Of th! $ower!%3 of the b$ood -reure dur!%3 treate%tthe -at!e%t are %ot aware 6he% the b$ood -reure ! ab%ora$$" h!3h; a%d -ro5!ded thereare %o dete(tab$e re%a$ $e!o%; the -reure dro-; a !t uua$$" doe !% -re3%a%(" The dro-! ofte% 5er" ra-!d; o ra-!d !% fa(t that !t oet!e ! ad5!ab$e to $ow dow% the -ro(ew!th -reure0uta!%!%3 ed!(at!o% u%t!$ the (!r(u$at!o% ha had a few da" t!e to ad?ut!te$f to the %ew !tuat!o% O% the other ha%d; ao%3 the thoua%d of (ae treated we ha5e%e5er ee% a%" u%toward !%(!de%t wh!(h (ou$d be attr!buted to the rather udde% dro- !% h!3hb$ood -reure

6he% a woa% uffer!%3 fro h!3h b$ood -reure be(oe -re3%a%t her b$ood -reure5er" oo% dro-; but after her (o%f!%ee%t !t a" 3radua$$" r!e ba( to !t forer $e5e$S!!$ar$"; a h!3h b$ood -reure -ree%t before H)G treate%t te%d to r!e a3a!% after thetreate%t ! o5er; thou3h th! ! %ot a$wa" the (ae 'ut the forer h!3h $e5e$ are rare$"rea(hed; a%d we ha5e 3athered the !-re!o% that u(h re$a-e re-o%d better to orthodo/dru3 u(h a Reer-!%e tha% before treate%t

24



Pe"c $ce%s

I% our (ae of obe!t" w!th 3atr!( or duode%a$ u$(er we ha5e %ot!(ed a ur-r!!%3 ub?e(t!5e!-ro5ee%t !% -!te of a d!et wh!(h wou$d 3e%era$$" be (o%!dered ot !%a--ro-r!ate for a%u$(er -at!e%t Here; too; there ! a !!$ar!t" w!th -re3%a%("; !% wh!(h -e-t!( u$(er hard$" e5ero((ur Howe5er we ha5e ee% two (ae w!th a -re5!ou h!tor" of e5era$ heorrha3e !%wh!(h a b$eed!%3 o((urred w!th!% * wee of the e%d of treate%t

Pso%ass, #n(e%nas, Ha%, a%cose $ce%s

A !% -re3%a%("; -or!a! 3reat$" !-ro5e dur!%3 treate%t but a" re$a-e whe% thetreate%t ! o5er 8ot -at!e%t -o%ta%eou$" re-ort a ared !-ro5ee%t !% the (o%d!t!o%of br!tt$e f!%3er%a!$ The $o of ha!r %ot !%fre>ue%t$" ao(!ated w!th obe!t" ! te-orar!$"arreted; thou3h !% 5er" rare (ae a% !%(reaed $o of ha!r ha bee% re-orted I reeber a(ae !% wh!(h a -at!e%t de5e$o-ed a -at(h" ba$d%e o0(a$$ed alopecia areata 0 after ae5ere eot!o%a$ ho(; ?ut before he wa about to tart a% H)G treate%t Ourderato$o3!t d!a3%oed the (ae a a -art!(u$ar$" e5ere o%e; -red!(t!%3 that a$$ the ha!rwou$d be $ot He (ou%e$ed a3a!%t the redu(!%3 treate%t; but !% 5!ew of " -re5!ou

e/-er!e%(e a%d a the -at!e%t wa 5er" a%/!ou %ot to -ot-o%e redu(!%3; I d!(ued theatter w!th the derato$o3!t a%d !t wa a3reed that; ha5!%3 fu$$" a(>ua!%ted the -at!e%t w!ththe !tuat!o%; the treate%t hou$d be tarted Dur!%3 the treate%t; wh!(h $ated four wee;the further de5e$o-e%t of the ba$d -at(he wa a$ot; !f %ot >u!te; arreted howe5er; w!th!%a wee of ha5!%3 f!%!hed the (oure of H)G; a$$ the rea!%!%3 ha!r fe$$ out a -red!(ted b"the derato$o3!t The !%teret!%3 -o!%t ! that the treate%t wa ab$e to -ot-o%e th! reu$tbut %ot to -re5e%t !t The -at!e%t ha %ow 3row% a %ew to( of ha!r of wh!(h he ! ?ut$"-roud

I% obee -at!e%t w!th $ar3e 5ar!(oe u$(er we were ur-r!ed to f!%d that thee u$(er hea$ra-!d$" u%der treate%t w!th H)G 6e ha5e !%(e treated %o% obee -at!e%t uffer!%3 fro

5ar!(oe u$(er w!th da!$" doe of H)G o% %ora$ d!et w!th e>ua$$" 3ood reu$t

The /P%e(nan"0 Mae

6he% a a$e -at!e%t hear that he ! about to be -ut !%to a (o%d!t!o% wh!(h !% oe re-e(treeb$e -re3%a%("; he ! uua$$" ho(ed a%d horr!f!ed The -h"!(!a% ut therefore(arefu$$" e/-$a!% that th! doe %ot ea% that he w!$$ be fe!%!Bed a%d that H)G !% %o wa"!%terfere w!th h! e/ He ut be ade to u%derta%d that !% the !%teret of the -ro-a3at!o%of the -e(!e %ature -ro5!de for a -erfe(t fu%(t!o%!%3 of the re3u$ator" head>uarter !% thed!e%(e-ha$o% dur!%3 -re3%a%(" a%d that we are ere$" u!%3 th! %atura$ afe3uard a aea% of (orre(t!%3 the d!e%(e-ha$!( d!order wh!(h ! re-o%!b$e for h! o5erwe!3ht

25



TECHNI1$E

Wa%nn(s

I ut war% the $a" reader that what fo$$ow ! a!%$" for the treat!%3 -h"!(!a% a%d ot(erta!%$" %ot a do0!t0"oure$f -r!er 8a%" of the e/-re!o% ued ea% oeth!%3 e%t!re$"

d!ffere%t to a >ua$!f!ed do(tor tha% that wh!(h the!r (oo% ue !-$!e; a%d o%$" a -h"!(!a%(a% (orre(t$" !%ter-ret the "-to wh!(h a" ar!e dur!%3 treate%t A%" -at!e%t whoth!% he (a% redu(e b" ta!%3 a few <hotK a%d eat!%3 $e ! %ot o%$" ure to bed!a--o!%ted but a" be head!%3 for er!ou troub$e The be%ef!t the -at!e%t (a% der!5e froread!%3 th! -art of the boo ! a fu$$er rea$!Bat!o% of how 5er" !-orta%t !t ! for h! to fo$$ow tothe $etter h! -h"!(!a% !%tru(t!o%

I% treat!%3 obe!t" w!th the H)G M d!et ethod we are ha%d$!%3 what ! -erha- the ot(o-$e/ or3a% !% the hua% bod" The d!e%(e-ha$o% fu%(t!o%a$ e>u!$!br!u ! de$!(ate$"-o!ed; o that whate5er ha--e% !% o%e -art ha re-er(u!o% !% other I% obe!t" th!ba$a%(e ! out of !$ter a%d (a% o%$" be retored !f the te(h%!>ue I a about to de(r!be !

fo$$owed !-$!(!t$" E5e% ee!%3$" !%!3%!f!(a%t de5!at!o%; -art!(u$ar$" thoe that at f!rt !3htee to be a% !-ro5ee%t; are 5er" $!ab$e to -rodu(e ot d!a--o!%t!%3 reu$t a%d e5e%a%%u$ the effe(t (o-$ete$" For !%ta%(e; !f the d!et ! !%(reaed fro to # or 7)a$or!e; the $o of we!3ht ! >u!te u%at!fa(tor" If the da!$" doe of H)G ! ra!ed to * orore u%!t da!$" !t a(t!o% ofte% a--ear to be re5ered; -o!b$" be(aue $ar3er doe e5oed!e%(e-ha$!( (ou%ter0re3u$at!o% O% the other ha%d; the d!e%(e-ha$o% ! a% e/tree$" robutor3a% !% -!te of !t u%be$!e5ab$e !%tr!(a(" Fro a% e5o$ut!o%ar" -o!%t of 5!ew !t ! o%e of theo$det or3a% !% our bod" a%d !t e5o$ut!o%ar" h!tor" date ba( ore tha% !$$!o% "earTh! ha te%dered !t e/traord!%ar!$" ada-tab$e to a$$ %atura$ e/!3e%(!e; a%d that ! o%e of thea!% reao% wh" the hua% -e(!e wa ab$e to e5o$5e 6hat !t e5o$ut!o% d!d %ot -re-are !tfor were the (o%d!t!o% to wh!(h hua% (u$ture a%d (!5!$!Bat!o% %ow e/-oe !t

Hs"o%) "a2n(

6he% a -at!e%t f!rt -ree%t h!e$f for treate%t; we tae a 3e%era$ h!tor" a%d %ote thet!e whe% the f!rt !3% of o5erwe!3ht were ober5ed 6e tr" to etab$!h the h!3het we!3htthe -at!e%t ha e5er had !% h! $!fe +ob5!ou$" e/($ud!%3 -re3%a%(",; whe% th! wa; a%d whateaure ha5e h!therto bee% tae% !% a% effort to redu(e

It ha bee% our e/-er!e%(e that thoe -at!e%t who ha5e bee% ta!%3 th"ro!d -re-arat!o% for$o%3 -er!od ha5e a $!3ht$" $ower a5era3e $o of we!3ht u%der treate%t w!th H)G tha%thoe who ha5e %e5er tae% th"ro!d Th! ! e5e% o !% thoe -at!e%t who ha5e bee% ta!%3th"ro!d be(aue the" had a% ab%ora$$" $ow baa$ etabo$!( rate I% a%" of thee (ae the

$ow '8R ! %ot due to a%" !%tr!%!( def!(!e%(" of the th"ro!d 3$a%d; but rather to a $a( ofd!e%(e-ha$!( t!u$at!o% of the th"ro!d 3$a%d 5!a the a%ter!or -!tu!tar" $obe 6e %e5er a$$owth"ro!d to be tae% dur!%3 treate%t; a%d "et a '8R wh!(h wa 5er" $ow before treate%t !uua$$" fou%d to be %ora$ after a wee or two of H)G M d!et Need$e to a"; th! doe %ota--$" to thoe (ae !% wh!(h a th"ro!d def!(!e%(" ha bee% -rodu(ed b" the ur3!(a$ reo5a$of a -art of a% o5era(t!5e 3$a%d It ! a$o ot !-orta%t to a(erta!% whether the -at!e%t hatae% d!uret!( +water e$!!%at!%3 -!$$, a th! a$o de(reae the we!3ht $o u%der the H)G

26



re3!e%

Retur%!%3 to our -ro(edure; we %e/t a the -at!e%t a few >uet!o% to wh!(h he ! he$d tore-$" !-$" w!th <"eK or <%oK Thee >uet!o% are Do "ou uffer fro heada(herheuat!( -a!% e%trua$ d!order (o%t!-at!o% breath$e%e or e/ert!o% wo$$e%a%$e Do "ou (o%!der "oure$f 3reed" Do "ou fee$ the %eed to eat %a( betwee%ea$

The -at!e%t the% tr!- a%d ! we!3hed a%d eaured The %ora$ we!3ht for h! he!3ht; a3e;e$eta$ a%d u(u$ar bu!$d ! etab$!hed fro tab$e of tat!t!(a$ a5era3e; whereb" !%woe% !t ! ofte% %e(ear" to ae a% a$$owa%(e for -art!(u$ar$" $ar3e a%d hea5" breatThe de3ree of o5erwe!3ht ! the% (a$(u$ated; a%d fro th! the durat!o% of treate%t (a% berou3h$" aeed o% the ba! of a% a5era3e $o of we!3ht of a $!tt$e $e tha% a -ou%d; a".04 3ra0-er doe; -er da" It ! a -art!(u$ar$" !%teret!%3 feature of the H)G treate%tthat !% reao%ab$" (oo-erat!5e -at!e%t th! f!3ure ! rearab$" (o%ta%t; re3ard$e of e/;a3e a%d de3ree of o5erwe!3ht

The Du%a"on o! T%ea"*en"

2at!e%t who %eed to $oe 1 -ou%d +7 3, or $e re>u!re *# da" treate%t w!th *. da!$"doe The e/tra three da" are %eeded be(aue a$$ -at!e%t ut (o%t!%ue the 0)a$or!ed!et for three da" after the $at Th! ! a 5er" ee%t!a$ -art of the treate%t; be(aue !f the"tart eat!%3 %ora$$" a $o%3 a there ! e5e% a tra(e of H)G !% the!r bod" the" -ut o% we!3hta$ar!%3$" at the e%d of the treate%t After three da" whe% a$$ the H)G ha bee% e$!!%atedth! doe %ot ha--e%; be(aue the b$ood ! the% %o $o%3er aturated w!th food a%d (a% thua((oodate a% e/tra !%f$u/ fro the !%tet!%e w!thout !%(rea!%3 !t 5o$ue b" reta!%!%3water

6e %e5er 3!5e a treate%t $at!%3 $e tha% *# da"; e5e% !% -at!e%t %eed!%3 to $oe o%$" -ou%d It ee that e5e% !% the !$det (ae of obe!t" the d!e%(e-ha$o% re>u!re aboutthree wee ret fro the a/!a$ e/ert!o% to wh!(h !t ha bee% -re5!ou$" ub?e(ted !% orderto re3a!% fu$$" !t %ora$ fat0ba%!%3 (a-a(!t" )$!%!(a$$" th! e/-ree !te$f !% the fa(t thatwhe% !% thee !$d (ae treate%t ! to--ed a oo% a the we!3ht ! %ora$; wh!(h a" bea(h!e5ed !% a wee; !t ! u(h ore ea!$" re3a!%ed tha% after a fu$$ (oure of *. doe

A oo% a u(h -at!e%t ha5e $ot a$$ the!r ab%ora$ u-erf$uou fat; the" at o%(e be3!% tofee$ ra5e%ou$" hu%3r" !% -!te of (o%t!%ued doe Th! ! be(aue H)G o%$" -ut ab%ora$fat !%to (!r(u$at!o% a%d (a%%ot; !% the doe ued; $!berate %ora$ fat de-o!t !%deed; !tee to -re5e%t the!r (o%u-t!o% A oo% a the!r tat!t!(a$$" %ora$ we!3ht ! rea(hed;thee -at!e%t are -ut o% &01 )a$or!e for the ret of the treate%t The d!et ! arra%3ed!% u(h a wa" that the we!3ht rea!% -erfe(t$" tat!o%ar" a%d ! thu (o%t!%ued for three da"

after the *.rd doe O%$" the% are the -at!e%t free to eat a%"th!%3 the" -$eae e/(e-t u3ara%d tar(he for the %e/t three wee

Su(h ear$" (ae are (oo% ao%3 a(tree; ode$; a%d -ero% who are t!red ofobe!t"; ha5!%3 ee% !t ra5a3e !% other eber of the!r fa!$" F!$ a(tree fre>ue%t$"e/-$a!% that the" ut we!3h $e tha% %ora$ 6!th th! re>uet we f$at$" refue to (o-$";f!rt; be(aue we u%dertae to (ure a d!order; %ot to (reate a %ew o%e; a%d e(o%d; be(aue

27



!t ! !% the %ature of the H)G ethod that !t ! e$f $!!t!%3 It be(oe (o-$ete$" !%effe(t!5ea oo% a a$$ ab%ora$ fat ! (o%ued A(tree w!th a $!3ht te%de%(" to obe!t"; ha5!%3tr!ed a$$ a%%er of redu(!%3 ethod; !%5ar!ab$" (oe to the (o%($u!o% that the!r f!3ure !at!fa(tor" o%$" whe% the" are u%derwe!3ht; !-$" be(aue %o%e of thee ethod reo5ethe!r u-erf$uou fat de-o!t 6he% the" ee that u%der H)G the!r f!3ure !-ro5e out of a$$-ro-ort!o% to the aou%t of we!3ht $ot; the" are %ear$" a$wa" (o%te%t to rea!% w!th!% the!r

%ora$ we!3ht0ra%3e6he% a -at!e%t ha ore tha% 1 -ou%d to $oe the treate%t tae $o%3er but the a/!uwe 3!5e !% a !%3$e (oure ! 4 doe; %or do we a a ru$e a$$ow -at!e%t to $oe ore tha%.4 $b +1 P3, at a t!e The treate%t ! to--ed whe% e!ther .4 $b ha5e bee% $ot or 4doe ha5e bee% 3!5e% The o%$" e/(e-t!o% we ae ! !% the (ae of 3rote>ue$" obee-at!e%t who a" be a$$owed to $oe a% add!t!o%a$ 0# $b !f th! o((ur before the 4 doeare u-

I**un") "o HC+

The reao% for $!!t!%3 a (oure to 4 doe ! that b" the% oe -at!e%t a" be3!% to how

!3% of H)G !u%!t" Thou3h th! -he%oe%o% ! we$$ %ow%; we (a%%ot a "et def!%e theu%der$"!%3 e(ha%! 8a"be after a (erta!% $e%3th of t!e the bod" $ear% to brea dow%a%d e$!!%ate H)G 5er" ra-!d$"; or -o!b$" -ro$o%3ed treate%t $ead to oe ort of(ou%ter0re3u$at!o% wh!(h a%%u$ the d!e%(e-ha$!( effe(t

After 4 da!$" doe !t tae about !/ wee before th! o0(a$$ed !u%!t" ! $ot a%d H)Ga3a!% be(oe fu$$" effe(t!5e :ua$$" after about 4 doe -at!e%t a" fee$ the o%et of!u%!t" a hu%3er wh!(h wa -re5!ou$" abe%t I% thoe (o-arat!5e$" rare (ae !% wh!(h!3% of !u%!t" de5e$o- before the fu$$ (oure of 4 doe ha bee% (o-$eted 0 a" at the.th doe 0 treate%t ut be to--ed at o%(e; be(aue !f !t ! (o%t!%ued the -at!e%t be3!% to$oo wear" a%d draw%; fee$ wea a%d hu%3r" a%d a%" further $o of we!3ht a(h!e5ed ! the%a$wa" at the e/-e%e of %ora$ fat Th! ! %ot o%$" u%de!rab$e; but %ora$ fat ! a$o

!%ta%t$" re3a!%ed a oo% a the -at!e%t ! retur%ed to a free d!et2at!e%t who %eed o%$" *. doe a" be !%?e(ted da!$"; !%($ud!%3 Su%da"; a the" %e5erde5e$o- !u%!t" I% thoe that tae 4 doe the o%et of !u%!t" (a% be de$a"ed !f the"are 3!5e% o%$" !/ doe a wee; $ea5!%3 out Su%da" or a%" other da" the" (hooe; -ro5!dedthat !t ! a$wa" the ae da" O% the da" o% wh!(h the" do %ot re(e!5e the doe the"uua$$" fee$ a $!3ht e%at!o% of hu%3er At f!rt we thou3ht that th! !3ht be -ure$"-"(ho$o3!(a$; but we fou%d that whe% %ora$ a$!%e ! !%?e(ted w!thout the -at!e%t%ow$ed3e the ae -he%oe%o% o((ur

Mens"%ua"on

Dur!%3 e%truat!o% %o doe are 3!5e%; but the d!et ! (o%t!%ued a%d (aue %o hardh!-"et a oo% a the e%truat!o% ! o5er; the -at!e%t be(oe e/tree$" hu%3r" u%$e thedoe are reued at o%(e It ! 5er" !-re!5e to ee the uffer!%3 of a woa% who ha(o%t!%ued her d!et for a da" or two be"o%d the e%d of the -er!od w!thout (o!%3 for her doea%d the% to hear the %e/t da" that a$$ hu%3er (eaed w!th!% a few hour after the doe a%d toee her o%(e a3a!% (o%te%t; f$or!d a%d (heerfu$ 6h!$e o% the >uet!o% of e%truat!o% !t uthe added that !% tee%a3ed 3!r$ the -er!od a" !% oe rare (ae be de$a"ed a%d

28



e/(e-t!o%a$$" to- a$to3ether If the% $ater th! ! art!f!(!a$$" !%du(ed oe we!3ht a" bere3a!%ed

#u%"he% Cou%ses

2at!e%t re>u!r!%3 the $o of ore tha% .4 $b ut ha5e a e(o%d or e5e% ore (oure Ae(o%d (oure (a% be tarted after a% !%ter5a$ of %ot $e tha% !/ wee; thou3h the -aue(a% be ore tha% !/ wee 6he% a th!rd; fourth or e5e% f!fth (oure ! %e(ear"; the!%ter5a$ betwee% (oure hou$d be ade -ro3re!5e$" $o%3er 'etwee% a e(o%d a%d th!rd(oure e!3ht wee hou$d e$a-e; betwee% a th!rd a%d fourth (oure twe$5e wee; betwee%a fourth a%d f!fth (oure twe%t" wee a%d betwee% a f!fth a%d !/th (oure !/ o%th I% th!wa" !t ! -o!b$e to br!%3 about a we!3ht redu(t!o% of 1 $b a%d ore !f re>u!red w!thout the$eat hardh!- to the -at!e%t

I% 3e%era$; e% do $!3ht$" better tha% woe% a%d ofte% rea(h a oewhat h!3her a5era3eda!$" $o Ver" ad5a%(ed (ae do a $!tt$e better tha% ear$" o%e; but !t ! a rearab$e fa(tthat th! d!ffere%(e ! o%$" ?ut tat!t!(a$$" !3%!f!(a%t

Cond"ons "ha" *us" be acce"ed be!o%e "%ea"*en"

O% the ba! of thee data the -robab$e durat!o% of treate%t (a% he (a$(u$ated w!th(o%!derab$e a((ura("; a%d th! ! e/-$a!%ed to the -at!e%t It ! ade ($ear to h! that dur!%3the (oure of treate%t he ut atte%d the ($!%!( da!$" to be we!3hed; !%?e(ted a%d 3e%era$$"(he(ed A$$ -at!e%t that $!5e !% Roe or ha5e re!de%t fr!e%d or re$at!o% w!th who the"(a% ta" are treated a out0-at!e%t; but -at!e%t (o!%3 fro abroad ut ta" !% theho-!ta$; a %o hote$ or retaura%t (a% be re$!ed u-o% to -re-are the d!et w!th uff!(!e%ta((ura(" Thee -at!e%t ha5e the!r ea$; $ee-; a%d atte%d the ($!%!( !% the ho-!ta$; but areotherw!e free to -e%d the!r t!e a the" -$eae !% the (!t" a%d !t urrou%d!%3 !3htee!%3;bath!%3 or theater03o!%3

It ! a$o ade ($ear that betwee% (oure the -at!e%t 3et %o treate%t a%d ! free to eata%"th!%3 he -$eae e/(e-t tar(he a%d u3ar dur!%3 the f!rt . wee It ! !-reed u-o%h! that he w!$$ ha5e to fo$$ow the -re(r!bed d!et to the $etter a%d that after the f!rt three da"th! w!$$ (ot h! %o effort; a he w!$$ fee$ %o hu%3er a%d a" !%deed ha5e d!ff!(u$t" !% 3ett!%3dow% the )a$or!e wh!(h he w!$$ be 3!5e% If thee (o%d!t!o% are %ot a((e-tab$e the (ae! refued; a a%" (o-ro!e or ha$f0eaure ! bou%d to -ro5e utter$" d!a--o!%t!%3 to-at!e%t a%d -h"!(!a% a$!e a%d ! a wate of t!e a%d e%er3"

Thou3h a -at!e%t (a% o%$" (o%!der h!e$f rea$$" (ured whe% he ha bee% redu(ed to h!tat!(a$$" %ora$ we!3ht; we do %ot !%!t that he (o!t h!e$f to that e/te%t E5e% a -art!a$$o of o5erwe!3ht ! h!3h$" be%ef!(!a$; a%d !t ! our e/-er!e%(e that o%(e a -at!e%t ha

(o-$eted a f!rt (oure he ! o e%thu!at!( about the eae w!th wh!(h the 0 to h!ur-r!!%3 0 reu$t are a(h!e5ed that he a$ot !%5ar!ab$" (oe ba( for ore There(erta!%$" (a% be %o doubt that !% " ($!%!( ore t!e ! -e%t o% da-!%3 o5er0e%thu!atha% o% !%!t!%3 that the ru$e of the treate%t be ober5ed

29



E-a*nn( "he a"en"

O%$" whe% a3reee%t ! rea(hed o% the -o!%t o far d!(ued do we -ro(eed w!th thee/a!%at!o% of the -at!e%t A %ote ! ade of the !Be of the f!rt u--er !%(!or; of a -ad of fato% the %a-e of the %e(; at the a/!$$a a%d o% the !%!de of the %ee The -ree%(e of tr!at!o%;a u-ra-ub!( fo$d; a thora(!( fo$d; a%3u$at!o% of e$bow a%d %ee ?o!%t; breat0de5e$o-e%t !%e% a%d woe%; edea of the a%$e a%d the tate of 3e%!ta$ de5e$o-e%t !% the a$e are

%oted

6here5er th! ee !%d!(ated we Q0ra" the e$$a tur(!(a; a the bo%" (a-u$e wh!(h (o%ta!%the -!tu!tar" 3$a%d ! (a$$ed; eaure the baa$ etabo$!( rate; Q0ra" the (het a%d tae a%e$e(tro(ard!o3ra 6e do a b$ood0(ou%t a%d a ed!e%tat!o% rate a%d et!ate ur!( a(!d;(ho$etero$; !od!%e a%d u3ar !% the fat!%3 b$ood

+an be!o%e 3oss

2at!e%t whoe 3e%era$ (o%d!t!o% ! $ow; ow!%3 to e/(e!5e -re5!ou d!et!%3; ut eat to(a-a(!t" for about o%e wee before tart!%3 treate%t; re3ard$e of how u(h we!3ht the"

a" 3a!% !% the -ro(e O%e (a%%ot ee- a -at!e%t (ofortab$" o% )a$or!e u%$e h!%ora$ fat reer5e are reao%ab$" we$$ to(ed It ! for th! reao% a$o that e5er" (ae;e5e% thoe that are a(tua$$" 3a!%!%3 ut eat to (a-a(!t" of the ot fatte%!%3 food the" (a%3et dow% u%t!$ the" ha5e had the th!rd doe It ! a fu%dae%ta$ !tae to -ut a -at!e%t o% )a$or!e a oo% a the doe are tarted; a !t ee to tae about three doe beforeab%ora$$" de-o!ted fat be3!% to (!r(u$ate a%d thu be(oe a5a!$ab$e

6e d!t!%3u!h betwee% the f!rt three doe; wh!(h we (a$$ <%o%0effe(t!5eK a far a the $oof we!3ht ! (o%(er%ed; a%d the ube>ue%t doe 3!5e% wh!$e the -at!e%t ! d!et!%3; wh!(h we(a$$ <effe(t!5eK The a5era3e $o of we!3ht ! (a$(u$ated o% the %uber of effe(t!5e doe a%dfro the we!3ht rea(hed o% the da" of the th!rd doe; wh!(h a" be we$$ abo5e what !t watwo da" ear$!er whe% the f!rt doe wa 3!5e%

8ot -at!e%t who ha5e bee% tru33$!%3 w!th d!et for "ear a%d %ow how ra-!d$" the" 3a!% !fthe" $et thee$5e 3o are 5er" hard to (o%5!%(e of the abo$ute %e(e!t" of 3or3!%3 for at$eat two da"; a%d "et th! ut he !%!ted u-o% (ate3or!(a$$" !f the further (oure oftreate%t ! to ru% ooth$" Thoe -at!e%t who ha5e to be -ut o% for(ed feed!%3 for a weebefore tart!%3 the doe uua$$" 3a!% we!3ht ra-!d$" 0 four to !/ -ou%d !% *4 hour ! %otu%uua$ 0 but after a da" or two th! ra-!d 3a!% 3e%era$$" $e5e$ off I% a%" (ae; the who$e 3a!%! uua$$" $ot !% the f!rt 4& hour of d!et!%3 It ! %e(ear" to -ro(eed !% th! a%%erbe(aue the 3a!% re0to( the de-$eted %ora$ reer5e; wherea the ube>ue%t $o !fro the ab%ora$ de-o!t o%$"

2at!e%t !% a at!fa(tor" 3e%era$ (o%d!t!o% a%d thoe who ha5e %ot ?ut -re5!ou$" retr!(tedthe!r d!et tart for(ed feed!%3 o% the da" of the f!rt doe Soe -ate%t a" that the" (a% %o$o%3er o5ereat be(aue the!r <toa(h ha hru%K after "ear of retr!(t!o% 6h!$e we %owthat %o toa(h e5er hr!%; we (o-ro!e b" !%!t!%3 that the" eat fre>ue%t$" of h!3h$"(o%(e%trated food u(h a !$ (ho(o$ate; -atr!e w!th wh!--ed (rea; u3ar; fr!ed eat+-art!(u$ar$" -or,; e33 a%d ba(o%; a"o%%a!e; bread w!th th!( butter a%d ?a; et( Thet!e a%d troub$e -e%t o% -re!%3 th! -o!%t u-o% !%(redu$ou or re$u(ta%t -at!e%t ! a$wa"

30



a-$" rewarded afterward b" the (o-$ete abe%(e of thoe d!ff!(u$t!e wh!(h -at!e%t whoha5e d!re3arded thee !%tru(t!o% are $!ab$e to e/-er!e%(e

Dur!%3 the two da" of for(ed feed!%3 fro the f!rt to the th!rd doe 0 a%" -at!e%t areur-r!ed that (o%trar" to the!r -re5!ou e/-er!e%(e the" do %ot 3a!% we!3ht a%d oe e5e%$oe The e/-$a%at!o% ! that !% thee (ae there ! a (o-e%ator" f$ow of ur!%e; wh!(hdra!% e/(e!5e water fro the bod" To oe e/te%t th! ee to be a d!re(t a(t!o% of

H)G; but !t a" a$o be due to a h!3her -rote!% !%tae; a we %ow that a -rote!%0def!(!e%td!et ae the bod" reta!% water

S"a%"n( "%ea"*en"

I% e%truat!%3 woe%; the bet t!e to tart treate%t ! !ed!ate$" after a -er!odTreate%t a" a$o be tarted $ater; but !t ! ad5!ab$e to ha5e at $eat te% da" !% ha%dbefore the o%et of the %e/t -er!od S!!$ar$"; the e%d of a (oure of H)G hou$d %e5er beade to (o!%(!de w!th e%truat!o% If th!%3 hou$d ha--e% to wor out that wa"; !t ! betterto 3!5e the $at doe three da" before the e/-e(ted date of the e%e o that a %ora$ d!et(a% he reued at o%et A$ter%at!5e$"; at $eat three doe hou$d be 3!5e% after the -er!od;

fo$$owed b" the uua$ three da" of d!et!%3 Th! ru$e %eed %ot be ober5ed !% u(h -at!e%twho ha5e rea(hed the!r %ora$ we!3ht before the e%d of treate%t a%d are a$read" o% ah!3her (a$or!( d!et

2at!e%t who re>u!re ore tha% the !%!u of *. doe a%d who therefore !- o%e da" awee !% order to -ot-o%e !u%!t" to H)G (a%%ot ha5e the!r th!rd doe o% the da" beforethe !%ter5a$ Thu !f !t ! de(!ded to !- Su%da"; the treate%t (a% be tarted o% a%" da" ofthe wee e/(e-t Thurda" Su--o!%3 the" tart o% Thurda"; the" w!$$ ha5e the!r th!rd doeo% Saturda"; wh!(h ! a$o the da" o% wh!(h the" tart the!r )a$or!e d!et The" wou$d the%ha5e %o doe o% the e(o%d da" of d!et!%3 th! e/-oe the to a% u%%e(ear" hardh!-;a w!thout the doe the" w!$$ fee$ -art!(u$ar$" hu%3r" Of (oure; the d!ff!(u$t" (a% be o5er(oe

b" e/(e-t!o%a$$" !%?e(t!%3 the o% the f!rt Su%da" If th! da" fa$$ betwee% the f!rt a%de(o%d or betwee% the e(o%d a%d th!rd doe; we uua$$" -refer to 3!5e the -at!e%t the e/trada" of for(ed feed!%3; wh!(h the a?or!t" ra-turou$" e%?o"

31



The De"

The )a$or!e d!et ! e/-$a!%ed o% the da" of the e(o%d doe to thoe -at!e%t who w!$$ be-re-ar!%3 the!r ow% food; a%d !t ! ot !-orta%t that the -ero% who w!$$ a(tua$$" (oo !-ree%t 0 the w!fe; the other or the (oo; a the (ae a" be Here !% Ita$" -at!e%t are 3!5e%the fo$$ow!%3 d!et heet

'reafat Tea or (offee !% a%" >ua%t!t"w!thout u3ar O%$" o%etab$e-oo%fu$ of !$ a$$owed!% *4 hour Sa((har!% orother weete%er a" beued

Lu%(h

1 3ra of 5ea$; beef;(h!(e% breat; freh wh!tef!h; $obter; (rab or hr!-

A$$ 5!!b$e fat ut be (arefu$$"reo5ed before (oo!%3; a%dthe eat ut be we!3hedraw It ut be bo!$ed or3r!$$ed w!thout add!t!o%a$ fatSa$o%; ee$; tu%a; herr!%3;dr!ed or -!($ed f!h are %ota$$owed The (h!(e% breatut be reo5ed raw frothe b!rd

O%e t"-e of 5e3etab$e o%$" tobe (hoe% fro the fo$$ow!%3-!%a(h; (hard; (h!(or"; beet03ree%; 3ree% a$ad;toatoe; (e$er"; fe%%e$;o%!o%; red rad!he;(u(uber; a-ara3u;(abba3e

. O2TIONAL O%e breadt!(+3r!!%o, or o%e 8e$ba toat

4 A% a--$e or a% ora%3e or aha%dfu$ of trawberr!e oro%e0ha$f 3ra-efru!t

32



D!%%er The ae four (ho!(e a$u%(h

The ?u!(e of o%e $eo% da!$" ! a$$owed for a$$ -ur-oe Sa$t; -e--er; 5!%e3ar; utard-owder; 3ar$!(; weet ba!$; -ar$e"; th"e; a?ora; et(; a" be ued for eao%!%3; but %oo!$; butter or dre!%3

Tea; (offee; -$a!% water; or !%era$ water are the o%$" dr!% a$$owed; but the" a" be tae% !%a%" >ua%t!t" a%d at a$$ t!e

I% fa(t; the -at!e%t hou$d dr!% about * $!ter of thee f$u!d -er da" 8a%" -at!e%t are afra!dto dr!% o u(h be(aue the" fear that th! a" ae the reta!% ore water Th! ! awro%3 %ot!o% a the bod" ! ore !%($!%ed to tore water whe% the !%tae fa$$ be$ow !t%ora$ re>u!ree%t

The fru!t or the breadt!( a" be eate% betwee% ea$ !%tead of w!th $u%(h or d!%%er; but%ot ore tha% tha% four !te $!ted for $u%(h a%d d!%%er a" be eate% at o%e ea$

No ed!(!%e or (oet!( other tha% $!-t!(; e"ebrow -e%(!$ a%d -owder a" be uedw!thout -e(!a$ -er!!o%

E5er" !te !% the $!t ! 3o%e o5er (arefu$$"; (o%t!%ua$$" tre!%3 the -o!%t that %o 5ar!at!o%other tha% thoe $!ted a" be !%trodu(ed A$$ th!%3 %ot $!ted are forb!dde%; a%d the -at!e%t !aured that %oth!%3 -er!!b$e ha bee% $eft out The 1 3ra of eat ut he(ru-u$ou$" we!3hed raw after a$$ 5!!b$e fat ha bee% reo5ed To do th! a((urate$" the-at!e%t ut ha5e a $etter0(a$e; a !t(he% (a$e are %ot uff!(!e%t$" a((urate a%d the

but(her hou$d (erta!%$" %ot be re$!ed u-o% Thoe %ot u%(oo% -at!e%t who fee$ that e5e%o $!tt$e food ! too u(h for the; (a% o!t a%"th!%3 the" w!h

There ! %o ob?e(t!o% to brea!%3 u- the two ea$ For !%ta%(e ha5!%3 a breadt!( a%d a%a--$e for breafat or a% ora%3e before 3o!%3 to bed; -ro5!ded the" are dedu(ted fro there3u$ar ea$ The who$e da!$" rat!o% of two breadt!( or two fru!t a" %ot be eate% at theae t!e; %or (a% a%" !te a5ed fro the -re5!ou da" be added o% the fo$$ow!%3 da" I%the be3!%%!%3 -at!e%t are ad5!ed to (he( e5er" ea$ a3a!%t the!r d!et heet before tart!%3to eat a%d %ot to re$" o% the!r eor" It ! a$o worth -o!%t!%3 out that a%" atte-t to ober5eth! d!et w!thout H)G w!$$ $ead to troub$e !% two to three da" 6e ha5e had (ae !% wh!(h-at!e%t ha5e -roud$" f$au%ted the!r d!et!%3 -ower !% fro%t of the!r fr!e%d w!thout e%t!o%!%3

the fa(t that the" are a$o re(e!5!%3 treate%t w!th H)G The" $et the!r fr!e%d tr" the aed!et; a%d whe% th! -ro5e to be a fa!$ure 0 a !t %e(ear!$" ut 0 the -at!e%t tart ra!%3 !%u%er!ted udo for u-erhua% w!$$-ower

It hou$d a$o be e%t!o%ed that two a$$ a--$e we!3h!%3 a u(h a o%e $ar3e o%e%e5erthe$e ha5e a h!3her (a$or!( 5a$ue a%d are therefore %ot a$$owed; thou3h there ! %oretr!(t!o% o% the !Be of o%e a--$e Soe -eo-$e do %ot rea$!Be that a ta%3er!%e ! %ot a%ora%3e a%d that (h!(e% breat doe %ot ea% the breat of a%" other fow$; %or doe !t ea%

33



a w!%3 or drut!(

The ot t!reoe -at!e%t are thoe who tart (ou%t!%3 )a$or!e a%d the% (oe u- w!th a$$a%%er of !%3e%!ou 5ar!at!o% wh!(h the" (o-!$e fro the!r $!tt$e boo 6he% o%e ha-e%t "ear of wear" reear(h tr"!%3 to ae a d!et a attra(t!5e a -o!b$e w!thout

?eo-ard!B!%3 the $o of we!3ht; (u$!%ar" 3e%!ue who are out to !-ro5e the!r u%ha--" $ot arehard to tae

Ma2n( u "he Cao%es

The d!et ued !% (o%?u%(t!o% w!th H)G ut %ot e/(eed )a$or!e -er da"; a%d the wa"thee )a$or!e are ade u- ! of utot !-orta%(e For !%ta%(e; !f a -at!e%t dro- the a--$ea%d eat a% e/tra breadt!( !%tead; he w!$$ %ot be 3ett!%3 ore )a$or!e but he w!$$ %ot $oewe!3ht There are a %uber of food; -art!(u$ar$" fru!t a%d 5e3etab$e; wh!(h ha5e the aeor e5e% $ower (a$or!( 5a$ue tha% thoe $!ted a -er!!b$e; a%d "et we f!%d that the"!%terfere w!th the re3u$ar $o of we!3ht u%der H)G; -reuab$" ow!%3 to the %ature of the!r(o-o!t!o% 2!!e%to -e--er; ora; art!(hoe a%d -ear are e/a-$e of th!

6h!$e th! d!et wor at!fa(tor!$" !% Ita$"; (erta!% od!f!(at!o% ha5e to be ade !% other(ou%tr!e For !%ta%(e; Aer!(a% beef ha a$ot doub$e the (a$or!( 5a$ue of South Ita$!a%beef; wh!(h ! %ot arb$ed w!th fat Th! arb$!%3 ! !-o!b$e to reo5e I% Aer!(a;therefore; $ow03rade 5ea$ hou$d be ued for o%e ea$ a%d f!h +e/($ud!%3 a$$ thoe -e(!eu(h a herr!%3; a(ere$; tu%a; a$o%; ee$; et(; wh!(h ha5e a h!3h fat (o%te%t; a%d a$$dr!ed; oed or -!($ed f!h,; (h!(e% breat; $obter; (rawf!h; -raw%; hr!-; (rabeat or!d%e" for the other ea$ 6here the Ita$!a% breadt!(; the o0(a$$ed 3r!!%!; are %ota5a!$ab$e; o%e 8e$ba toat a" be ued !%tead; thou3h the" are -"(ho$o3!(a$$" $eat!f"!%3 A 8e$ba toat ha about the ae we!3ht a the 5er" -orou 3r!!%! wh!(h ! u(hore to $oo at a%d to (hew

I% a%" (ou%tr!e -e(!a$$" -re-ared u%weete%ed a%d $ow )a$or!e food are free$" a5a!$ab$e;a%d oe of thee (a% be te%tat!5e$" ued 6he% $o(a$ (o%d!t!o% or the feed!%3 hab!t of the-o-u$at!o% ae (ha%3e %e(ear"; !t ut be bor%e !% !%d that the tota$ da!$" !%tae ut%ot e/(eed )a$or!e !f the bet -o!b$e reu$t are to be obta!%ed; that the da!$" rat!o%hou$d (o%ta!% * 3ra of fat0free -rote!% a%d a 5er" a$$ aou%t of tar(h

ut a the da!$" doe of H)G ! the ae !% a$$ (ae; o the ae d!et -ro5e to beat!fa(tor" for a a$$ e$der$" $ad" of $e!ure or a hard wor!%3 u(u$ar 3!a%t :%der theeffe(t of H)G the obee bod" ! a$wa" ab$e to obta!% a$$ the )a$or!e !t %eed fro theab%ora$ fat de-o!t; re3ard$e of whether !t ue u- 1 or 4 -er da" It ut beade 5er" ($ear to the -at!e%t that he ! $!5!%3 to a far 3reater e/te%t o% the fat wh!(h he !$o!%3 tha% o% what he eat

8a%" -at!e%t a wh" e33 are %ot a$$owed The (o%te%t of two 3ood !Bed e33 arerou3h$" e>u!5a$e%t to 1 3ra of eat; but fortu%ate$" the "o$ (o%ta!% a $ar3e aou%t offat; wh!(h ! u%de!rab$e Ver" o((a!o%a$$" we a$$ow e33 0 bo!$ed; -oa(hed or raw 0 to -at!e%twho de5e$o- a% a5er!o% to eat; but !% th! (ae the" ut add the wh!te of three e33 tothe o%e the" eat who$e I% (ou%tr!e where (otta3e (heee ade fro !ed !$ !a5a!$ab$e 1 3ra a" o((a!o%a$$" be ued !%tead of the eat; but %o other (heee are

34



a$$owed

e(e"a%ans

Str!(t 5e3etar!a% u(h a orthodo/ H!%du -ree%t a -e(!a$ -rob$e; be(aue !$ a%d(urd are the o%$" a%!a$ -rote!% the" w!$$ eat To u--$" the w!th uff!(!e%t -rote!% of a%!a$or!3!% the" ut dr!% (( of !ed !$ -er da"; thou3h -art of th! rat!o% (a% be tae%a (urd A far a fru!t; 5e3etab$e a%d tar(h are (o%(er%ed; the!r d!et ! the ae a that of%o%05e3etar!a% the" (a%%ot be a$$owed the!r uua$ !%tae of 5e3etab$e -rote!% fro$e3u!%ou -$a%t u(h a bea% or fro wheat or %ut; %or (a% the" ha5e the!r (utoar"r!(e I% -!te of thee e5ere retr!(t!o%; the!r a5era3e $o ! about ha$f that of %o%05e3etar!a%; -reuab$" ow!%3 to the u3ar (o%te%t of the !$

#au") De"n(

Few -at!e%t w!$$ tae o%e word for !t that the $!3htet de5!at!o% fro the d!et ha u%derH)G d!atrou reu$t a far a the we!3ht ! (o%(er%ed Th! e/tree e%!t!5!t" ha thead5a%ta3e that the a$$et error ! !ed!ate$" dete(tab$e at the da!$" we!3h!%3 but ot

-at!e%t ha5e to ae the e/-er!e%(e before the" w!$$ be$!e5e !t

2ero% !% h!3h off!(!a$ -o!t!o% u(h a eba" -ero%%e$; -o$!t!(!a%; e%!or e/e(ut!5e;et(; who are ob$!3ed to atte%d o(!a$ fu%(t!o% to wh!(h the" (a%%ot br!%3 the!r ea3er ea$ut be to$d beforeha%d that a% off!(!a$ d!%%er w!$$ (ot the the $o of about three da"treate%t; howe5er (arefu$ the" are a%d !% -!te of a fr!e%d$" a%d wou$d0be (oo-erat!5e hot6e 3e%era$$" ad5!e the to a5o!d a$$0rou%d ebarrae%t; the a$ot !%e5!tab$e tur% of(o%5erat!o% to the!r we!3ht -rob$e a%d the out-our!%3 of $a" (ou%e$ fro the!r tab$e-art%er b" %ot $ett!%3 !t be %ow% that the" are u%der treate%t The" hou$d tae da!%t"er5!%3 of e5er"th!%3; h!de what the" (a% u%der the (ut$er" a%d boo the 3a!% wh!(h a"tae three da" to 3et r!d of a o%e of the a(r!f!(e wh!(h the!r -rofe!o% e%ta!$ A$$ow!%3

three da" for the!r (orre(t!o% u(h !%(!de%t do %ot ?eo-ard!Be the treate%t; -ro5!ded the"do %ot o((ur a$$ too fre>ue%t$"; !% wh!(h (ae treate%t hou$d be -ot-o%ed to a o(!a$$"ore -ea(efu$ eao%

"a*ns and ane*a

Soo%er or $ater ot -at!e%t e/-re a fear that the" a" be ru%%!%3 out of 5!ta!% or thatthe retr!(ted d!et a" ae the a%e!( O% th! (ore the -h"!(!a% (a% (o%f!de%t$" re$!e5ethe!r a--rehe%!o% b" e/-$a!%!%3 that e5er" t!e the" $oe a -ou%d of fatt" t!ue; wh!(h the"do a$ot da!$"; o%$" the a(tua$ fat ! bur%ed u- a$$ the 5!ta!%; the -rote!%; the b$ood; a%dthe !%era$ wh!(h th! t!ue (o%ta!% !% abu%da%(e are fed ba( !%to the bod" A(tua$$"; a$ow b$ood (ou%t %ot due to a%" er!ou d!order of the b$ood for!%3 t!ue !-ro5e dur!%3treate%t; a%d we ha5e %e5er e%(ou%tered a !3%!f!(a%t -rote!% def!(!e%(" %or !3% of a $a(of 5!ta!% !% -at!e%t who are d!et!%3 re3u$ar$"

The #%s" Da)s o! T%ea"*en"

O% the da" of the th!rd doe !t ! a$ot rout!%e to hear two rear O%e ! <@ou %ow;Do(tor; I ure !t o%$" -"(ho$o3!(a$; but I a$read" fee$ >u!te d!ffere%tK So (oo% ! th!

35



rear; e5e% fro 5er" e-t!(a$ -at!e%t; that we he!tate to a((e-t the -"(ho$o3!(a$!%ter-retat!o% The other t"-!(a$ rear ! <Now that I ha5e bee% a$$owed to eat a%"th!%3 Iwa%t; I (a%t 3et !t dow% S!%(e "eterda" I fee$ $!e a tuffed -!3 Food ?ut doe%t ee to!%teret e a%" ore; a%d I a $o%3!%3 to 3et o% w!th "our d!etK 8a%" -at!e%t %ot!(e thatthe" are -a!%3 ore ur!%e a%d that the we$$!%3 !% the!r a%$e ! $e e5e% before the" tartd!et!%3

O% the da" of the fourth doe ot -at!e%t de($are that the" are fee$!%3 f!%e The" ha5euua$$" $ot two -ou%d or ore; oe a" the" fee$ a b!t e-t" but hate% to e/-$a!% that th!doe %ot aou%t to hu%3er Soe (o-$a!% of a !$d heada(he of wh!(h the" ha5e bee%forewar%ed a%d for wh!(h the" ha5e bee% 3!5e% -er!!o% to tae a-!r!%

Dur!%3 the e(o%d a%d th!rd da" of d!et!%3 0 that !; the f!fth a%d !/th doe 0 thee !%or(o-$a!%t !-ro5e wh!$e the we!3ht (o%t!%ue to dro- at about doub$e the uua$$" o5era$$a5era3e of a$ot o%e -ou%d -er da"; o that a oderate$" e5ere (ae a" b" the fourthda" of d!et!%3 ha5e $ot a u(h a &01 $b

It ! uua$$" at th! -o!%t that a d!ffere%(e a--ear betwee% thoe -at!e%t who ha5e $!tera$$"

eate% to (a-a(!t" dur!%3 the f!rt two da" of treate%t a%d thoe who ha5e %ot The forerfee$ rearab$" we$$ the" ha5e %o hu%3er; %or do the" fee$ te-ted whe% other eat %ora$$"at the ae tab$e The" fee$ $!3hter; ore ($ear0headed a%d %ot!(e a de!re to o5e >u!te(o%trar" to the!r -re5!ou $ethar3" Thoe who ha5e d!re3arded the ad5!(e to eat to (a-a(!t"(o%t!%ue to ha5e !%or d!(ofort a%d do %ot ha5e the ae eu-hor!( e%e of we$$0be!%3u%t!$ about a wee $ater It ee that the!r %ora$ fat reer5e re>u!re that u(h ore t!ebefore the" are fu$$" to(ed

#uc"ua"ons n 4e(h" oss

After the fourth or f!fth da" of d!et!%3 the da!$" $o of we!3ht be3!% to de(reae to o%e -ou%dor oewhat $e -er ($a"; a%d there ! a a$$er ur!%ar" out-ut 8e% ofte% (o%t!%ue to $oere3u$ar$" at that rate; but woe% are ore !rre3u$ar; !% -!te of fau$t$e d!et!%3 There a" be%o dro- at a$$ for two or three da" a%d the% a udde% $o wh!(h reetab$!he the %ora$a5era3e Thee f$u(tuat!o% are e%t!re$" due to 5ar!at!o% !% the rete%t!o% a%d e$!!%at!o% ofwater; wh!(h are ore ared !% woe% tha% !% e%

The we!3ht re3!tered b" the (a$e ! deter!%ed b" two -ro(ee; %ot %e(ear!$""%(hro%!Bed :%der the !%f$ue%(e of H)G fat ! be!%3 e/tra(ted fro the (e$$; !% wh!(h !t !tored !% the fatt" t!ue 6he% thee (e$$ are e-t" a%d therefore er5e %o -ur-oe; thebod" brea dow% the (e$$u$ar tru(ture a%d aborb !t; but brea!%3 u- of ue$e (e$$;(o%%e(t!5e t!ue; b$ood 5ee$; et(; a" $a3 beh!%d the -ro(e of fat0e/tra(t!o% 6he% th!ha--e%; the bod" a--ear to re-$a(e oe of the e/tra(ted fat w!th water wh!(h ! reta!%ed

for th! -ur-oe A water ! hea5!er tha% fat the (a$e a" how %o $o of we!3ht; a$thou3huff!(!e%t fat ha a(tua$$" bee% (o%ued to ae u- for the def!(!t !% the 0)a$or!e d!et6he% the% u(h t!ue ! f!%a$$" broe% dow%; the water ! $!berated a%d there ! a udde%f$ood of ur!%e a%d a ared $o of we!3ht Th! !-$e !%ter-retat!o% of what ! rea$$" a%e/tree$" (o-$e/ e(ha%! ! the o%e we 3!5e thoe -at!e%t who wa%t to %ow wh" !t !that o% (erta!% da" the" do %ot $oe; thou3h the" ha5e (o!tted %o d!etar" error

36



2at!e%t who ha5e -re5!ou$" re3u$ar$" ued d!uret!( a a ethod of redu(!%3; $oe fat dur!%3the f!rt two or three wee of treate%t wh!(h how !% the!r eauree%t; but the (a$ea" how $!tt$e or %o $o be(aue the" are re-$a(!%3 the %ora$ water (o%te%t of the!r bod"wh!(h ha bee% deh"drated D!uret!( hou$d %e5er be ued for redu(!%3

In"e%%u"ons o! We(h" 3oss

6e d!t!%3u!h four t"-e of !%terru-t!o% !% the re3u$ar da!$" $o The f!rt ! the o%e that haa$read" bee% e%t!o%ed !% wh!(h the we!3ht ta" tat!o%ar" for a da" or two; a%d th! o((ur;-art!(u$ar$" toward the e%d of a (oure; !% a$ot e5er" (ae

The Pa"eau

The e(o%d t"-e of !%terru-t!o% we (a$$ a <-$ateauK A -$ateau $at 40# da" a%d fre>ue%t$"o((ur dur!%3 the e(o%d ha$f of a fu$$ (oure; -art!(u$ar$" !% -at!e%t that ha5e bee% do!%3we$$ a%d whoe o5era$$ a5era3e of %ear$" a -ou%d -er effe(t!5e doe ha bee% a!%ta!%edThoe who are $o!%3 ore tha% the a5era3e a$$ ha5e a -$ateau oo%er or $ater A -$ateaua$wa" (orre(t; !te$f; but a%" -at!e%t who ha5e be(oe a((utoed to a re3u$ar da!$"

$o 3et u%%e(ear!$" worr!ed a%d be3!% to fret No aou%t of e/-$a%at!o% (o%5!%(e thethat a -$ateau doe %ot ea% that the" are %o $o%3er re-o%d!%3 %ora$$" to treate%t

I% u(h (ae we (o%!der !t -er!!b$e; for -ure$" -"(ho$o3!(a$ reao%; to brea u- the-$ateau Th! (a% be do%e !% two wa" O%e ! a o0(a$$ed <a--$e da"K A% a--$e0da" be3!% at$u%(h a%d (o%t!%ue u%t!$ ?ut before $u%(h of the fo$$ow!%3 da" The -at!e%t are 3!5e% !/$ar3e a--$e a%d are to$d to eat o%e whe%e5er the" fee$ the de!re thou3h !/ a--$e ! thea/!u a$$owed Dur!%3 a% a--$e0da" %o other food or $!>u!d e/(e-t -$a!% water area$$owed a%d of water the" a" o%$" dr!% ?ut e%ou3h to >ue%(h a% u%(ofortab$e th!rt !feat!%3 a% a--$e t!$$ $ea5e the th!rt" 8ot -at!e%t fee$ %o %eed for water a%d are >u!teha--" w!th the!r !/ a--$e Need$e to a"; a% a--$e0da" a" %e5er be 3!5e% o% the da" o%

wh!(h there ! %o doe The a--$e0da" -rodu(e a 3rat!f"!%3 $o of we!3ht o% the fo$$ow!%3da"; (h!ef$" due to the e$!!%at!o% of water Th! water ! %ot re3a!%ed whe% the -at!e%treue the!r %ora$ 0)a$or!e d!et at $u%(h; a%d o% the fo$$ow!%3 da" the" (o%t!%ue to $oewe!3ht at!fa(tor!$"

The other wa" to brea u- a -$ateau ! b" 3!5!%3 a %o%0er(ur!a$ d!uret!( +we ue 1 tab$et ofh"3roto%, for o%e da"

Th! ! !-$er for the -at!e%t; but we -refer the a--$e0da"; a we oet!e f!%d that thou3hthe d!uret!( ! 5er" effe(t!5e o% the fo$$ow!%3 da" !t a" tae two to three da" before the%ora$ da!$" redu(t!o% ! reued; throw!%3 the -at!e%t !%to a %ew f!t of de-a!r It ! ue$eto 3!5e e!ther a% a--$e0da" or a d!uret!( u%$e the we!3ht ha bee% tat!o%ar" for at $eat four

da" w!thout a%" d!etar" error ha5!%3 bee% (o!tted

Reachn( a #o%*e% 3e'e

The th!rd t"-e of !%terru-t!o% !% the re3u$ar $o of we!3ht a" $at u(h $o%3er 0 te% da" totwo wee Fortu%ate$"; !t ! rare a%d o%$" o((ur !% 5er" ad5a%(ed (ae; a%d the% hard$"e5er dur!%3 the f!rt (oure of treate%t It ! ee% o%$" !% thoe -at!e%t who dur!%3 oe

37



-er!od of the!r $!5e ha5e a!%ta!%ed a (erta!% f!/ed de3ree of obe!t" for te% "ear or orea%d ha5e the% at oe t!e ra-!d$" !%(reaed be"o%d that we!3ht 6he% the% !% the (oure oftreate%t the forer $e5e$ ! rea(hed; !t a" tae two wee of %o $o; !% -!te of H)G a%dd!et; before further redu(t!o% ! %ora$$" reued

Mens"%ua In"e%%u"on

The fourth t"-e of !%terru-t!o% ! the o%e wh!(h ofte% o((ur a few da" before a%d dur!%3 thee%trua$ -er!od a%d !% oe woe% at the t!e of o5u$at!o% It ut a$o be e%t!o%ed thatwhe% a woa% be(oe -re3%a%t dur!%3 treate%t 0 a%d th! ! b" %o ea% u%(oo% 0he at o%(e (eae to $oe we!3ht A% u%e/-$a!%ed arret of redu(t!o% ha o% e5era$o((a!o% ra!ed our u-!(!o% before the f!rt -er!od wa !ed If !% u(h (ae;e%truat!o% ! de$a"ed; we to- !%?e(t!%3 a%d do a -re(!-!tat!o% tet f!5e da" $ater No-re3%a%(" tet hou$d be (arr!ed out ear$!er tha% f!5e da" after the $at doe; a otherw!ethe H)G a" 3!5e a fa$e -o!t!5e reu$t

Ora$ (o%tra(e-t!5e a" be ued dur!%3 treate%t

De"a%) E%%o%s

A%" !%terru-t!o% of the %ora$ $o of we!3ht wh!(h doe %ot f!t -erfe(t$" !%to o%e of thoe(ate3or!e ! a$wa" due to oe -o!b$" 5er" !%or d!etar" error S!!$ar$"; a%" 3a!% of oretha% 1 3ra ! !%5ar!ab$" the reu$t of oe tra%3re!o% or !tae; u%$e !t ha--e%o% or about the da" of o5u$at!o% or dur!%3 the three da" -re(ed!%3 the o%et of e%truat!o%;!% wh!(h (ae !t ! !3%ored I% a$$ other (ae the reao% for the 3a!% ut be etab$!hed ato%(e

The -at!e%t who fra%$" ad!t that he ha te--ed out of h! re3!e% whe% to$d thatoeth!%3 ha 3o%e wro%3 ! %o -rob$e He ! a$wa" ur-r!ed at be!%3 fou%d out; be(aueu%$e he ha ee% th! h!e$f he w!$$ %ot be$!e5e that a a$ted a$o%d; a (ou-$e of -otato(h!-; a 3$a of toato ?u!(e or a% e/tra ora%3e w!$$ br!%3 about a def!%!te !%(reae !% h!we!3ht o% the fo$$ow!%3 da"

Ver" ofte% he wa%t to %ow wh" e/tra food we!3h!%3 o%e ou%(e hou$d !%(reae h! we!3htb" !/ ou%(e 6e e/-$a!% th! !% the fo$$ow!%3 wa" :%der the !%f$ue%(e of H)G the b$ood !aturated w!th food a%d the b$ood 5o$ue ha ada-ted !te$f o that !t (a% o%$" ?uta((oodate the )a$or!e wh!(h (oe !% fro the !%tet!%a$ tra(t !% the (oure of theda" A%" add!t!o%a$ !%(oe; howe5er $!tt$e th! a" be; (a%%ot be a((oodated a%d theb$ood ! therefore for(ed to !%(reae !t 5o$ue uff!(!e%t$" to ho$d the e/tra food; wh!(h !t (a%o%$" do !% a 5er" d!$uted for Thu !t ! %ot the we!3ht of what ! eate% that -$a" thedeter!%!%3 ro$e but rather the aou%t of water wh!(h the bod" ut reta!% to a((oodate

th! food

Th! (a% be !$$utrated b" e%t!o%!%3 the (ae of a$t I% order to ho$d o%e tea-oo%fu$ of a$tthe bod" re>u!re o%e $!ter of water; a !t (a%%ot a((oodate a$t !% a%" h!3her(o%(e%trat!o% Thu; !f a -ero% eat o%e tea-oo%fu$ of a$t h! we!3ht w!$$ 3o u- b" oretha% two -ou%d a oo% a th! a$t ! aborbed fro h! !%tet!%e

38





do%e I% that ato-here %o fru!tfu$ !%5et!3at!o% (a% be (o%du(ted o we (a$$" e/-$a!% thatwe are %ot a((u!%3 h! of a%"th!%3 but that we %ow for (erta!% fro our %ot !%(o%!derab$ee/-er!e%(e that oeth!%3 ha 3o%e wro%3 a%d that we ut %ow !t dow% >u!et$" to3ethera%d tr" a%d f!%d out what !t wa O%(e the -at!e%t rea$!Be that !t ! !% h! ow% !%teret that he-$a" a% a(t!5e a%d %ot ere$" a -a!5e ro$e !% th! ear(h; the reao% for the etba( !a$ot !%5ar!ab$" d!(o5ered Ha5!%3 bee% throu3h hu%dred of u(h e!o%; we are %ear$"

a$wa" ab$e to d!t!%3u!h the de$!berate $!ar fro the -at!e%t who ! ere$" foo$!%3 h!e$f or! rea$$" u%aware of ha5!%3 erred

3a%s and #oos

6he% we ee obee -at!e%t there are 3e%era$$" two of u -ree%t !% order to -eed u-rout!%e ha%d$!%3 Thu whe% we ha5e to !%5et!3ate a r!e !% we!3ht; a 3$a%(e ! uff!(!e%t toae ure that we a3ree or d!a3ree If after a few >uet!o% we both fee$ reao%ab$" urethat the -at!e%t ! de$!berate$" $"!%3; we te$$ h! that th! ! our o-!%!o% a%d war% h! thatu%$e he (oe ($ea% we a" refue further treate%t The wa" he rea(t to th! fur%!headd!t!o%a$ -roof whether we are o% the r!3ht tra( or %ot we %ow 5er" rare$" ae a !tae

If the -at!e%t brea dow% a%d (o%fee; we e$t a%d are a$$ for3!5e%e a%d treate%t-ro(eed @et !f u(h -erfora%(e ha5e to be re-eated ore tha% two or three t!e; werefue further treate%t Th! ha--e% !% $e tha% 1J of our (ae If the -at!e%t ! tubbor%a%d w!$$ %ot ad!t what he ha bee% u- to; we uua$$" 3!5e h! o%e ore (ha%(e a%d(o%t!%ue treate%t e5e% thou3h we ha5e bee% u%ab$e to f!%d the reao% for h! 3a!% I% a%"u(h (ae there ! %o re-et!t!o%; a%d fre>ue%t$" the -at!e%t doe the% (o%fe a few da"$ater after he ha thou3ht th!%3 o5er

The -at!e%t who ! foo$!%3 h!e$f ! the o%e who ha (o!tted oe tr!f$!%3; offe%e a3a!%tthe ru$e but who ha bee% ab$e to (o%5!%(e h!e$f that th! ! of %o !-orta%(e a%d (a%%ot-o!b$" a((ou%t for the 3a!% !% we!3ht 6oe% ee -art!(u$ar$" -ro%e to 3ett!%3 thee$5e

e%ta%3$ed !% u(h de$u!o% O% the other ha%d; !t doe fre>ue%t$" ha--e% that a -at!e%t w!$$ !%the !dt of a (o%5erat!o% u%th!%!%3$" -ear a% o$!5e or for3et that he ha a$read" eate% h!breadt!(

A other -re-ar!%3 food for the fa!$" a" out of heer hab!t for3et that he ut %ot tatethe au(e to ee whether !t %eed ore a$t Soet!e a r!(h a!de% au%t (a%%ot beoffe%ded b" refu!%3 a (u- of tea !%to wh!(h he ha -ut two tea-oo% of u3ar; thou3htfu$$"reeber!%3 the -at!e%t tate fro -re5!ou o((a!o% Su(h !%(!de%t are $e3!o% a%d areuua$$" (o%feed w!thout he!tat!o%; but oe -at!e%t ee 3e%u!%e$" ab$e to for3et thee$a-e a%d reeber the w!th a 5!!b$e ho( o%$" after !%!te%t >uet!o%!%3

I% thee (ae we 3o (arefu$$" o5er the da" Soet!e the -at!e%t ha bee% !%5!ted to a

ea$ or 3o%e to a retaura%t; %a!5e$" be$!e5!%3 that the food ha a(tua$$" bee% -re-arede/a(t$" a((ord!%3 to !%tru(t!o% The" w!$$ a" <@e; %ow that I (oe to th!% of !t the tead!d ee a b!t b!33er tha% the o%e I ha5e at hoe; a%d !t d!d tate better a"be there wa a$!tt$e fat o% !t; thou3h I -e(!a$$" to$d the to (ut !t a$$ awa"K Soet!e the breadt!( werebroe% a%d a few fra3e%t eate%; a%d <8a"be the" were a $!tt$e ore tha% o%eK It ! %otu%(oo% for -at!e%t to -$a(e too u(h re$!a%(e o% the!r eor" of the d!et0heet a%d tarteat!%3 (arrot; bea% or -ea a%d the% to ee 3e%u!%e$" ur-r!ed whe% the!r atte%t!o% !

40



(a$$ed to the fa(t that thee are forb!dde%; a the" ha5e %ot bee% $!ted

Cos*e"cs

6he% %o d!etar" error ! e$!(!ted we tur% to (oet!( 8ot woe% f!%d !t hard to be$!e5e thatfat; o!$; (rea a%d o!%te%t a--$!ed to the !% are aborbed a%d !%terfere w!th we!3htredu(t!o% b" H)G ?ut a !f the" had bee% eate% Th! a$ot !%(red!b$e e%!t!5!t" to e5e%u(h 5er" !%or !%(reae !% %utr!t!o%a$ !%tae ! a -e(u$!ar feature of the H)G ethod For!%ta%(e; we f!%d that -ero% who hab!tua$$" ha%d$e or3a%!( fat; u(h a worer !% beaut"-ar$or; aeur; but(her; et( %e5er how what we (o%!der a at!fa(tor" $o of we!3htu%$e the" (a% a5o!d fat (o!%3 !%to (o%ta(t w!th the!r !%

The -o!%t ! o !-orta%t that I w!$$ !$$utrate !t w!th two (ae A $ad" who wa (oo-erat!%3-erfe(t$" udde%$" !%(reaed ha$f a -ou%d )arefu$ >uet!o%!%3 brou3ht %oth!%3 to $!3ht Shehad (erta!%$" ade %o d!etar" error %or had he ued a%" !%d of fa(e (rea; a%d he waa$read" !% the e%o-aue A we fe$t that we (ou$d trut her !-$!(!t$"; we $eft the >uet!o%u-e%ded @et ?ut a he wa about to $ea5e the (o%u$t!%3 roo he udde%$" to--ed;tur%ed a%d %a--ed her f!%3er <I5e 3ot !t;K he a!d Th! ! what had ha--e%ed She had

bou3ht here$f a %ew et of ae0u- -ot a%d bott$e a%d; u!%3 her f!%3er; had tra%ferredher $ar3e aorte%t of (oet!( to the %ew (o%ta!%er !% a%t!(!-at!o% of the da" he wou$dbe ab$e to ue the a3a!% after her treate%t

The other (ae (o%(er% a a% who !-reed u a be!%3 5er" (o%(!e%t!ou He waabout * $b o5erwe!3ht but d!d %ot $oe at!fa(tor!$" fro the o%et of treate%t A3a!% a%da3a!% we tr!ed to f!%d the reao% but w!th %o u((e; u%t!$ o%e da" he a!d <I %e5er to$d "outh!; but I ha5e a 3$a e"e I% fa(t; I ha5e a who$e et of the I fre>ue%t$" (ha%3e the; a%de5er" t!e I do that I -ut a -e(!a$ o!%te%t !% " e"eo(et Do "ou th!% that (ou$d ha5ea%"th!%3 to do w!th !tK A we thou3ht ?ut that; we aed h! to to- u!%3 th! o!%te%t; a%dfro that da" o% h! we!3ht0$o wa re3u$ar

6e are -art!(u$ar$" a5ere to thoe oder% (oet!( wh!(h (o%ta!% horo%e; a a%"!%terfere%(e w!th e%do(r!%e re3u$at!o% dur!%3 treate%t ut be abo$ute$" a5o!ded 8a%"woe% whoe !% ha !% the (oure of "ear be(oe ad?uted to the ue of fat (o%ta!%!%3(oet!( f!%d that the!r !% 3et dr" a oo% a the" to- u!%3 the I% u(h (ae we-er!t the ue of -$a!% !%era$ o!$; wh!(h ha %o %utr!t!o%a$ 5a$ue O% the other ha%d; !%era$o!$ hou$d %ot be ued !% -re-ar!%3 the food; f!rt be(aue of !t u%de!rab$e $a/at!5e >ua$!t";a%d e(o%d be(aue !t aborb oe fat0o$ub$e 5!ta!%; wh!(h are the% $ot !% the too$ 6edo -er!t the ue of $!-t!(; -owder a%d u(h $ot!o% a are e%t!re$" free of fatt" ubta%(e6e a$o a$$ow br!$$!a%t!%e to be ued o% the ha!r but !t ut %ot be rubbed !%to the (a$-Ob5!ou$" u%0ta% o!$ ! -roh!b!ted

8a%" woe% are horr!f!ed whe% to$d that for the durat!o% of treate%t the" (a%%ot ue fa(e(rea or ha5e fa(!a$ aa3e The" fear that th! a%d the $o of we!3ht w!$$ ru!% the!r(o-$e/!o% The" (a% be fu$$" reaured :%der treate%t %ora$ fat ! retored to the !%;wh!(h ra-!d$" be(oe freh a%d tur3!d; a!%3 the e/-re!o% u(h ore "outhfu$ Th! ! a(hara(ter!t!( of the H)G ethod wh!(h ! a (o%ta%t our(e of wo%der to -at!e%t who ha5ee/-er!e%(ed or ee% !% other the fa(!a$ ra5a3e -rodu(ed b" the uua$ ethod of redu(!%3

A% obee woa% of 7 ob5!ou$" (a%%ot e/-e(t to ha5e her -ued fa(e redu(ed to %ora$

41



w!thout a wr!%$e; but !t ! rearab$e how "outhfu$ her fa(e rea!% !% -!te of her a3e

The oce

I%(!de%ta$$"; a%other !%teret!%3 feature of the H)G ethod ! that !t doe %ot ru!% a !%3!%35o!(e The t"-!(a$$" obee -r!a do%%a uua$$" f!%d that whe% he tr!e to redu(e the t!breof her 5o!(e ! $!ab$e to (ha%3e; a%d u%derta%dab$" th! terr!f!e her :%der H)G th! doe%ot ha--e% !%deed; !% a%" (ae the 5o!(e !-ro5e a%d the breath!%3 !%5ar!ab$" doe 6eha5e had a%" (ae of -rofe!o%a$ !%3er 5er" (arefu$$" (o%tro$$ed b" e/-ert 5o!(etea(her; a%d the aetro ha5e bee% o e%thu!at!( that the" %ow fre>ue%t$" e%d u-at!e%t

O"he% Reasons !o% a +an

A-art fro d!et a%d (oet!( there (a% be a few other reao% for a a$$ r!e !% we!3htSoe -at!e%t u%w!tt!%3$" tae (hew!%3 3u; throat -at!$$e; 5!ta!% -!$$; (ou3h "ru- et(;w!thout rea$!B!%3 that the u3ar or fat the" (o%ta!% a" !%terfere w!th a re3u$ar $o of we!3htSe/ horo%e or (ort!o%e !% !t 5ar!ou oder% for ut be a5o!ded; thou3h ora$

(o%tra(e-t!5e are -er!tted I% fa(t the o%$" e$f0ed!(at!o% we a$$ow ! a-!r!% for aheada(he; thou3h heada(he a$ot !%5ar!ab$" d!a--ear after a wee of treate%t;-art!(u$ar$" !f of the !3ra!%e t"-e

O((a!o%a$$" we a$$ow a $ee-!%3 tab$et or a tra%>u!$!Ber; but -at!e%t hou$d be to$d that wh!$eu%der treate%t the" %eed a%d a" 3et $e $ee- For !%ta%(e; here !% Ita$" where !t !(utoar" to $ee- dur!%3 the !eta wh!(h $at fro o%e to four !% the after%oo% ot-at!e%t f!%d that thou3h the" $!e dow% the" are u%ab$e to $ee-

6e e%(oura3e w!!%3 a%d u% bath!%3 dur!%3 treate%t; but !t hou$d be reebered thata e5ere u%bur% a$wa" -rodu(e a te-orar" r!e !% we!3ht; e5!de%t$" due to waterrete%t!o% The ae a" be ee% whe% a -at!e%t 3et a (oo% (o$d dur!%3 treate%tF!%a$$"; the we!3ht (a% te-orar!$" !%(reae 0 -arado/!(a$ thou3h th! a" ou%d 0 after a%e/(e-t!o%a$ -h"!(a$ e/ert!o% of $o%3 durat!o% $ead!%3 to a fee$!%3 of e/haut!o% A 3ae ofte%%!; a 5!3orou w!; a ru%; a r!de o% horeba( or a rou%d of 3o$f do %ot ha5e th! effe(tbut a $o%3 tre; a da" of !!%3; row!%3 or ("($!%3 or da%(!%3 !%to the a$$ hour uua$$" reu$t!% a 3a!% of we!3ht o% the fo$$ow!%3 da"; u%$e the -at!e%t ! !% -erfe(t tra!%!%3 I% -at!e%t(o!%3 fro abroad; where the" a$wa" ue the!r (ar; we ofte% ee th! effe(t after atre%uou da" of ho--!%3 o% foot; !3htee!%3 a%d 5!!t to 3a$$er!e a%d ueu Thou3hthe e/tra u(u$ar effort !%5o$5ed doe (o%ue oe add!t!o%a$ )a$or!e; th! a--ear to beoffet b" the rete%t!o% of water wh!(h the t!red (!r(u$at!o% (a%%ot at o%(e e$!!%ate

Ae""e5%educn( D%u(s6e hard$" e5er ue a-heta!%e; the a--et!te0redu(!%3 dru3 u(h a De/edr!%; De/a!$;2re$ud!%; et(; a there ee to be %o %eed for the dur!%3 the H)G treate%t The o%$"t!e we f!%d the uefu$ ! whe% a -at!e%t ! for !-e$$!%3 a%d u%foreee% reao% ob$!3ed tofore3o the doe for three to four da" a%d "et w!he to (o%t!%ue the d!et o that he %eed %ot!%terru-t the (oure

42





her ethod; wh!(h he had fou%d ue$e !% her ow% (ae

How a%"o%e !% h! r!3ht !%d ! ab$e to be$!e5e that fatt" t!ue (a% be h!fted e(ha%!(a$$" orbe ade to 5a%!h b" >ueeB!%3 ! be"o%d " (o-rehe%!o% The o%$" effe(t obta!%ed !e5ere bru!!%3 The tor% t!ue the% for (ar; a%d thee $ow$" (o%tra(t a!%3 the fatt"t!ue e5e% harder a%d ore u%"!e$d!%3

A $ad" o%(e (o%u$ted u for her ot u%3a!%$" $e3 Lar3e ae of fat bu$3ed o5er thea%$e of her t!%" feet; a%d there were about 4 $b too u(h o% her h!- a%d th!3h 6eaured her that th! o5erwe!3ht (ou$d be $ot a%d that her a%$e wou$d ared$" !-ro5e !%the -ro(e Her treate%t -ro3reed ot at!fa(tor!$" but to our ur-r!e there wa %o!-ro5ee%t !% her a%$e 6e the% d!(o5ered that he had for "ear bee% ta!%3 e5er" !%dof e(ha%!(a$; e$e(tr!( a%d heat treate%t for her $e3 a%d that he had ade u- her !%d toreort to -$at!( ur3er" !f we fa!$ed

Re0e/a!%!%3 the fat abo5e her a%$e; we fou%d that !t wa u%uua$$" hard 6e attr!butedth! to the (ou%t$e !%or !%?ur!e !%f$!(ted b" %ead!%3 Thee !%?ur!e had hea$ed but had$eft a tou3h %etwor of (o%%e(t!5e (ar0t!ue !% wh!(h the fat wa !-r!o%ed Read" to tr"

a%"th!%3; he wa -ut to bed for the rea!%!%3 three wee of her f!rt (oure w!th her $ower$e3 t!3ht$" tra--ed !% u%"!e$d!%3 ba%da3e E5er" da" the -reure wa !%(reaed The(ob!%at!o% of H)G; d!et a%d tra--!%3 brou3ht about a ared !-ro5ee%t !% the ha-e ofher a%$e At the e%d of her f!rt (oure he retur%ed to her hoe abroad Three o%th $aterhe (ae ba( for her e(o%d (oure She had a!%ta!%ed both her we!3ht a%d the!-ro5ee%t of her a%$e The ae -ro(edure wa re-eated; a%d after f!5e wee he $eftthe ho-!ta$ w!th a %ora$ we!3ht a%d $e3 that; !f %ot e/a(t$" ha-e$"; were at $eatu%obtru!5e 6here %o u(h !%?ur!e of the t!ue ha5e bee% !%f$!(ted b" !%a--ro-r!ateethod of treate%t; thee drat!( eaure are %e5er %e(ear"

Bood Su(a%

Toward the e%d of a (oure or whe% a -at!e%t ha %ear$" rea(hed h! %ora$ we!3ht !to((a!o%a$$" ha--e% that the b$ood u3ar dro- be$ow %ora$; a%d we ha5e e5e% ee% th!!% -at!e%t who had a% ab%ora$$" h!3h b$ood u3ar before treate%t Su(h a% atta( ofh"-o3$"(e!a ! a$ot !de%t!(a$ w!th the o%e ee% !% d!abet!( who ha5e tae% too u(h!%u$!% The atta( (oe o% udde%$" there ! the ae fee$!%3 of $!3ht0headed%e;wea%e !% the %ee; treb$!%3; a%d u%ot!5ated weat!%3 but u%der H)G h"-o3$"(e!adoe %ot -rodu(e a%" fee$!%3 of hu%3er A$$ thee "-to are a$ot !%ta%t$" re$!e5ed b"ta!%3 two hea-ed tea-oo% of u3ar

I% the (oure of treate%t the -o!b!$!t" of u(h a% atta( ! e/-$a!%ed to thoe -at!e%t whoare !% a -hae !% wh!(h a dro- !% b$ood u3ar a" o((ur The" are !%tru(ted to ee- u3ar or

3$u(oe weet ha%d"; -art!(u$ar$" whe% dr!5!%3 a (ar The" are a$o to$d to wat(h the effe(t ofta!%3 u3ar 5er" (arefu$$" a%d re-ort the fo$$ow!%3 da" Th! ! !-orta%t; be(aue a%/!ou-at!e%t to who u(h a% atta( ha bee% e/-$a!%ed are a-t to tae u3ar u%%e(ear!$"; !%wh!(h (ae !t !%e5!tab$" -rodu(e a 3a!% !% we!3ht a%d doe %ot draat!(a$$" re$!e5e the"-to for wh!(h !t wa tae%; -ro5!%3 that thee were %ot due to h"-o3$"(e!a Soe-at!e%t !tae the effe(t of eot!o%a$ tre for h"-o3$"(e!a 6he% the "-to are>u!($" re$!e5ed b" u3ar th! ! -roof that the" were !%deed due to a% ab%ora$ $ower!%3 of

44



the b$ood u3ar; a%d !% that (ae there ! %o !%(reae !% the we!3ht o% the fo$$ow!%3 da" 6ea$wa" u33et that u3ar be tae% !f the -at!e%t ! !% doubt

O%(e u(h a% atta( ha bee% re$!e5ed w!th u3ar we ha5e %e5er ee% !t re(ur o% the!ed!ate$" ube>ue%t da"; a%d o%$" 5er" rare$" doe a -at!e%t ha5e two u(h atta(e-arated b" e5era$ da" dur!%3 a (oure of treate%t I% -at!e%t who ha5e %ot eate%uff!(!e%t$" dur!%3 the f!rt two da" of treate%t we oet!e 3!5e u3ar whe% the !%or

"-to uua$$" fe$t dur!%3 the f!rt three da" of treate%t (o%t!%ue be"o%d that t!e; a%d!% oe (ae th! ha eeed to -eed u- the eu-hor!a ord!%ar!$" ao(!ated w!th the H)Gethod

The Ra"o o! Pounds "o Inches

A% !%teret!%3 feature of the H)G ethod ! that; re3ard$e of how fat a -at!e%t !; the3reatet (!r(ufere%(e 0 abdoe% or h!- a the (ae a" be 0 ! redu(ed at a (o%ta%t ratewh!(h ! e/traord!%ar!$" ($oe to 1 ( -er !$o3ra of we!3ht $ot At the be3!%%!%3 oftreate%t the (ha%3e !% eauree%t ! oewhat 3reater tha% th!; but at the e%d of a(oure !t ! a$ot !%5ar!ab$" fou%d that the 3!rth ! a a%" (e%t!eter $e a the %uber of

!$o3ra b" wh!(h the we!3ht ha bee% redu(ed I ha5e %e5er ee% th! ($ear (ut re$at!o%h!-!% -at!e%t that tr" to redu(e b" d!et!%3 o%$"

P%ea%n( "he Sou"on

Hua% (hor!o%!( 3o%adotro-h!% (oe o% the aret a a h!3h$" o$ub$e -owder wh!(h ! the-ure ubta%(e e/tra(ted fro the ur!%e of -re3%a%t woe% Su(h -re-arat!o% are (arefu$$"ta%dard!Bed; a%d a%" bra%d ade b" a re$!ab$e -hara(eut!(a$ (o-a%" ! -robab$" a 3ooda a%" other The ubta%(e hou$d be e/tra(ted fro the ur!%e a%d %ot fro the -$a(e%ta;a%d !t ut of (oure be of hua% a%d %ot of a%!a$ or!3!% The -owder ! ea$ed !% a-ou$eor !% rubber0(a--ed bott$e !% 5ar"!%3 aou%t wh!(h are tated !% I%ter%at!o%a$ :%!t I% th!

for H)G ! tab$e howe5er; o%$" u(h -re-arat!o% hou$d be ued that ha5e the date ofa%ufa(ture a%d the date of e/-!r" ($ear$" tated o% the $abe$ or -a(a3e A u!tab$e o$5e%t! a$wa" u--$!ed !% a e-arate a-ou$e !% the ae -a(a3e

O%(e H)G ! !% o$ut!o% !t ! far $e tab$e It a" be e-t at roo0te-erature for two tothree da"; but !f the o$ut!o% ut be e-t $o%3er !t hou$d a$wa" be refr!3erated 6he%treat!%3 o%$" o%e or two (ae !u$ta%eou$"; 5!a$ (o%ta!%!%3 a a$$ %uber of u%!t a"1 I: hou$d be ued The 1 (( of o$5e%t wh!(h ! u--$!ed b" the a%ufa(turer !!%?e(ted !%to the rubber0 (a--ed bott$e (o%ta!%!%3 the H)G; a%d the -owder ut d!o$5e!%ta%t$" Of th! o$ut!o% 1* (( are w!thdraw% for ea(h doe O%e u(h bott$e of 1 I:therefore fur%!he & doe 6he% ore tha% o%e -at!e%t ! be!%3 treated; the" hou$d %otea(h ha5e the!r ow% bott$e but rather a$$ be !%?e(ted fro the ae 5!a$ a%d a freh o$ut!o%ade whe% th! ! e-t"

A we are uua$$" treat!%3 a fa!r %uber of -at!e%t at the ae t!e; we -refer to ue 5!a$(o%ta!%!%3 u%!t 6!th thee the a%ufa(ture a$o u--$" 1 (( of o$5e%t Of u(h ao$ut!o% * (( (o%ta!% the 1* I: wh!(h ! the ta%dard doe for a$$ (ae a%d wh!(hhou$d %e5er be e/(eeded Th! a$$ aou%t ! awward to ha%d$e a((urate$" +!t re>u!re a%!%u$!% "r!%3e, a%d ! watefu$; be(aue there ! a $o of o$ut!o% !% the %oBB$e of the "r!%3e

45



a%d !% the %eed$e 6e therefore -refer a h!3her d!$ut!o%; wh!(h we -re-are !% the fo$$ow!%3wa" The o$5e%t u--$!ed ! !%?e(ted !%to the rubber(a--ed bott$e (o%ta!%!%3 the I: Athee bott$e are too a$$ to ho$d ore o$5e%t; we w!thdraw ((; !%?e(t !t !%to a% e-t"rubber0(a--ed bott$e a%d add (( of %ora$ a$!%e to ea(h bott$e Th! 3!5e u 1 (( ofo$ut!o% !% ea(h bott$e; a%d of th! o$ut!o% (( (o%ta!% 1* I: Th! aou%t ! (o%5e%!e%tto !%?e(t w!th a% ord!%ar" "r!%3e

In6ec"n(

H)G -rodu(e $!tt$e or %o t!ue0rea(t!o%; !t ! (o-$ete$" -a!%$e a%d !% the a%" thoua%dof doe we ha5e 3!5e% we ha5e %e5er ee% a% !%f$aator" or u--urat!5e rea(t!o% at the!te of the doe

O%e hou$d a5o!d $ea5!%3 a 5a(uu !% the bott$e after -re-ar!%3 the o$ut!o% or afterw!thdrawa$ of the aou%t re>u!red for the doe a otherw!e a$(oho$ ued for ter!$!B!%3 afre>ue%t$" -erforated rubber (a- !3ht be draw% !%to the o$ut!o% 6he% har- %eed$e areued; !t oet!e ha--e% that a $!tt$e b!t of rubber ! -u%(hed out of the rubber (a- a%d (a%be ee% a a a$$ b$a( -e( f$oat!%3 !% the o$ut!o% A thee b!t of rubber are hea5!er

tha% the o$ut!o% the" ra-!d$" ett$e out; a%d !t ! thu ea" to a5o!d draw!%3 the !%to the"r!%3e

6e ue 5er" f!%e %eed$e that are two !%(he $o%3 a%d !%?e(t dee- !%tra3$utea$$" !% the outeru--er >uadra%t of the butto( The doe hou$d !f -o!b$e %ot be 3!5e% !%to the u-erf!(!a$fat $a"er; wh!(h !% 5er" obee -at!e%t ut be (o-reed o a to e%ab$e the %eed$e torea(h the u($e Ob5!ou$" %eed$e a%d "r!%3e ut be (arefu$$" wahed; ter!$!Bed a%dha%d$ed ae-t!(a$$" It ! a$o !-orta%t that the da!$" doe hou$d be 3!5e% at !%ter5a$ a($oe to *4 hour a -o!b$e A%" atte-t to e(o%o!Be !% t!e b" 3!5!%3 $ar3er doe at$o%3er !%ter5a$ ! dooed to -rodu(e $e at!fa(tor" reu$t

There are hard$" a%" (o%tra!%d!(at!o% to the H)G ethod Treate%t (a% be (o%t!%ued !%the -ree%(e of ab(ee; u--urat!o%; $ar3e !%fe(ted wou%d a%d a?or fra(ture Sur3er"a%d 3e%era$ a%ethe!a are %o reao% to to- a%d we ha5e 3!5e% treate%t dur!%3 a e5ereatta( of a$ar!a A(%e or bo!$ are %o (o%tra!%d!(at!o% the forer uua$$" ($ear u-; a%dfuru%(u$o! (oe to a% e%d Throbo-h$eb!t! ! %o (o%tra!%d!(at!o%; a%d we ha5e treatede5era$ obee -at!e%t w!th H)G a%d the 0)a$or!e d!et wh!$e uffer!%3 fro th! (o%d!t!o%Our !-re!o% ha bee% that !% obee -at!e%t the -h$eb!t! doe rather better a%d (erta!%$"%o wore tha% u%der the uua$ treate%t a$o%e Th! a$o a--$!e to -at!e%t uffer!%3 fro5ar!(oe u$(er wh!(h te%d to hea$ ra-!d$"

#b%ods

6h!$e uter!%e f!bro!d ee to be !% %o wa" affe(ted b" H)G !% the doe we ue; we ha5efou%d that 5er" $ar3e; e/ter%a$$" -a$-ab$e uter!%e "oa are a-t to 3!5e troub$e 6e are(o%5!%(ed that th! ! e%t!re$" due to the rather udde% d!a--eara%(e of fat fro the -e$5!(bed u-o% wh!(h the" ret a%d that !t ! the we!3ht of the tuor -re!%3 o% the u%der$"!%3t!ue wh!(h a((ou%t for the d!(ofort or -a!% wh!(h a" ar!e dur!%3 treate%t 6h!$e wed!re3ard e5e% fa!r0!Bed or u$t!-$e "oa; we !%!t that 5er" $ar3e o%e be o-eratedbefore treate%t 6e ha5e had -at!e%t -ree%t thee$5e for redu(!%3 fat fro the!r

46



abdoe% who howed %o !3% of obe!t"; but had a $ar3e abdo!%a$ tuor

+as"ones

Sa$$ to%e !% the 3a$$ b$adder a" !% -at!e%t who ha5e re(e%t$" had t"-!(a$ (o$!( (aueore fre>ue%t (o$!( u%der treate%t w!th H)G Th! a" be due to the a$ot (o-$eteabe%(e of fat fro the d!et; wh!(h -re5e%t the %ora$ e-t"!%3 of the 3a$$ b$adder 'eforeu%derta!%3 treate%t we e/-$a!% to u(h -at!e%t that there ! a r! of ore fre>ue%t a%d-o!b$" e5ere "-to a%d that !t a" be(oe %e(ear" to o-erate If the" are -re-aredto tae th! r! a%d -ro5!ded the" a3ree to u%der3o a% o-erat!o% !f we (o%!der th!!-erat!5e; we -ro(eed w!th treate%t; a after we!3ht redu(t!o% w!th H)G the o-erat!5e r!! (o%!derab$" redu(ed !% a% obee -at!e%t I% u(h (ae we a$wa" 3!5e a dru3 wh!(ht!u$ate the f$ow of b!$e; a%d !% the a?or!t" of (ae %oth!%3 u%toward ha--e% O% theother ha%d; we ha5e $ooed for a%d %ot fou%d a%" e5!de%(e to u33et that the H)Gtreate%t $ead to the forat!o% of 3a$$to%e a -re3%a%(" oet!e doe

The Hea%"

D!order of the heart are %ot a a ru$e (o%tra!%d!(at!o% I% fa(t; the reo5a$ of ab%ora$ fat 0-art!(u$ar$" fro the heart0u($e a%d fro the urrou%d!%3 of the (oro%ar" arter!e 0 (a% o%$"be be%ef!(!a$ !% (ae of "o(ard!a$ wea%e; a%d a%" u(h -at!e%t are referred to u b"(ard!o$o3!t 6!th!% the f!rt wee of treate%t a$$ -at!e%t 0 %ot o%$" heart (ae 0 rear thatthe" ha5e $ot u(h of the!r breath$e%e

Co%ona%) Occuson

I% obee -at!e%t who ha5e re(e%t$" ur5!5ed a (oro%ar" o(($u!o%; we ado-t the fo$$ow!%3-ro(edure !% (o$$aborat!o% w!th the (ard!o$o3!t 6e wa!t u%t!$ %o further e$e(tro(ard!o3ra-h!((ha%3e ha5e o((urred for a -er!od of three o%th Rout!%e treate%t ! the% tarted u%der(arefu$ (o%tro$ a%d !t ! uua$ to f!%d a further e$e(tro(ard!o3ra-h!( !-ro5ee%t of a (o%d!t!o%wh!(h wa -re5!ou$" tat!o%ar"

I% the thoua%d of (ae we ha5e treated we ha5e %ot o%(e ee% a%" ort of (oro%ar"!%(!de%t o((ur dur!%3 or hort$" after treate%t The ae a--$!e to (erebra$ 5a(u$ara((!de%t Nor ha5e we e5er ee% a (ae of throbo! of a%" ort de5e$o- dur!%3 treate%t;e5e% thou3h a h!3h b$ood -reure ! ra-!d$" $owered I% th! re-e(t; too; the H)G treate%treeb$e -re3%a%("

Tee"h and "a*ns

2at!e%t whoe teeth are !% -oor re-a!r oet!e 3et ore troub$e u%der -ro$o%3ed

treate%t; ?ut a a" o((ur !% -re3%a%(" I% u(h (ae we do a$$ow (a$(!u a%d 5!ta!% D;thou3h %ot !% a% o!$" o$ut!o% The o%$" other 5!ta!% we -er!t ! 5!ta!% ); wh!(h we ue !%$ar3e doe (ob!%ed w!th a% a%t!h!ta!%e at the o%et of a (oo% (o$d There ! %oob?e(t!o% to the ue of a% a%t!b!ot!( !f th! ! re>u!red; for !%ta%(e b" the de%t!t I% (ae ofbro%(h!a$ atha a%d ha" fe5er we ha5e o((a!o%a$$" reorted to (ort!o%e dur!%3 treate%ta%d f!%d that tr!a(!%o$o%e ! the $eat $!e$" to !%terfere w!th the $o of we!3ht; but a%"athat!( !-ro5e w!th H)G a$o%e

47



Acoho

Obee hea5" dr!%er; e5e% thoe border!%3 o% a$(oho$!; ofte% do ur-r!!%3$" we$$ u%derH)G a%d !t ! e/(e-t!o%a$ for the to tae a dr!% wh!$e u%der treate%t 6he% the" do; the"f!%d that a re$at!5e$" a$$ >ua%t!t" of a$(oho$ -rodu(e !%to/!(at!o% Su(h -at!e%t a" thatthe" do %ot fee$ the %eed to dr!% Th! a" !% -art be due to the eu-hor!a wh!(h the treate%t-rodu(e a%d !% -art to the (o-$ete abe%(e of the %eed for >u!( ute%a%(e fro wh!(h

ot obee -at!e%t uffer

Thou3h we ha5e had a few (ae that ha5e (o%t!%ued abt!%e%(e $o%3 after treate%t; otherre$a-e a oo% a the" are ba( o% a %ora$ d!et 6e ha5e a few <re3u$ar (utoerK who;ha5!%3 o%(e bee% redu(ed to the!r %ora$ we!3ht; tart to dr!% a3a!% thou3h wat(h!%3 the!rwe!3ht The% after oe o%th the" -ur-oe$" o5ereat !% order to 3a!% uff!(!e%t we!3ht fora%other (oure of H)G wh!(h te-orar!$" 3et the out of the!r dr!%!%3 rout!%e 6e do %ot-art!(u$ar$" we$(oe u(h (ae; but we ee %o reao% for refu!%3 the!r re>uet

Tube%cuoss

It ! !%teret!%3 that obee -at!e%t uffer!%3 fro !%a(t!5e -u$o%ar" tuber(u$o! (a% beafe$" treated 6e ha5e u%der 5er" (arefu$ (o%tro$ treated -at!e%t a ear$" a three o%thafter the" were -ro%ou%(ed !%a(t!5e a%d ha5e %e5er ee% a re$a-e o((ur dur!%3 or hort$"after treate%t I% fa(t; we o%$" ha5e o%e (ae o% our re(ord !% wh!(h a(t!5e tuber(u$o!de5e$o-ed !% a "ou%3 a% about o%e "ear after a treate%t wh!(h had $ated three weeEar$!er Q0ra" howed a (a$(!f!ed -ot fro a (h!$dhood !%fe(t!o% wh!(h had %ot -rodu(ed($!%!(a$ "-to There wa a fa!$" h!tor" of tuber(u$o!; a%d h! !$$%e tarted u%derad5ere (o%d!t!o% wh!(h (erta!%$" had %oth!%3 to do w!th the treate%t Re!dua$(a$(!f!(at!o% fro a% ear$" !%fe(t!o% are e/(eed!%3$" (oo%; a%d we %e5er (o%!der the a(o%tra!%d!(at!o% to treate%t

The Pan!u HeeI% obee -at!e%t who ha5e bee% tr"!%3 de-erate$" to ee- the!r we!3ht dow% b" e5ered!et!%3; a (ur!ou "-to oet!e o((ur The" (o-$a!% of a% u%bearab$e -a!% !% the!rhee$ wh!(h the" fee$ o%$" wh!$e ta%d!%3 or wa$!%3 A oo% a the" tae the we!3ht off the!rhee$ the -a!% (eae Thee (ae are the ba%e of the rheuato$o3!t a%d ortho-ed!(ur3eo% who ha5e treated the before the" (oe to u A$$ the uua$ !%5et!3at!o% aree%t!re$" %e3at!5e; a%d there ! %ot the $!3htet re-o%e to a%t!0 rheuat!( ed!(at!o% or-h"!othera-" The -a!% a" be o e5ere that the -at!e%t are ob$!3ed to 3!5e u- the!ro((u-at!o%; a%d the" are %ot !%fre>ue%t$" $abe$ed a a (ae of h"ter!a 6he% the!r hee$ are(arefu$$" e/a!%ed o%e f!%d that the o$e ! ofter tha% %ora$ a%d that the hee$ bo%e 0 the(a$(a%eu 0 (a% be d!t!%(t$" fe$t; wh!(h ! %ot the (ae !% a %ora$ foot

6e !%ter-ret the (o%d!t!o% a a $a( of the hard fatt" -ad o% wh!(h the (a$(a%eu ret a%dwh!(h -rote(t both the bo%e a%d the !% of the o$e fro -reure Th! fat ! $!e a -r!%3"(uh!o% wh!(h (arr!e the we!3ht of the bod" Sta%d!%3 o% a hee$ !% wh!(h th! fat ! !!%3 orredu(ed ut ob5!ou$" be 5er" -a!%fu$ I% the!r effort to ee- the!r we!3ht dow% thee-at!e%t ha5e (o%ued th! %ora$ tru(tura$ fat

48



Thoe -at!e%t who ha5e a %ora$ or ub%ora$ we!3ht wh!$e how!%3 the t"-!(a$$" obee fatde-o!t are ade to eat to (a-a(!t"; ofte% u(h a3a!%t the!r w!$$; for o%e wee The" 3a!%we!3ht ra-!d$" but there ! %o !-ro5ee%t !% the -a!%fu$ hee$ The" are the% tarted o% therout!%e H)G treate%t O5erwe!3ht -at!e%t are treated !ed!ate$" I% both (ae the -a!%(o-$ete$" d!a--ear !% 10* da" of d!et!%3; uua$$" arou%d the 1th da" of treate%t; a%do far %o (ae ha had a re$a-e; thou3h we ha5e bee% ab$e to fo$$ow u- u(h -at!e%t for

"ear6e are -art!(u$ar$" !%tereted !% thee (ae; a the" fur%!h further -roof of the (o%te%t!o%that H)G M )a$or!e %ot o%$" reo5e ab%ora$ fat but a(tua$$" -er!t %ora$ fat to bere-$a(ed; !% -!te of the def!(!e%t food !%tae It ! (erta!%$" %ot o that the ere $o of we!3htredu(e the -a!%; be(aue !t fre>ue%t$" d!a--ear before the we!3ht the -at!e%t had -r!or tothe -er!od of for(ed feed!%3 ! rea(hed

The S2e"ca Pa"en"

A%" do(tor who tart u!%3 the H)G ethod for the f!rt t!e w!$$ ha5e (o%!derab$e d!ff!(u$t";-art!(u$ar$" !f he h!e$f ! %ot fu$$" (o%5!%(ed; !% a!%3 -at!e%t be$!e5e that the" w!$$ %ot fee$

hu%3r" o% )a$or!e a%d that the!r fa(e w!$$ %ot (o$$a-e New -at!e%t a$wa" a%t!(!-atethe -he%oe%a the" %ow o we$$ fro -re5!ou treate%t a%d d!et a%d are !%(redu$ouwhe% to$d that thee w!$$ %ot o((ur 6e o5er(oe a$$ th! b" $ett!%3 %ew -at!e%t -e%d a $!tt$et!e !% the wa!t!%3 roo w!th o$der ha%d; who (a% a$wa" be re$!ed u-o% to a$$a" thee fearw!th e5a%3e$!t!( Bea$; ofte% deo%trat!%3 the f!%er -o!%t o% the!r ow% bod"

A wa!t!%30roo f!$$ed w!th obee -at!e%t who (o%3re3ate da!$" ! a ort of 3rou- thera-" The"(o-are %ote a%d -o- ba( !%to the wa!t!%3 roo after the (o%u$tat!o% to a%%ou%(e the(ore of the $at *4 hour to a% e%thra$$ed aud!e%(e The" (ro0(he( o% the!r d!et a%doet!e (o%fe !% wh!(h the" tr" to h!de fro u; uua$$" w!th the reu$t that the -at!e%t!% who the" ha5e (o%f!ded -a$-!tat!%3$" tatt$e the who$e d!3ra(efu$ tor" to u w!th a <'ut

do%t $et her %ow I to$d "ouK

Concudn( a Cou%se

6he% the three da" of d!et!%3 after the $at doe are o5er; the -at!e%t are to$d that the" a"%ow eat a%"th!%3 the" -$eae; e/(e-t u3ar a%d tar(h; -ro5!ded the" fa!thfu$$" ober5e o%e!-$e ru$e Th! ru$e ! that the" ut ha5e the!r ow% -ortab$e bathroo0(a$e a$wa" atha%d; -art!(u$ar$" wh!$e tra5e$!%3 The" ut w!thout fa!$ we!3h thee$5e e5er" or%!%3 athe" 3et out of bed; ha5!%3 f!rt e-t!ed the!r b$adder If the" are !% the hab!t of ha5!%3breafat !% bed; the" ut we!3h before breafat

It tae about . wee before the we!3ht rea(hed at the e%d of the treate%t be(oe tab$e;

!e doe %ot how 5!o$e%t f$u(tuat!o% after a% o((a!o%a$ e/(e Dur!%3 th! -er!od -at!e%tut rea$!Be that the o0(a$$ed (arboh"drate; that ! u3ar; r!(e; bread; -otatoe; -atr!e et(;are b" far the ot da%3erou If %o (arboh"drate whatoe5er are eate%; fat (a% be!%du$3ed !% oewhat ore $!bera$$" a%d e5e% a$$ >ua%t!t!e of a$(oho$; u(h a a 3$a ofw!%e w!th ea$; doe %o har; but a oo% a fat a%d tar(h are (ob!%ed th!%3 are 5er"$!ab$e to 3et out of ha%d Th! ha to be ober5ed 5er" (arefu$$" dur!%3 the f!rt . wee afterthe treate%t ! e%ded otherw!e d!a--o!%te%t are a$ot ure to o((ur

49



S2n( a Mea

A $o%3 a the!r we!3ht ta" w!th!% two -ou%d of the we!3ht rea(hed o% the da" of the $atdoe; -at!e%t hou$d tae %o %ot!(e of a%" !%(reae but the oe%t the (a$e 3oe be"o%dtwo -ou%d; e5e% !f th! ! o%$" a few ou%(e; the" ut o% that ae da" e%t!re$" !-breafat a%d $u%(h but tae -$e%t" to dr!% I% the e5e%!%3 the" ut eat a hu3e tea w!tho%$" a% a--$e or a raw toato Of (oure th! ru$e a--$!e o%$" to the or%!%3 we!3ht E/0

obee -at!e%t hou$d %e5er (he( the!r we!3ht dur!%3 the da"; a there a" be w!def$u(tuat!o% a%d thee are ere$" a$ar!%3 a%d (o%fu!%3

I" s o! u"*os" *o%"ance "ha" "he *ea s s2ed on "he sa*e da) as "he scae%e(s"e%s an nc%ease o! *o%e "han "4o ounds and "ha" *ssn( "he *eas s no"os"oned un" "he !oo4n( da). If a ea$ ! !--ed o% the da" !% wh!(h a 3a!% !re3!tered !% the or%!%3; th! br!%3 about a% !ed!ate dro- of ofte% o5er a -ou%d 'ut !fthe !--!%3 of the ea$ 0 a%d !--!%3 ea% $!tera$$" !--!%3; %ot ?ut ha5!%3 a $!3ht ea$ 0! -ot-o%ed; the -he%oe%o% doe %ot o((ur a%d e5era$ da" of tr!(t d!et!%3 a" be%e(ear" to (orre(t the !tuat!o%

8ot -at!e%t hard$" e5er %eed to !- a ea$ If the" ha5e eate% a hea5" $u%(h the" fee$ %ode!re to eat the!r d!%%er; a%d !% th! (ae %o !%(reae tae -$a(e If the" ee- the!r we!3ht atthe -o!%t rea(hed at the e%d of the treate%t; e5e% a hea5" d!%%er doe %ot br!%3 about a%!%(reae of two -ou%d o% the %e/t or%!%3 a%d doe %ot therefore (a$$ for a%" -e(!a$eaure 8ot -at!e%t are ur-r!ed how a$$ the!r a--et!te ha be(oe a%d "et howu(h the" (a% eat w!thout 3a!%!%3 we!3ht The" %o $o%3er uffer fro a% ab%ora$ a--et!tea%d fee$ at!f!ed w!th u(h $e food tha% before I% fa(t; the" are uua$$" d!a--o!%ted thatthe" (a%%ot a%a3e the!r f!rt %ora$ ea$; wh!(h the" ha5e bee% -$a%%!%3 for wee

3osn( *o%e We(h"

An e-5a"en" shoud ne'e% (an *o%e "han "4o ounds 4"hou" **eda"e) co%%ec"n(

"hs, bu" " s e7ua) undes%abe "ha" *o%e "han "4o bs. be os" a!"e% "%ea"*en",because a (%ea"e% oss s a4a)s ache'ed a" "he e-ense o! no%*a !a". A%" %ora$ fatthat ! $ot ! !%5ar!ab$" re3a!%ed a oo% a ore food ! tae%; a%d !t ofte% ha--e% that th!rebou%d o5erhoot the u--er two $b $!!t

T%oube A!"e% T%ea"*en"

Two d!ff!(u$t!e a" be e%(ou%tered !% the !ed!ate -ot0treate%t -er!od 6he% a -at!e%tha (o%ued a$$ h! ab%ora$ fat or whe%; after a fu$$ (oure; the doe ha te-orar!$" $ot!t eff!(a(" ow!%3 to the bod" ha5!%3 3radua$$" e5o$5ed a (ou%ter re3u$at!o%; the -at!e%t ato%(e be3!% to fee$ u(h ore hu%3r" a%d e5e% wea I% -!te of re-eated war%!%3; oe

o5er0e%thu!at!( -at!e%t do %ot re-ort th! Howe5er; !% about two da" the fa(t that the" arebe!%3 u%der%our!hed be(oe 5!!b$e !% the!r fa(e; a%d treate%t ! the% to--ed at o%(eI% u(h (ae 0 a%d o%$" !% u(h (ae 0 we a$$ow a 5er" $!3ht !%(reae !% the d!et; u(h a a%e/tra a--$e; 1 3ra of eat or two or three e/tra breadt!( dur!%3 the three da" ofd!et!%3 after the $at doe

6he% ab%ora$ fat ! %o $o%3er be!%3 -ut !%to (!r(u$at!o% e!ther be(aue !t ha bee%

50



(o%ued or be(aue !u%!t" ha et !%; th! ! a$wa" fe$t b" the -at!e%t a udde%;!%to$erab$e a%d (o%ta%t hu%3er I% th! e%e the H)G ethod ! (o-$ete$" e$f0$!!t!%36!th H)G !t ! !-o!b$e to redu(e a -at!e%t; howe5er e%thu!at!(; be"o%d h! %ora$we!3ht A oo% a %o ore ab%ora$ fat ! be!%3 !ued; the bod" tart (o%u!%3 %ora$fat; a%d th! ! a$wa" re3a!%ed a oo% a ord!%ar" feed!%3 ! reued The -at!e%t the%f!%d that the *0. $b he ha $ot dur!%3 the $at da" of treate%t are !ed!ate$" re3a!%ed

A ea$ ! !--ed a%d a"be a -ou%d ! $ot The %e/t da" th! -ou%d ! re3a!%ed; !% -!te ofa (arefu$ wat(h o5er the food !%tae I% a few da" a tearfu$ -at!e%t ! ba( !% the (o%u$t!%3roo; (o%5!%(ed that her (ae ! a fa!$ure

A$$ that ! ha--e%!%3 ! that the ee%t!a$ fat $ot at the e%d of the treate%t; ow!%3 to the-at!e%t re$u(ta%(e to re-ort a u(h 3reater hu%3er; ! be!%3 re-$a(ed The we!3ht at wh!(hu(h a -at!e%t ut tab!$!Be thu $!e *0. $b h!3her tha% the we!3ht rea(hed at the e%d ofthe treate%t O%(e th! h!3her ba!( $e5e$ ! etab$!hed; further d!ff!(u$t!e !% (o%tro$$!%3 thewe!3ht at the %ew -o!%t of tab!$!Bat!o% hard$" ar!e

Be4a%e o! O'e%5en"husas*

The other troub$e wh!(h ! fre>ue%t$" e%(ou%tered !ed!ate$" after treate%t ! a3a!% due too5er0e%thu!a Soe -at!e%t (a%%ot be$!e5e that the" (a% eat fa!r$" %ora$$" w!thoutre3a!%!%3 we!3ht The" d!re3ard the ad5!(e to eat a%"th!%3 the" -$eae e/(e-t u3ar a%dtar(h a%d wa%t to -$a" afe The" tr" ore or $e to (o%t!%ue the 0)a$or!e d!et o% wh!(hthe" fe$t o we$$ dur!%3 treate%t a%d ae o%$" !%or 5ar!at!o%; u(h a re-$a(!%3 the eatw!th a% e33; (heee; or a 3$a of !$ To the!r horror the" f!%d that !% -!te of th! bra5ura;the!r we!3ht 3oe u- So; fo$$ow!%3 !%tru(t!o%; the" !- o%e ea3er $u%(h a%d at %!3ht eato%$" a $!tt$e a$ad a%d dr!% a -ot of u%weete%ed tea; be(o!%3 !%(rea!%3$" hu%3r" a%dwea The %e/t or%!%3 the" f!%d that the" ha5e !%(reaed "et a%other -ou%d The" fee$terr!b$e; a%d e5e% the dreaded we$$!%3 of the!r a%$e ! ba( Nora$$" we (he( our -at!e%to%e wee after the" ha5e bee% eat!%3 free$"; but thee (ae retur% !% a few da" E!ther the!r

e"e are f!$$ed w!th tear or the" a%3r!$" !-$" that whe% we to$d the to eat %ora$$" we were ?ut foo$!%3 the

P%o"en de!cenc)

Here too; the e/-$a%at!o% ! >u!te !-$e Dur!%3 treate%t the -at!e%t ha bee% o%$" ?utabo5e the 5er3e of -rote!% def!(!e%(" a%d ha had the ad5a%ta3e of -rote!% be!%3 fed ba(!%to h! "te fro the breadow% of fatt" t!ue O%(e the treate%t ! o5er there ! %oore H)G !% the bod" a%d th! -ro(e %o $o%3er tae -$a(e :%$e a% ade>uate aou%t of-rote!% ! eate% a oo% a the treate%t ! o5er; -rote!% def!(!e%(" ! bou%d to de5e$o-; a%dth! !%e5!tab$" (aue the ared rete%t!o% of water %ow% a hu%3er0 edea

The treate%t ! 5er" !-$e The -at!e%t ! to$d to eat two e33 for breafat a%d a hu3etea for $u%(h a%d d!%%er fo$$owed b" a $ar3e he$-!%3 of (heee a%d to -ho%e throu3h thewe!3ht the %e/t or%!%3 6he% thee !%tru(t!o% are fo$$owed a tu%%ed 5o!(e ! heard tore-ort that two $b ha5e 5a%!hed o5er%!3ht; that the a%$e are %ora$ but that $ee- wad!turbed; ow!%3 to a% e/traord!%ar" %eed to -a $ar3e >ua%t!t!e of water The -at!e%t ha5!%3$ear%ed th! $eo% uua$$" ha %o further troub$e

51



Reases

A a 3e%era$ ru$e o%e (a% a" that #J07J of our (ae e/-er!e%(e $!tt$e or %o d!ff!(u$t" !%ho$d!%3 the!r we!3ht -era%e%t$" Re$a-e a" be due to %e3$!3e%(e !% the ba!( ru$e of da!$"we!3h!%3 8a%" -at!e%t th!% that th! ! u%%e(ear" a%d that the" (a% ?ud3e a%" !%(reaefro the f!t of the!r ($othe Soe do %ot (arr" the!r (a$e w!th the o% a ?our%e" a !t !(uberoe a%d tae a b!3 b!te out of the!r $u33a3e0a$$owa%(e whe% f$"!%3 Th! ! a

d!atrou !tae; be(aue after a (oure of H)G a u(h a 1 $b (a% be re3a!%edw!thout a%" %ot!(eab$e (ha%3e !% the f!t of the ($othe The reao% for th! ! that aftertreate%t %ew$" a(>u!red fat ! at f!rt e5e%$" d!tr!buted a%d doe %ot how the forer-refere%(e for (erta!% -art of the bod"

2re3%a%(" or the e%o-aue a" a%%u$ the effe(t of a -re5!ou treate%t 6oe% who taetreate%t dur!%3 the o%e "ear after the $at e%truat!o% 0 that ! at the o%et of thee%o-aue 0 do ?ut a we$$ a other; but ao%3 the the re$a-e rate ! h!3her u%t!$ thee%o-aue ! fu$$" etab$!hed The -er!od of o%e "ear after the $at e%truat!o% a--$!eo%$" to woe% who are %ot be!%3 treated w!th o5ar!a% horo%e If thee are tae%; the-ree%o-aua$ -er!od a" be !%def!%!te$" -ro$o%3ed

Late tee%a3e 3!r$ who uffer fro atta( of (o-u$!5e eat!%3 ha5e b" far the wort re(ordof a$$ a far a re$a-e are (o%(er%ed

2at!e%t who ha5e o%(e tae% the treate%t %e5er ee to he!tate to (oe ba( for a%otherhort (oure a oo% a the" %ot!(e that the!r we!3ht ! o%(e a3a!% 3ett!%3 out of ha%d The"(oe >u!te (heerfu$$" a%d ho-efu$$"; aured that the" (a% be he$-ed a3a!% Re-eat (oureare ofte% e5e% ore at!fa(tor" tha% the f!rt treate%t a%d ha5e the ad5a%ta3e; a doe(o%d (oure; that the -at!e%t a$read" %ow that he w!$$ fee$ (ofortab$e throu3hout

Plan of a 0or"al ,ourse

1* I: of H)G da!$" +e/(e-t dur!%3 e%truat!o%, u%t!$ 4 doe ha5e bee% 3!5e%

:%t!$ .rd doe for(ed feed!%3

After .rd doe; (a$or!e d!et to be (o%t!%ued u%t!$ 7* hour after the $at doe

For the fo$$ow!%3 . wee; a$$ food a$$owed e/(e-t tar(h a%d u3ar !% a%" for +(arefu$ w!th5er" weet fru!t,

After . wee; 5er" 3radua$$" add tar(h !% a$$ >ua%t!t!e; a$wa" (o%tro$$ed b" or%!%3we!3h!%3

,O0,.2SIO0

The H)G M d!et ethod (a% br!%3 re$!ef to e5er" (ae of obe!t"; but the ethod ! %ot !-$eIt ! 5er" t!e (o%u!%3 a%d re>u!re -erfe(t (oo-erat!o% betwee% -h"!(!a% a%d -at!e%tEa(h (ae ut be ha%d$ed !%d!5!dua$$"; a%d the -h"!(!a% ut ha5e t!e to a%wer>uet!o%; a$$a" fear a%d reo5e !u%derta%d!%3 He ut a$o (he( the -at!e%t da!$"6he% oeth!%3 3oe wro%3 he ut at o%(e !%5et!3ate u%t!$ he f!%d the reao% for a%"

52



3a!% that a" ha5e o((urred I% ot (ae !t ! ue$e to ha%d the -at!e%t a d!et0heet a%d$et the %ure 3!5e h! a =hot=

The ethod !%5o$5e a h!3h$" (o-$e/ bod!$" e(ha%!; a%d e5e% thou3h our theor" a"be wro%3 the -h"!(!a% ut ae h!e$f oe ort of -!(ture of what ! a(tua$$" ha--e%!%3otherw!e he w!$$ %ot be ab$e to dea$ w!th u(h d!ff!(u$t!e a a" ar!e dur!%3 treate%t

I ut be3 thoe tr"!%3 the ethod for the f!rt t!e to adhere 5er" tr!(t$" to the te(h%!>uea%d the !%ter-retat!o% here out$!%ed a%d thu treat a few hu%dred (ae before ebar!%3 o%e/-er!e%t of the!r ow%; a%d u%t!$ the% refra!% fro !%trodu(!%3 !%%o5at!o%; howe5er thr!$$!%3the" a" ee I% a %ew ethod; !%%o5at!o% or de-arture fro the or!3!%a$ te(h%!>ue (a%o%$" be uefu$$" e5a$uated a3a!%t a ubta%t!a$ ba(3rou%d of e/-er!e%(e w!th what ! at theoe%t the orthodo/ -ro(edure

I ha5e tr!ed to (o5er a$$ the -rob$e that (oe to " !%d @et a bew!$der!%3 arra" of %ew>uet!o% ee- ar!!%3; a%d " !%ter-retat!o% are t!$$ f$u!d I% -art!(u$ar; I ha5e %e5er hada% o--ortu%!t" of (o%du(t!%3 the $aborator" !%5et!3at!o% wh!(h are o %e(ear" for atheoret!(a$ u%derta%d!%3 of ($!%!(a$ ober5at!o%; a%d I (a% o%$" ho-e that thoe ore

fortu%ate$" -$a(ed w!$$ !% t!e be ab$e to f!$$ th! 3a-

The -rob$e of obe!t" are -erha- %ot o draat!( a the -rob$e of (a%(er or -o$!o; butthe" ofte% (aue $!fe0$o%3 uffer!%3 How a%" -ro!!%3 (areer ha5e bee% ru!%ed b"e/(e!5e fat how a%" $!5e ha5e bee% horte%ed If oe wa" 0 howe5er (uberoe 0(a% be fou%d to (o-e effe(t!5e$" w!th th! u%!5era$ -rob$e of oder% (!5!$!Bed a%; ourwor$d w!$$ be a ha--!er -$a(e for (ou%t$e fe$$ow e% a%d woe%

53



G.OSSR3 4

C 6here5er u%fa!$!ar ter are ued; the" w!$$ be fou%d !% the!r re-e(t!5e a$-habet!(a$ -$a(eThe $a" reader (a% therefore ae h! ow% (ro0refere%(e

ACNE . . . )oo% !% d!eae !% wh!(h -!-$e; ofte% (o%ta!%!%3 -u; a--ear o% fa(e;

%e( a%d hou$der

ACTH . . . Abbre5!at!o% for adre%o(ort!(otro-h!( horo%e O%e of the a%" horo%e-rodu(ed b" the a%ter!or $obe of the -!tu!tar" 3$a%d A)TH (o%tro$ the outer -art; r!%d or(orte/ of the adre%a$ 3$a%d 6he% A)TH ! !%?e(ted !t draat!(a$$" re$!e5e arthr!t!( -a!%; but!t ha a%" u%de!rab$e !de effe(t; ao%3 wh!(h ! a (o%d!t!o% !!$ar to e5ere obe!t"

A)TH ! %ow uua$$" re-$a(ed b" (ort!o%e

ADRENA3IN . . . Horo%e -rodu(ed b" the !%%er -art of the Adre%a$ Ao%3 a%" otherfu%(t!o%; adre%a$!% ! (o%(er%ed w!th b$ood -reure; eot!o%a$ tre; fear a%d (o$d

ADRENA3S . . . E%do(r!%e 3$a%d Sa$$ bod!e !tuated ato- the !d%e" a%d he%(e a$o

%ow% a u-rare%a$ 3$a%d The adre%a$ ha5e a% outer r!%d or (orte/ wh!(h -rodu(e 5!ta$$"!-orta%t horo%e; ao%3 wh!(h are )ort!o%e0!!$ar ubta%(e The adre%a$ (orte/ !(o%tro$$ed b" A)TH The !%%er -art of the adre%a$; the edu$$a; e(rete adre%a$!% a%d !(h!ef$" (o%tro$$ed b" the auto%oou %er5ou "te

ADRENOCORTE8... See adre%a$

AMPHETAMINES . . . S"%thet!( dru3 wh!(h redu(e the aware%e of hu%3er a%d t!u$atee%ta$ a(t!5!t"; re%der!%3 $ee- !-o!b$e 6he% ued for the $atter two -ur-oe the" areda%3erou$" hab!t0for!%3 The" do %ot d!!%!h the bod" %eed for food; but ere$"u--re the -er(e-t!o% of that %eed The or!3!%a$ dru3 wa %ow% a 'e%Bedr!%e; frowh!(h oder% 5ar!a%t u(h a De/edr!%e; De/a!$; a%d 2re$ud!%; et(; ha5e bee% der!5ed

A-heta!%e a" he$- a% obee -at!e%t to -re5e%t a further !%(reae !% we!3ht but areu%at!fa(tor" for redu(!%3; a the" do %ot (ure the u%der$"!%3 d!order a%d a the!r -ro$o%3edue a" $ead to a$%utr!t!o% a%d add!(t!o%

ARTERIOSC3EROSIS . . . Harde%!%3 of the arter!a$ wa$$ throu3h the (a$(!f!(at!o% of ab%ora$de-o!t of a fat$!e ubta%(e %ow% a (ho$etero$

ASCHHE9M5ONDE; . . . Author of a tet b" wh!(h ear$" -re3%a%(" (a% be d!a3%oed b"!%?e(t!%3 a woa% ur!%e !%to fea$e !(e The H)G -ree%t !% -re3%a%(" ur!%e -rodu(e(erta!% (ha%3e !% the 5a3!%a of thee a%!a$ 8a%" !!$ar tet; u!%3 other a%!a$ u(ha rabb!t; fro3; et( ha5e bee% de5!ed

ASSIMI3ATE . . . Aborb d!3eted food fro the !%tet!%e

A$TONOMO$S . . . Here ued to de(r!be the !%de-e%de%t or 5e3etat!5e %er5ou "tewh!(h a%a3e the autoat!( re3u$at!o% of the bod"

BASA3 METABO3ISM . . . The bod" (he!(a$ tur%o5er at (o-$ete ret a%d whe% fat!%3The baa$ etabo$!( rate ! e/-reed a the aou%t of o/"3e% ued u- !% a 3!5e% t!e The

54



baa$ etabo$!( rate +'8R, ! (o%tro$$ed b" the th"ro!d 3$a%d

CA3ORIE . . . The -h"!(!t (a$or!e ! the aou%t of heat re>u!red to ra!e the te-eratureof 1 (( of water b" 1 de3ree )e%t!3rade The d!et!(!a% )a$or!e +a$wa" wr!tte% w!th a (a-!ta$), ! 1 t!e 3reater Thu whe% we -ea of a )a$or!e d!et th! ea% that the bod"! be!%3 u--$!ed w!th a u(h fue$ a wou$d be re>u!red to ra!e the te-erature of $!terof water b" 1 de3ree )e%t!3rade or $!ter b" 1 de3ree Th! ! >u!te !%uff!(!e%t to (o5er

the heat a%d e%er3" re>u!ree%t of a% adu$t bod" I% the H)G ethod the def!(!t ! ade u-fro the ab%ora$ fat0de-o!t; of wh!(h 1 $b fur%!he the bod" w!th ore tha% *)a$or!e A th! ! rou3h$" the aou%t $ot e5er" da"; a -at!e%t u%der H)G ! %e5er hort offue$

CEREBRA3 . . . Of the bra!% )erebra$ 5a(u$ar d!eae ! a d!order (o%(er%!%3 the b$ood5ee$ of the bra!%; u(h a (erebra$ throbo! or heorrha3e; %ow% a a-o-$e/" ortroe

CHO3ESTERO3 . . . A fat$!e ubta%(e (o%ta!%ed !% a$ot e5er" (e$$ of the bod" I% theb$ood !t e/!t !% two for; %ow% a free a%d eter!f!ed The $atter for ! u%der (erta!%

(o%d!t!o% de-o!ted !% the !%%er $!%!%3 of the arter!e +ee arter!o($ero!, No ($ear a%ddef!%!te re$at!o%h!- betwee% fat !%tae a%d (ho$etero$0$e5e$ !% the b$ood ha "et bee%etab$!hed

CHORIONIC . . . Of the (hor!o%; wh!(h ! -art of the -$a(e%ta or after0b!rth The ter (hor!o%!(! ?ut$" a--$!ed to H)G; a th! horo%e ! e/($u!5e$" -rodu(ed !% the -$a(e%ta; fro where!t e%ter the hua% other b$ood a%d ! $ater e/(reted !% her ur!%e

COMP$3SIE EATIN+. . . A for of ora$ 3rat!f!(at!o% w!th wh!(h a re-reed e/0!%t!%(t !oet!e 5!(ar!ou$" re$!e5ed )o-u$!5e eat!%3 ut %ot be (o%fued w!th the rea$ hu%3erfro wh!(h ot obee -at!e%t uffer

CON+ENITA3 . . . A%" (o%d!t!o% wh!(h e/!t at or before b!rth

CORONARY ARTERIES Two b$ood 5ee$ wh!(h e%(!r($e the heart a%d u--$" a$$ theb$ood re>u!red b" the heart0u($e

CORP$S 3$TE$M . . . A "e$$ow bod" wh!(h for !% the o5ar" at the fo$$!($e fro wh!(h a%e33 ha bee% deta(hed Th! bod" a(t a a% e%do(r!%e 3$a%d a%d -$a" a% !-orta%t ro$e !%e%truat!o% a%d -re3%a%(" It e(ret!o% ! o%e of the e/ horo%e; a%d !t ! t!u$ated b"a%other horo%e %ow% a LSH; wh!(h ta%d for $uteu t!u$at!%3 horo%e LSH !-rodu(ed !% the a%ter!or $obe of the -!tu!tar" 3$a%d LSH ! tru$" 3o%adotro-h!( a%d ut %e5erbe (o%fued w!th H)G; wh!(h ! a tota$$" d!ffere%t ubta%(e; ha5!%3 %o d!re(t a(t!o% o% the(or-u $uteu

CORTE8 . . . Outer (o5er!%3 or r!%d The ter ! a--$!ed to the outer -art of the adre%a$ but! a$o ued to de(r!be the 3ra" atter wh!(h (o5er the wh!te atter of the bra!%

CORTISONE . . . A "%thet!( ubta%(e wh!(h a(t $!e a% adre%a$ horo%e It ! toda" ued!% the treate%t of a $ar3e %uber of !$$%ee; a%d e5era$ (he!(a$ 5ar!a%t ha5e bee%-rodu(ed; ao%3 wh!(h are -red%!o%e a%d tr!a(!%o$o%e

55



C$SHIN+ . . . A 3reat Aer!(a% bra!% ur3eo% who de(r!bed a (o%d!t!o% of e/tree obe!t"ao(!ated w!th "-to of adre%a$ d!order )uh!%3 S"%droe a" be (aued b"or3a%!( d!eae of the -!tu!tar" or the adre%a$ 3$a%d but; a wa $ater d!(o5ered; !t a$oo((ur a a reu$t of e/(e!5e A)TH ed!(at!o%

DIENCEPHA3ON . . . A -r!!t!5e a%d he%(e 5er" o$d -art of the bra!% wh!(h $!e betwee% a%du%der the two $ar3e he!-here I% a% the d!e%(e-ha$o% +or h"-otha$au, ! ubord!%ate

to the h!3her bra!% or (orte/; a%d "et !t u$t!ate$" (o%tro$ a$$ that ha--e% !%!de the bod" Itre3u$ate a$$ the e%do(r!%e 3$a%d; the auto%oou %er5ou "te; the tur%o5er of fat a%du3ar It ee a$o to be the eat of the -r!!t!5e a%!a$ !%t!%(t a%d ! the re$a" tat!o% atwh!(h eot!o% are tra%$ated !%to bod!$" rea(t!o%

DI$RETIC. . . A%" ubta%(e that !%(reae the f$ow of ur!%e

DYS#$NCTION . . . Ab%ora$ fu%(t!o%!%3 of a%" or3a%; be th! e/(e!5e; def!(!e%t or !% a%"wa" a$tered

EDEMA . . . A% ab%ora$ a((uu$at!o% of water !% the t!ue

E3ECTROCARDIO+RAM . . . Tra(!%3 of e$e(tr!( -he%oe%a ta!%3 -$a(e !% the heart dur!%3ea(h beat The tra(!%3 -ro5!de !%forat!o% about the (o%d!t!o% a%d wor!%3 of the heartwh!(h ! %ot otherw!e obta!%ab$e

ENDOCRINE . . . 6e d!t!%3u!h e%do(r!%e a%d e/o(r!%e 3$a%d The forer -rodu(ehoro%e; (he!(a$ re3u$ator; wh!(h the" e(rete d!re(t$" !%to the b$ood (!r(u$at!o% !% the3$a%d a%d fro where the" are (arr!ed a$$ o5er the bod" E/a-$e of e%do(r!%e 3$a%d arethe -!tu!tar"; the th"ro!d a%d the adre%a$ E/o(r!%e 3$a%d -rodu(e a 5!!b$e e(ret!o% u(ha a$!5a; weat; ur!%e There are a$o 3$a%d wh!(h are e%do(r!%e a%d e/o(r!%e E/a-$eare the tet!($e; the -rotate a%d the -a%(rea; wh!(h -rodu(e the horo%e !%u$!% a%dd!3et!5e fere%t wh!(h f$ow fro the 3$a%d !%to the !%tet!%a$ tra(t E%do(r!%e 3$a%d are

($oe$" !%ter0de-e%de%t of ea(h other; the" are $!%ed to the auto%oou %er5ou "te a%dthe d!e%(e-ha$o% -re!de o5er th! who$e !%(red!b$" (o-$e/ re3u$ator" "te

EMACIATED . . . Gro$" u%der%our!hed

E$PHORIA . . . A fee$!%3 of -art!(u$ar -h"!(a$ a%d e%ta$ we$$ be!%3

#ERA3 . . . 6!$d; u%retra!%ed

#IBROID . . . A%" be%!3% %ew 3rowth of (o%%e(t!5e t!ue 6he% u(h a tuor or!3!%atefro a u($e; !t ! %ow% a a "oa The ot (oo% eat of "oa ! the uteru

#O33IC3E . . . A%" a$$ bod!$" ("t or a( (o%ta!%!%3 a $!>u!d Here the ter a--$!e to the

o5ar!a% ("t !% wh!(h the e33 ! fored The e33 ! e/-e$$ed whe% a r!-e fo$$!($e burt a%dth! ! %ow% a o5u$at!o% +ee (or-u $uteur%,

#SH . . . Abbre5!at!o% for fo$$!($e0t!u$at!%3 horo%e FSH ! a%other +ee (or-u $uteu,a%ter!or -!tu!tar" horo%e wh!(h a(t d!re(t$" o% the o5ar!a% fo$$!($e a%d ! therefore (orre(t$"(a$$ed a 3o%adotro-h!%

56



+3ANDS . . . See e%do(r!%e

+ONADOTROPHIN . . . See (or-u $uteu; fo$$!($e a%d FSH Go%adotro-h!( $!tera$$" ea%e/ 3$a%d0d!re(ted FSH; LSH a%d the e>u!5a$e%t horo%e !% the a$e; a$$ -rodu(ed !% thea%ter!or $obe of the -!tu!tar" 3$a%d; are true 3o%adotro-h!% :%fortu%ate$" a%d (o%fu!%3$";the ter 3o%adotro-h!% ha a$o bee% a--$!ed to the -$a(e%ta$ horo%e of -re3%a%(" %ow%a hua% (hor!o%!( 3o%adotro-h!% +H)G, Th! horo%e a(t o% the d!e%(e-ha$o% a%d (a%

o%$" !%d!re(t$" !%f$ue%(e the e/ 3$a%d 5!a the a%ter!or $obe of the -!tu!tar"

HC+ . . . Abbre5!at!o% for hua% (hor!o%!( 3o%adotro-h!%

HORMONES . . . See e%do(r!%e

HYPERTENSION . . . H!3h b$ood -reure

HYPO+3YCEMIA . . . A (o%d!t!o% !% wh!(h the b$ood u3ar ! be$ow %ora$ It (a% be re$!e5edb" eat!%3 u3ar

HYPOPHYSIS . . . A%other %ae for the -!tu!tar" 3$a%d

HYPOTHESIS . . . A te%tat!5e e/-$a%at!o% or -e(u$at!o% o% how ober5ed fa(t a%d !o$ated(!e%t!f!( data (a% be brou3ht !%to a% !%te$$e(tua$$" at!f"!%3 re$at!o%h!- of (aue a%d effe(tH"-othee are uefu$ for d!re(t!%3 further reear(h; but the" are %ot %e(ear!$" a%e/-o!t!o% of what ! be$!e5ed to be the truth 'efore a h"-othe! (a% ad5a%(e to the d!3%!t"of a theor" or a $aw; !t ut be (o%f!red b" a$$ future reear(h A oo% a reear(h tur% u-data wh!(h %o $o%3er f!t the h"-othe!; !t ! !ed!ate$" aba%do%ed for a better o%e

3SH . . . See (or-u $uteu

METABO3ISM . . . See baa$ etabo$!

MI+RAINE . . . Se5ere ha$f0!ded heada(he ofte% ao(!ated w!th 5o!t!%3

M$COID . . . S$!e0$!e

MYOCARDI$M . . . The heart0u($e

MYOMA . . . See f!bro!d

MY8EDEMA . . . A((uu$at!o% of a u(o!d ubta%(e !% the t!ue wh!(h o((ur !% (ae ofe5ere -r!ar" th"ro!d def!(!e%("

NEO3ITHIC . . . I% the h!tor" of hua% (u$ture we d!t!%3u!h the Ear$" Sto%e A3e or2a$eo$!th!(; the 8!dd$e Sto%e A3e or 8eo$!th!( a%d the New Sto%e A3e or Neo$!th!( -er!od

The Neo$!th!( -er!od tarted about & "ear a3o whe% the f!rt atte-t at a3r!(u$ture;-otter" a%d a%!a$ doet!(at!o% ade at the e%d of the 8eo$!th!( -er!od udde%$" be3a% tode5e$o- ra-!d$" a$o%3 the road that $ed to oder% (!5!$!Bat!o%

NORMA3 SA3INE . . . A $ow (o%(e%trat!o% of a$t !% water e>ua$ to the a$!%!t" of bod" f$u!d

PH3EBITIS . . . A% !%f$aat!o% of the 5e!% 6he% a b$ood0($ot for at the !te of the

57



!%f$aat!o%; we -ea of throbo-h$eb!t!

PIT$ITARY . . . A 5er" (o-$e/ e%do(r!%e 3$a%d wh!(h $!e at the bae of the u$$; (o%!t!%3(h!ef$" of a% a%ter!or a%d a -oter!or $obe The -!tu!tar" ! (o%tro$$ed b" the d!e%(e-ha$o%;wh!(h re3u$ate the a%ter!or $obe b" ea% of horo%e wh!(h rea(h !t throu3h a$$ b$ood5ee$ The -oter!or $obe ! (o%tro$$ed b" %er5e wh!(h ru% fro the d!e%(e-ha$o% !%to th!-art of the 3$a%d The a%ter!or $obe e(rete a%" horo%e; ao%3 wh!(h are thoe that

re3u$ate other 3$a%d u(h a the th"ro!d; the adre%a$ a%d the e/ 3$a%d

P3ACENTA . . . The after0b!rth I% woe%; a $ar3e a%d h!3h$" (o-$e/ or3a% throu3h wh!(hthe (h!$d !% the wob re(e!5e !t %our!he%t fro the other bod" It ! the or3a% !% wh!(hH)G ! a%ufa(tured a%d the% 3!5e% off !%to the other b$ood

PROTEIN . . . The $!5!%3 ubta%(e !% -$a%t a%d a%!a$ (e$$ Herb!5orou a%!a$ (a% thr!5eo% -$a%t -rote!% a$o%e; but a% ut ha5e oe -rote!% of a%!a$ or!3!% +!$; e33 or f$eh,to $!5e hea$th!$" 6he% !%uff!(!e%t -rote!% ! eate%; the bod" reta!% water

PSORIASIS . . . A !% d!eae wh!(h -rodu(e (a$" -at(he Thee te%d to d!a--eardur!%3 -re3%a%(" a%d dur!%3 the treate%t of obe!t" b" the H)G ethod

RENA3 . . . Of the !d%e"

RESERPINE . . . A% I%d!a% dru3 e/te%!5e$" ued !% the treate%t of h!3h b$ood -reure a%doe for of e%ta$ d!order

RETENTION ENEMA . . . The $ow !%fu!o% of a $!>u!d !%to the re(tu; fro where !t !aborbed a%d %ot e5a(uated

SACR$M . . . A fu!o% of the $ower 5ertebrate !%to the $ar3e bo%" a to wh!(h the -e$5! !atta(hed

SEDIMENTATION RATE . . . The -eed at wh!(h a u-e%!o% of red b$ood (e$$ ett$e out A ra-!d ett$!%3 out ! (a$$ed a h!3h ed!e%tat!o% rate a%d a" be !%d!(at!5e of a $ar3e%uber of bod!$" d!order of -re3%a%("

SE8$A3 SE3ECTION . . . A e/ua$ -refere%(e for !%d!5!dua$ wh!(h how (erta!% tra!t If th!-refere%(e or e$e(t!o% 3oe o% 3e%erat!o% after 3e%erat!o%; ore a%d ore !%d!5!dua$how!%3 the tra!t w!$$ a--ear ao%3 the 3e%era$ -o-u$at!o% The %atura$ e%5!ro%e%t ha $!tt$eor %oth!%3 to do w!th th! -ro(e Se/ua$ e$e(t!o% therefore d!ffer fro %atura$ e$e(t!o%; towh!(h oder% a% ! %o $o%3er ub?e(t be(aue he (ha%3e h! e%5!ro%e%t rather tha% $etthe e%5!ro%e%t (ha%3e h!

STRIATION . . . Tear!%3 of the $ower $a"er of the !% ow!%3 to ra-!d tret(h!%3 !% obe!t" or

dur!%3 -re3%a%(" 6he% f!rt fored tr!ae are dar redd!h $!%e wh!(h $ater (ha%3e !%towh!te (ar

S$PRARENA3 +3ANDS . . . See adre%a$

SYNDROME . . . A 3rou- of "-to wh!(h !% the!r ao(!at!o% are (hara(ter!t!( of a-art!(u$ar d!order

58



THROMBOPH3EBITIS . . . See -h$eb!t!

THROMB$S . . . A b$ood0($ot !% a b$ood05ee$

TRIAMCINO3ONE . . . A oder% der!5at!5e of (ort!o%e

$RIC ACID . . . A -rodu(t of !%(o-$ete -rote!%0breadow% or ut!$!Bat!o% !% the bod" 6he%

ur!( a(!d be(oe de-o!ted !% the 3r!t$e of the ?o!%t we -ea of 3out

ARICOSE $3CERS . . . )hro%!( u$(erat!o% abo5e the a%$e due to 5ar!(oe 5e!% wh!(h!%terfere w!th the %ora$ b$ood (!r(u$at!o% !% the affe(ted area

E+ETATIE . . . See auto%oou

ERTEBRATE . . . A%" a%!a$ that ha a ba(0bo%e

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