NOTE: The use of hCG, which is a hormone, must be pre­scri­bed and super­vised by a le­gal­ly li­censed and qual­if­ied med­ic­al pro­fes­sion­al. Do NOT at­tempt to ac­qui­re and self-​medicate with it out­side this frame­work, as you could be li­ab­le for sev­ere Fed­er­al and state pen­al­ties, as well as nas­ty health con­se­quen­ces. Also, it is rec­om­men­ded you use the in­jec­ted, not[why?] ho­meo­path­ic­al­ly di­lu­ted and/or sub­lin­gual hCG prep­ara­tions, as there is no guar­an­tee that these pro­vide the bene­fits of the ac­tu­al ac­tive hor­mone in prop­er do­sage, as des­cri­bed by Sim­eons be­low.
Wherever you see a blue, superscript footnote link in square brackets — like the one after “injected, not” above, you can click it to read its foot­note at the end of the book. Click the same square-​brack­et­ed item there to re­turn to the ci­ta­tion point, to con­tin­ue read­ing. The up- and down-​ar­row icons and bold, un­der­lined links through­out al­low you to navi­gate the book by click­ing the mouse on them, rath­er than hav­ing to use the scroll bars. TOC links index the browser to the book’s Table of Contents, for random access to sections. You can also use the key­board’s up- and down ar­rows. Most brow­sers let you use {Ctrl}+ and {Ctrl}– to en­large or shrink the text — or use the View | Zoom func­tion off its drop-​down menu.


Pounds & Inches


UPA NEW APPROACH TO OBESITY
BY: DR. A.T.W. SIMEONSImage of dr. A.T.W. Simeons
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 - ROME VIALE MURA GIANICOLENSI, 77


Table of Contents
UP Foreword       
THE NATURE OF OBESITY THE TREATMENT OF OBESITY hCG Complicating disorders The “Pregnant” Male TECHNIQUE Interruptions of Weight Loss Dietary Errors Unforeseen Interruptions of Treatment
Muscular Fatigue  
Massage
Blood Sugar
Lbs. : ins. Ratio
GLOSSARY | REFERENCES


FOREWORD
TOC

This book discusses a new interpretation of the nature of obe­sity, and while it does not ad­vo­cate yet an­oth­er fan­cy slim­ming diet, it does des­cribe a meth­od of treat­ment which has grown out of theo­reti­cal con­sid­era­tions based on clin­ic­al ob­ser­va­tion.

What I have to say is an essence of views distilled out of forty years of grap­pling with the fun­da­men­tal prob­lems of obe­sity, its cau­ses, its symp­toms, and its very na­ture. In these many years of spec­ial­ized work, thou­sands of ca­ses have pas­sed through my hands and were care­ful­ly stud­ied. Every new theo­ry, every new meth­od, every prom­is­ing lead was con­sid­er­ed, ex­peri­men­tal­ly screen­ed and crit­ic­al­ly evaluated as soon as it be­came known. But in­vari­ab­ly the re­sults were dis­ap­poin­ting and lacki­ng in uni­for­mity.

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I felt that we were merely nibbling at the fringe of a great problem, as, indeed, do most seri­ous stu­dents of over­weight. We have grown pret­ty sure that the ten­den­cy to ac­cu­mu­late ab­nor­mal fat is a very def­in­ite meta­boli­c dis­or­der, much as is, for in­stance, dia­be­tes. Yet the loc­ali­za­tion and the na­ture of this dis­order re­mained a mys­tery. Every new ap­proach seemed to lead into a blind al­ley, and though pa­tients were told that they are fat be­cause they eat too much, we be­lieved that this is nei­ther the whole truth nor the last word in the mat­ter.

Re­fu­sing to be side-​tracked by an all too fac­ile in­ter­pre­ta­tion of obe­sity, I have al­ways held that over­eat­ing is the result of the dis­or­der, not its cause, and that we can make lit­tle head­way until we can build for our­selves some sort of theo­ret­ic­al struc­ture with which to ex­plain the con­di­tion. Wheth­er such a struc­ture rep­re­sents the truth is not im­por­tant at this moment. What it must do is to give us an in­tel­lec­tu­al­ly sat­is­fy­ing in­ter­pre­ta­tion of what is hap­pen­ing in the obese body. It must also be able to with­stand the on­slaught of all hith­er­to known clin­ic­al facts, and fur­nish a hard back­ground against which the res­ults of treat­ment can be ac­cur­ate­ly as­ses­sed.

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To me this requirement seems basic, and it has always been the cen­ter of my in­ter­est. In deal­ing with obese pa­tients it be­came a ha­bit to reg­is­ter and or­der every clin­ic­al ex­peri­ence as if it were an odd-​look­ing piece of a jig-​saw puz­zle. And then, as in a jig-​saw puz­zle, lit­tle clus­ters of frag­ments be­gan to form, though they seemed to fit in no­where. As the years pas­sed, these clusters grew big­ger and star­ted to amal­gam­ate un­til, about six­teen years ago, a com­plete pic­ture became dim­ly dis­cer­nib­le. This pic­ture was, and still is, dot­ted with gaps for which I can­not find the piec­es, but I do now feel that a theo­reti­­c­al struc­ture is vis­ib­le as a whole.

With mounting experience, more and more facts seemed to fit snug­ly into the new frame­work, and when then a treat­ment based on such specu­la­tions showed con­sis­tent­ly sat­is­fac­to­ry res­ults, I was sure that some prac­tic­al ad­vance had been made, re­gard­less of wheth­er the theo­ret­i­c­al in­ter­pre­ta­tion of these res­ults is cor­rect or not.

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The clinical results of the new treatment have been pub­lished in sci­en­tifi­c jour­nal[1], and these re­ports have been gen­er­al­ly well re­ceived by the pro­fes­sion, but the very na­ture of a sci­en­tif­ic ar­tic­le does not per­mit the full pres­en­ta­tion of new theo­reti­cal con­cepts, nor is there room to dis­cuss the fi­ner points of tech­nique and the rea­sons for ob­ser­ving them.

During the 16 years that have elapsed since I first published my findings, I have had many hun­dreds of in­quir­ies from re­search in­sti­tutes, doc­tors, and pa­tients. Hith­er­to I could only re­fer those in­ter­est­ed to my sci­en­tif­ic pa­pers, though I re­al­ized that these did not con­tain suf­fic­ient in­for­ma­tion to ena­ble doc­tors to con­duct the new treat­ment sat­is­fac­tori­ly. Those who tried were ob­liged to gain their own ex­peri­ence through the many tri­als and er­rors which I have long since over­come.

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Doctors from all over the world have come to Italy to study the method, first hand in my clin­ic in the Sal­va­tor Mun­di In­ter­na­tion­al Hos­pit­al in Rome. For some of them the time they could spare has been too short to get a full grasp of the tech­nique, and in any case the num­ber of those whom I have been able to meet per­son­al­ly is small com­pared with the many re­quests for fur­ther de­tailed in­for­ma­tion which keep com­ing in. I have tried to keep up with these de­mands by cor­re­spon­dence, but the vol­ume of this work has be­come un­man­age­able, and that is one ex­cuse for wri­ting this book.

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In dealing with a disorder in which the patient must take an ac­tive part in the treat­ment, it is, I be­lieve, es­sen­tial that he or she have an un­der­stan­ding of what is be­ing done and why. Only then can there be in­tel­lig­ent co­oper­ation be­tween phys­ic­ian and pa­tient. In order to avoid wri­ting two books, one for the phys­ic­ian and an­oth­er for the pa­tient — a pros­pect which would prob­ab­ly have re­sul­ted in no book at all — I have tried to meet the re­quire­ments of both in a sin­gle book. This is a rath­er dif­fic­ult en­ter­prise in which I may not have suc­cee­ded. The ex­pert will grum­ble about long-​win­ded­ness, while the lay rea­der may oc­ca­sion­al­ly have to look up an un­fa­mi­liar word in the glos­sary pro­vi­ded for him.

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To make the text more readable, I shall be unashamedly au­thori­ta­tive and avoid all the hed­ging and ten­ta­tive­ness with which it is cus­tom­ary to ex­press new sci­en­tif­ic con­cepts grown out of clin­ic­al ex­peri­ence, and not as yet con­firmed by clear-​cut lab­ora­tory ex­peri­ments. Thus, when I make what reads like a fac­tu­al state­ment, the pro­fes­sion­al rea­der may have to trans­late into: 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 of fur­ther re­search be­fore the hy­poth­es­is can be con­sid­er­ed a valid theo­ry. If we can from the out­set es­tab­lish this as a mu­tu­al­ly ac­cep­ted con­ven­tion, I hope to avoid be­ing ac­cused of spec­ula­tive ex­uber­ance.

THE NATURE OF OBES­ITY TOC
Obesity a Disorder

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As a basis for our discussion, we postulate that obes­ity in all its many forms is due to an ab­nor­mal func­tion­ing of some part of the body, and that ev­ery ounce of ab­nor­mall­y-​ac­cu­mu­la­ted fat is al­ways the re­sult of the same dis­or­der of cer­tain reg­ul­at­ory mech­an­isms. Per­sons suf­fer­ing from this par­ticu­lar dis­or­der will get fat re­gard­less of wheth­er they eat ex­ces­sive­ly, nor­mal­ly, or less than nor­mal. A per­son who is free of the dis­or­der will nev­er get fat, even if he fre­quent­ly over­eats.

Those in whom the disorder is severe will accumulate fat very rap­id­ly, those in whom it is mod­er­ate will grad­ual­ly in­crease in weight, and those in whom it is mild may be able to keep their ex­cess weight sta­tion­ary for long peri­ods. In all these cases a loss of weight brought about by diet­ing, treat­ments with thy­roid, ap­pet­ite-​re­du­cing drugs, laxa­tives, vio­lent exer­cise, mas­sage, baths, etc., is only tem­por­ary, and will be rap­id­ly re­gained as soon as the re­du­cing reg­im­en is re­laxed. The rea­son is simp­ly that none of these meas­ures cor­rects the ba­sic dis­or­der.

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While there are great variations in the severity of obes­ity, we shall con­sid­er all the dif­fer­ent forms in both sexes and at all ages as al­ways being due to the same dis­or­der. Varia­tions in form would then be part­ly a mat­ter of de­gree, part­ly an in­herit­ed bodi­ly con­stitu­tion, and part­ly the res­ult of a sec­on­dary in­volve­ment of en­doc­rine glands such as the pit­ui­tary, the thy­roid, the ad­ren­als, or the sex glands. On the other hand, we pos­tu­late that no de­fic­ien­cy of any of these glands can ever dir­ect­ly pro­duce the com­mon dis­or­der known as obes­ity.

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If this reasoning is correct, it follows that a treatment aimed at cu­ring the dis­or­der must be equal­ly ef­fec­tive in both sexes, at all ages, and in all forms of obes­ity. Un­less this is so, we are en­ti­tled to har­bor grave doubts as to wheth­er a given treat­ment cor­rects the un­der­ly­ing dis­or­der. More­over, any claim that the dis­or­der has been cor­rec­ted must be sub­stan­ti­ated by the abil­ity of the pa­tient to eat nor­mal­ly of any food he pleases with­out re­gain­ing ab­nor­mal fat after treat­ment. Only if these con­di­tions are ful­fil­led can we leg­it­im­ate­ly speak of cu­ring obes­ity rath­er than of re­duc­ing weight.

Our problem thus presents itself as an enquiry into the localization and the nature of the disorder which leads to obes­ity. The history of this enquiry is a long series of high hopes and bitter disappointments.

The History of Obes­ity TOC

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There was a time, not so long ago, when obes­ity was con­sid­er­ed a sign of health and pros­per­ity in man and of beauty, amor­ous­ness and fe­cun­di­ty in wom­en. This at­ti­tude prob­ab­ly dates back to Neo­lith­ic times, about 8000 years ago; when for the first time in the his­tory of cul­ture, man be­gan to own prop­er­ty, do­mes­tic ani­mals, ara­ble land, hou­ses, pot­tery and met­al tools. Be­fore that, with the pos­sib­le ex­cep­tion of some ra­ces such as the Hot­ten­tots, obes­ity was al­most non-​ex­is­tent, as it still is in all wild ani­mals and most primi­tive races.

Today obes­ity is extremely common among all civilized races, be­cause a dis­po­si­tion to the dis­or­der can be in­her­i­ted. Wher­ev­er ab­nor­mal fat was re­gar­ded as an as­set, sex­ual sel­ec­tion ten­ded to prop­ag­ate the trait. It is only in very re­cent times that mani­fest obes­ity has lost some of its al­lure, though the cult of the out­size bust – always a sign of la­tent obes­ity – shows that the trend still lin­gers on.

The Significance of Regular Meals TOC

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In the early Neolithic times another change took place which may well account for the fact that today nearly all inherited dis­po­si­tions sooner or la­ter de­vel­op into mani­fest obes­ity. This change was the in­sti­tu­tion of reg­ul­ar meals. In pre-​Neo­lith­ic times, man ate only when he was hun­gry and on1y as much as he re­qui­red to still the pangs of hun­ger. More­over, much of his food was raw, and all of it was un­re­fined. He roa­sted his meat, but he did not boil it, as he had no pots, and what lit­tle he may have grub­bed from the Earth and picked from the trees, he ate as he went along.

The whole structure of man’s omnivorous digestive tract is, like that of an ape, rat or pig, ad­jus­ted to the con­tin­ual nib­bling of tid­bits. It is not suit­ed to oc­ca­sion­al gor­ging as is, for in­stance, the in­tes­tine of the car­niv­or­ous cat fam­ily. Thus, the in­sti­tu­tion of reg­ul­ar meals, par­tic­ul­arly of food ren­dered rap­id­ly as­sim­il­ab­le, placed a great bur­den on mod­ern man’s abil­ity to cope with large quan­tit­ies of food sud­den­ly pour­ing into his sys­tem from the in­tes­tin­al tract.

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The institution of regular meals meant that man had to eat more than his body re­quired at the mo­ment of eat­ing so as to tide him over un­til the next meal. Food ren­der­ed eas­ily di­ges­tib­le sud­den­ly flood­ed his body with nour­ish­ment of which he was in no need at the mo­ment. Some­how, some­where, this sur­plus had to be stored.

Three Kinds of Fat TOC

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In the human body we can distinguish three kinds of fat:

  1. The structural fat which fills the gaps between various organs, a sort of pack­ing ma­teri­al. Struc­tur­al fat also per­forms such im­por­tant functions as bed­ding the kid­neys in soft elas­tic tis­sue, pro­tec­ting the cor­on­ary ar­ter­ies, and keep­ing the skin smooth and taut. It also pro­vides the springy cush­ion of hard fat under the bones of the feet, with­out which we would be un­able to walk.
  2. A normal reserve of fuel upon which the body can free­ly draw when the nu­tri­tion­al in­come from the in­tes­tin­al tract is in­suf­fic­ient to meet the de­mand. Such nor­mal res­erves are lo­cal­ized all over the body. Fat is a sub­stance which packs the high­est cal­or­ic val­ue into the smal­lest space so that nor­mal res­erves of fuel for mus­cul­ar ac­tiv­ity and the main­ten­ance of body tem­pera­ture can be most eco­nom­ic­al­ly stored in this form. Both these types of fat, struc­tur­al and res­erve, are nor­mal, and even if the body stocks them to ca­pac­ity, this can nev­er be called obes­ity.
  3. But there is a third type of fat which is entirely abnormal. It is the ac­cu­mu­la­tion of such fat, and of such fat only, from which the over­weight pa­tient suf­fers. This ab­nor­mal fat is also a po­ten­tial re­serve of fuel, but un­like the nor­mal res­erves it is not avail­able to the body in a nu­tri­tion­al emer­gen­cy. It is, so to speak, locked away in a fixed de­pos­it, and is not kept in a cur­rent ac­count[2], as are the nor­mal res­erves.

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When an obese patient tries to reduce by starving himself, he will first lose his nor­mal fat res­erves. When these are ex­haus­ted he be­gins to burn up struc­tur­al fat, and only as a last res­ort will the body yield its ab­nor­mal res­erves, though by that time the pa­tient usu­al­ly feels so weak and hun­gry that the diet is aban­doned. It is just for this rea­son that obese pa­tients com­plain that when they diet they lose the wrong fat. They feel fam­ished and tired, and their face be­comes drawn and hag­gard, but their belly, hips, thighs and up­per arms show lit­tle im­prove­ment. The fat they have come to de­test stays on, and the fat they need to cov­er their bones gets less and less. Their skin wrin­kles, and they look old and mis­er­ab­le. And that is one of the most frus­tra­ting and de­pres­sing ex­peri­en­ces a hu­man be­ing can have.

Injustice to the Obese TOC

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When then obese patients are accused of cheating, gluttony, lack of will power, greed and sex­ual com­plex­es, the strong be­come in­dig­nant and de­cide that mod­ern medi­cine is a fraud and its rep­re­sen­ta­tives fools, while the weak just give up the strug­gle in des­pair. In ei­ther case the res­ult is the same: a fur­ther gain in weight, res­ig­na­tion to an abom­in­ab­le fate and the re­so­lu­tion at least to live tol­er­ab­ly the short span al­lot­ted to them — a fig for doc­tors and in­su­rance com­pan­ies.

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Obese patients only feel physically well as long as they are sta­tion­ary or gai­ning weight. They may feel guil­ty, ow­ing to the leth­ar­gy and in­do­lence al­ways as­so­cia­ted with obes­ity. They may feel ashamed of what they have been led to be­lieve is a lack of con­trol. They may feel hor­rif­ied by the ap­pear­ance of their nude body and the tight­ness of their clothes. But they have a primi­tive feel­ing of ani­mal con­tent which turns to mis­ery and suf­fer­ing as soon as they make a re­so­lute at­tempt to re­duce. For this there are sound reasons.

In the first place, more caloric energy is required to keep a large body at a cer­tain tem­pe­ra­ture than to heat a small body. Sec­ond­ly, the mus­cul­ar ef­fort of mov­ing a heavy body is grea­ter than in the case of a light body. The mus­cul­ar ef­fort con­sumes ca­lor­ies, which must be pro­vi­ded by food. Thus, all other fac­tors be­ing equal, a fat per­son re­qui­res more food than a lean one. One might there­fore rea­son that if a fat per­son eats only the ad­di­tion­al food his body re­qui­res, he should be able to keep his weight sta­tion­ary. Yet every phys­ic­ian who has stud­ied obese pa­tients un­der rig­or­ous­ly con­trol­led con­di­tions knows that this is not true.

Many obese patients actually gain weight on a diet which is cal­or­ic­al­ly de­fic­ient for their ba­sic needs. There must thus be some other mech­an­ism at work.

Glandular Theories TOC

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At one time it was thought that this mechanism might be con­cern­ed with the sex glands. Such a con­nec­tion was sug­ges­ted by the fact that many ju­ven­ile obese pa­tients show an un­der-​de­vel­op­ment of the sex organs (Frölich’s syndrome, ed.). The mid­dle-​age spread in men and the ten­den­cy of many wom­en to put on weight in the meno­pause seemed to in­dic­ate a cau­sal con­nec­tion be­tween dim­in­ish­ing sex func­tion and over­weight. Yet, when high­ly active sex hor­mones became avail­able, it was found that their ad­mini­stra­tion had no ef­fect what­so­ev­er on obe­sity. The sex glands could there­fore not be the seat of the dis­order.

The Thyroid Gland TOC

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When it was discovered that the thyroid gland controls the rate at which body-​fuel is con­sumed, it was thought that by ad­min­is­ter­ing thy­roid gland to obese pa­tients their ab­nor­mal fat de­pos­its could be burned up more rap­id­ly. This too proved to be en­tire­ly dis­ap­poin­ting, be­cause as we now know, these ab­nor­mal de­pos­its take no part in the body’s en­er­gy-​turn­over — they are in­ac­ces­sib­ly locked away. Thy­roid medi­ca­tion mere­ly for­ces the body to con­sume its nor­mal fat res­erves, which are al­ready de­ple­ted in obese pa­tients, and then to break down struc­tur­al­ly es­sen­tial fat with­out touch­ing the ab­nor­mal de­pos­its. In this way a pa­tient may be brought to the brink of star­va­tion in spite of hav­ing a hun­dred pounds of fat to spare. Thus, any weight loss brought about by thy­roid medi­ca­tion is al­ways at the ex­pense of fat of which the body is in dire need.

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While the majority of obese patients have a perfectly nor­mal thy­roid gland, and some even have an over­ac­tive thy­roid, one also oc­ca­sion­al­ly sees a case with a real thy­roid de­fic­ien­cy. In such ca­ses, treat­ment with thy­roid brings about a small loss of weight, but this is not due to the loss of any ab­nor­mal fat: It is en­tire­ly the re­sult of the elim­in­ation of a mu­coid sub­stance, cal­led myx­ed­ema, which the body ac­cu­mu­lates when there is a marked pri­mary thy­roid de­fic­ien­cy. More­over, pa­tients suf­fer­ing only from a sev­ere lack of thy­roid hor­mone nev­er be­come obese in the true sense. Pos­sib­ly also the ob­ser­va­tion that nor­mal per­sons — though not the obese — lose weight rap­id­ly when their thy­roid be­comes over­ac­tive may have con­tribu­ted to the false no­tion that thy­roid de­fic­ien­cy and obes­ity are con­nec­ted. Much mis­un­der­stan­ding about the sup­po­sed role of the thy­roid gland in obes­ity is still met with, and it is now real­ly high time that thy­roid prep­ara­tions be once and for all struck off the list of rem­ed­ies for obes­ity. This is par­tic­ul­ar­ly so be­cause giv­ing thy­roid gland to an obese pa­tient whose thy­roid is eith­er nor­mal or over­ac­tive, be­sides being use­less, is de­ci­ded­ly dan­ger­ous.

The Pituitary Gland TOC

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The next gland to be falsely incriminated was the anterior lobe of the pit­ui­ta­ry, or hy­po­phys­is. This most im­por­tant gland lies well pro­tec­ted in a bony cap­sule at the base of the skull. It has a vast num­ber of func­tions in the body, among which is the regu­la­tion of all the other im­por­tant en­do­crine glands. The fact that var­ious signs of an­teri­or pit­ui­tary de­fic­ien­cy are often as­so­cia­ted with obes­ity raised the hope that the seat of the dis­or­der might be in this gland. But al­though a large num­ber of pit­ui­tary hor­mones have been iso­la­ted and many ex­tracts of the gland pre­pared, not a sin­gle one or any com­bina­tion of such fac­tors proved to be of any val­ue in the treat­ment of obes­ity. Quite re­cent­ly, how­ever, a fat-​mo­bi­li­zing fac­tor has been found in pit­ui­tary glands, but it is still too early to say wheth­er this fac­tor is des­tined to play a role in the treat­ment of obes­ity.

The Adrenals TOC

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Recently, a long series of brilliant discoveries concerning the working of the ad­ren­al or su­pra­ren­al glands, small bod­ies which sit atop the kid­neys, have cre­ated tre­men­dous in­ter­est. This in­ter­est also turned to the prob­lem of obes­ity when it was dis­cov­er­ed that a con­di­tion which in some re­spects res­em­bles a sev­ere case of obes­ity — the so cal­led Cush­ing’s Syn­drome — was caused by a glan­du­lar new-​growth of the ad­ren­als or by their ex­ces­sive stim­ula­tion with ACTH, which is the pit­ui­tary hor­mone gov­ern­ing the ac­tiv­ity of the ou­ter rind or cor­tex of the ad­ren­ als.

When we learned that an abnormal stimulation of the adrenal cor­tex could pro­duce signs that res­em­ble true obes­ity, this know­ledge fur­nished no prac­tic­al means of treat­ing obes­ity by de­creas­ing the ac­tiv­ity of the ad­ren­al cor­tex. There is no evi­dence to sug­gest that in obes­ity there is any ex­cess of ad­reno­cor­tic­al ac­tiv­ity; in fact, all the evi­dence points to the con­trary. There seems to be rath­er a lack of ad­reno­cor­tic­al func­tion and a de­crease in the se­cre­tion of ACTH from the an­teri­or pit­ui­ta­ry lobe.[3]

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So, here again our search for the mechanism which pro­du­ces obes­ity led us into a blind al­ley. Re­cent­ly, many stu­dents of obes­ity have re­ver­ted to the ni­hil­is­tic at­ti­tude that obes­ity is caused simp­ly by over­eat­ing, and that it can only be cured by un­dereat­ing.

The Diencephalon or Hypothalamus TOC

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For those of us who refused to be discouraged, there remained one slight hope: Bur­ied deep down in the mas­sive hu­man brain there is a part which we have in com­mon with all ver­teb­rate ani­mals: the so-​cal­led di­en­ceph­al­on. It is a very prim­it­ive part of the brain, and has in man been al­most smoth­er­ed by the huge mas­ses of ner­vous tis­sue with which we think, rea­son and vol­un­tar­ily move our body. The di­en­ceph­al­on is the part from which the cen­tral ner­vous sys­tem con­trols all the au­to­mat­ic ani­mal func­tions of the body, such as breath­ing, the heart beat, di­ges­tion, sleep, sex, the uri­nary sys­tem, the au­to­nom­ous or vege­ta­tive ner­vous sys­tem, and via the pit­ui­tary, the whole in­ter­play of the en­doc­rine glands.

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It was therefore not unreasonable to suppose that the com­plex op­era­tion of stor­ing and is­su­ing fuel to the body might also be con­trol­led by the di­en­ceph­al­on. It has long been known that the con­tent of sug­ar — an­oth­er form of fuel ​ in the blood de­pends on a cer­tain ner­vous cen­ter in the di­en­ceph­al­on. When this cen­ter is des­troy­ed in lab­ora­to­ry ani­mals, they de­vel­op a con­di­tion rath­er sim­il­ar to hu­man sta­ble dia­be­tes. It has also long been known that the de­struc­tion of an­oth­er di­en­ceph­al­ic cen­ter pro­du­ces a vo­ra­cious ap­pet­ite and a rap­id gain in weight in ani­mals which nev­er get fat spon­ta­ne­ous­ly.

The Fat-bank TOC

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Assuming that in man such a center controlling the movement of fat does ex­ist, its func­tion would have to be much like that of a bank: When the body as­sim­il­ates from the in­tes­tin­al tract more fuel than it needs at the mo­ment, this sur­plus is de­pos­it­ed in what may be com­pared with a cur­rent ac­count. Out of this ac­count it can al­ways be with­drawn as re­qui­red. All nor­mal fat res­erves are in such a cur­rent ac­count, and it is prob­ab­le that a di­en­ceph­al­ic cen­ter man­ag­es the de­pos­its and with­draw­als.

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When now, for reasons which will be discussed later, the de­pos­its grow rap­id­ly while small with­draw­als be­come more fre­quent, a point may be reached which goes be­yond the di­en­ceph­al­on’s ban­king cap­ac­ity. Just as a ban­ker might sug­gest to a weal­thy cli­ent that in­stead of ac­cu­mu­la­ting a large and un­man­age­ab­le cur­rent ac­count, he should in­vest his sur­plus cap­it­al, the body ap­pears to es­tab­lish a fixed de­pos­it into which all sur­plus funds go, but from which they can no lon­ger be with­drawn by the pro­ce­dure used in a cur­rent ac­count. In this way the di­en­ceph­al­ic “fat-​bank” frees it­self from all work which goes be­yond its nor­mal ban­king ca­pac­ity. The on­set of obes­ity dates from the mo­ment the di­en­ceph­al­on adopts this la­bor-​sa­ving ruse. Once a fixed de­pos­it has been es­tab­lish­ed the nor­mal fat re­serves are held at a mini­mum, while every avail­ab­le sur­plus is locked away in the fixed de­pos­it, and is there­fore taken out of nor­mal cir­cu­la­tion.

THREE BASIC CAUSES OF OBESITY TOC

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Assuming that there is a limit to the diencephalon’s fat-​ban­king ca­pac­ity, it fol­lows that there are three ba­sic ways in which obes­ity can be­come mani­fest:

  1. The Inherited Factor
    The first is that the fat-banking capacity is abnormally low from birth. Such a con­gen­it­al­ly-​low di­en­ceph­al­ic cap­ac­ity would then rep­re­sent the in­her­it­ed fac­tor in obes­ity. When this ab­nor­mal trait is mar­ked­ly pres­ent, obes­ity will de­vel­op at an early age in spite of nor­mal feed­ing: This could ex­plain why among broth­ers and sis­ters eat­ing the same food at the same ta­ble, some be­come obese, and oth­ers do not.
  2. Other Diencephalic Disorders TOC
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    The second way in which obes­ity can become established is the low­er­ing of a pre­vi­ous­ly nor­mal fat-​ban­king cap­ac­ity ow­ing to some oth­er di­en­ceph­al­ic dis­or­der. It seems to be a gen­er­al rule that when one of the many di­en­ceph­al­ic cen­ters is par­tic­ul­ar­ly over­taxed, it tries to in­crease its ca­pac­ity at the ex­pense of other cen­ters.

    In the menopause and after castration, the hormones pre­vi­ous­ly pro­duced in the sex glands no lon­ger cir­cu­late in the body. In the pres­ence of nor­mal­ly-​func­tion­ing sex glands, their hor­mones act as a brake on the se­cre­tion of the sex-​gland stimu­la­ting hor­mones of the an­teri­or pit­ui­tary. When this brake is re­moved, the an­ter­ior pit­ui­ta­ry enor­mous­ly in­crea­ses its out­put of these sex-​gland stimu­la­ting hor­mones, though they are now no lon­ger ef­fec­tive. In the ab­sence of any res­ponse from the non-​func­tion­ing or mis­sing sex glands, there is noth­ing to stop the an­teri­or pit­ui­tary from pro­du­cing more and more of these hor­mones. This situ­ation cau­ses an ex­ces­sive strain on the di­en­ceph­al­ic cen­ter which con­trols the func­tion of the an­teri­or pit­ui­tary. In or­der to cope with this ad­di­tion­al bur­den, the cen­ter ap­pears to draw more and more energy away from other cen­ters, such as those con­cerned with emo­tion­al sta­bil­ity, the blood cir­cu­la­tion (hot flushes), and other au­ton­om­ous ner­vous regu­la­tions, par­tic­ul­ar­ly also from the not so vi­tal­ly im­por­tant fat bank.

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    The so-called “stable” type of diabetes heavily involves the di­en­ceph­al­ic blood-​sug­ar regu­la­ting cen­ter. The di­en­ceph­al­on tries to meet this ab­nor­mal load by swit­ching en­er­gy des­tined for the fat bank over to the sug­ar-​regu­la­ting cen­ter, with the res­ult that the fat-​ban­king cap­ac­ity is re­duced to the point at which it is forced to es­tab­lish a fixed de­pos­it, and thus in­iti­ate the dis­or­der we call obes­ity. In this case one would have to con­sid­er the dia­be­tes the pri­mary cause of the obes­ity, but it is also pos­sib­le that the proc­ess is rev­er­sed in the sense that a de­fic­ient or over­worked fat cen­ter draws ener­gy from the sug­ar cen­ter, in which case the obes­ity would be the cause of that type of dia­be­tes in which the pan­cre­as is not pri­mari­ly in­volved. Fi­nal­ly, it is con­cei­vab­le that in Cush­ing’s syn­drome those symp­toms which re­sem­ble obes­ity are en­tire­ly due to the with­draw­al of ener­gy from the di­en­ceph­al­ic fat bank in or­der to make it avail­ab­le to the high­ly dis­turbed cen­ter which gov­erns the an­teri­or pit­ui­tary ad­reno­cor­tic­al sys­tem.

    Whether obes­ity is caused by a marked inherited deficiency of the fat-center or by some entirely different diencephalic regulatory disorder, its insurgence obviously has nothing to do with overeating and in either case obes­ity is certain to develop regardless of dietary restrictions. In these cases any enforced food deficit is made up from essential fat reserves and normal structural fat, much to the disadvantage of the patient's general health.

  3. The Exhaustion of the Fat Bank TOC
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    But there is still a third way in which obes­ity can become es­tab­lished, and that is when a pre­sum­ab­ly nor­mal fat cen­ter is sud­den­ly — the em­pha­sis is on sud­den­ly — cal­led upon to deal with an en­or­mous in­flux of food far in ex­cess of mo­men­tary re­quire­ments. At first glance it does seem that here we have a straight­for­ward case of over­ea­ting be­ing re­spon­sib­le for obes­ity, but on fur­ther an­al­ys­is it soon be­comes clear that the re­la­tion of cause and effect is not so sim­ple:
    • In the first place, we are merely as­su­ming that the cap­ac­ity of the fat cen­ter is nor­mal, while it is pos­sib­le and even prob­ab­le that only per­sons who have some in­her­it­ed trait in this dir­ec­tion can be­come obese mere­ly by over­eat­ing.
    • Secondly, in many of these cases the amount of food ea­ten re­mains the same, and it is only the con­sump­tion of fuel which is suddenly de­creased, as when an ath­lete is con­fined to bed for many weeks with a bro­ken bone or when a man lea­ding a high­ly ac­tive life is sud­den­ly tied to his desk in an of­fice and to tele­vis­ion at home. Simi­lar­ly, when a per­son, grown up in a cold cli­mate, is trans­fer­red to a trop­ic­al coun­try and con­tin­ues to eat as be­fore, he may de­vel­op obes­ity be­cause in the heat far less fuel is re­qui­red to main­tain the nor­mal body tem­pera­ture.
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    When a person suffers a long period of privation, be it due to chron­ic ill­ness, pov­er­ty, fam­ine, or the exi­gen­cies of war, his di­en­ceph­al­ic regu­la­tions ad­just them­selves to some ex­tent to the low food in­take. When then sud­den­ly these con­di­tions change, and he is free to eat all the food he wants, this is lia­ble to over­whelm his fat-​reg­ula­ting cen­ter. Dur­ing the last war[4] about 6000 gross­ly under­fed Po­lish re­fu­gees who had spent har­row­ing years in Rus­sia were trans­fer­red to a camp in In­dia where they were well housed, given nor­mal Brit­ish army ra­tions and some cash to buy a few ex­tras. With­in about three months, 85% were suf­fer­ing from obes­ity.

    In a per­son eat­ing coarse and un­re­fined food, the di­ges­tion is slow, and only a lit­tle nour­ish­ment at a time is as­sim­ila­ted from the in­tes­tin­al tract. When such a per­son is sud­den­ly able to ob­tain high­ly re­fined foods such as sugar, white flour, but­ter, and oil, these are so rap­id­ly di­ges­ted and as­sim­ila­ted, that the rush of in­com­ing fuel which oc­curs at ev­ery meal may even­tu­al­ly over­pow­er the di­en­ceph­al­ic reg­ula­tory mech­an­isms, and thus lead to obes­ity. This is com­mon­ly seen in the poor man who sud­den­ly be­comes rich enough to buy the more ex­pen­sive re­fined foods, though his to­tal cal­or­ic in­take re­mains the same, or is even less than be­fore.

Psychological Aspects TOC

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Much has been written about the psychological aspects of obes­ity. Among its many func­tions. the di­en­ceph­al­on is also the seat of our prim­it­ive ani­mal in­stincts, and just as in an emer­gen­cy it can switch ener­gy from one cen­ter to an­oth­er, so it seems to be able to trans­fer pres­sure from one in­stinct to an­oth­er. Thus, a lone­ly and un­hap­py per­son de­prived of all emo­tion­al com­fort and of all in­stinct grati­fi­ca­tion ex­cept the stil­ling of hun­ger and thirst, can use these as out­lets for pent-​up in­stinct pres­sure, and so de­vel­op obes­ity. Yet, once that has hap­pen­ed, no amount of psy­cho­thera­py or analy­sis, hap­pi­ness, com­pany, or the grati­fi­ca­tion of other in­stincts, will cor­rect the con­di­tion.

Compulsive Eating TOC

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No end of injustice is done to obese patients by accusing them of com­pul­sive ea­ting, which is a form of di­ver­ted sex grat­ifi­ca­tion. Most obese pa­tients do not suf­fer from com­pul­sive eat­ing; they suf­fer genu­ine hun­ger — real, gnaw­ing, tor­tur­ing hun­ger — which has noth­ing what­ev­er to do with com­pul­sive eat­ing. Even their sud­den des­ire for sweets is mere­ly the res­ult of the ex­peri­ence that sweets, pas­tries and al­co­hol will most rap­id­ly of all foods al­lay the pangs of hun­ger. This has noth­ing to do with di­ver­ted in­stincts.

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On the other hand, compulsive eating does occur in some obese pa­tients, par­ticu­lar­ly in girls in their late teens or early twen­ties. Com­pul­sive eat­ing dif­fers fun­da­men­tal­ly from the obese pa­tient’s grea­ter need for food. It comes on in at­tacks, and is nev­er as­so­cia­ted with real hun­ger, a fact which is read­ily ad­mit­ted by the pa­tients. They only feel a fe­ral des­ire to stuff. Two pounds of choco­lates may be de­voured in a few min­utes; cold, greasy food from the re­frig­era­tor, stale bread, left­overs on stacked plates, al­most any­thing edi­ble is cram­med down with terri­fy­ing speed and fer­oc­ity.

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I have occasionally been able to watch such an attack with­out the pa­tient’s know­ledge, and it is a frigh­ten­ing, ugly spec­tac­le to be­hold, even if one does real­ize that mech­an­isms en­tire­ly be­yond the pa­tient’s con­trol are at work. A care­ful en­quiry into what may have brought on such an at­tack al­most in­vari­ab­ly re­veals that it is pre­ce­ded by a strong un­re­solved sex-​stimu­la­tion, the higher cen­ters of the brain hav­ing blocked prim­it­ive di­en­ceph­al­ic in­stinct grat­if­ica­tion. The pres­sure is then let off through an­oth­er prim­it­ive chan­nel, which is oral grat­if­ica­tion. In my ex­peri­ence, the only thing that will cure this con­dition is un­in­hib­it­ed sex, a thera­peu­tic pro­ce­dure which is hard­ly ever feas­ib­le, for if it were, the pa­tient would have adop­ted it with­out pro­fes­sion­al promp­ting, nor would this in any way cor­rect the as­so­cia­ted obes­ity. It would only raise new and often great­er prob­lems if used as a the­ra­peu­tic meas­ure.

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Patients suffering from real compulsive eating are com­para­tive­ly rare. In my prac­tice they con­sti­tute about 1-2%. Treat­ing them for obes­ity is a heart­ren­ding job. They do per­fect­ly well be­tween at­tacks, but a single bout oc­cur­ring while under treat­ment may an­nul sev­er­al weeks of thera­py. Lit­tle won­der that such pa­tients become dis­cour­aged. In these cases I have found that psy­cho­the­ra­py may make the pa­tient ful­ly un­der­stand the mech­an­ism, but it does noth­ing to stop it. Per­haps so­ci­ety’s grow­ing sex­ual per­mis­sive­ness will make com­pul­sive eat­ing even rarer.

Whether a patient is really suffering from compulsive eating or not is hard to de­cide be­fore treat­ment, be­cause many obese pa­tients think that their des­ire for food — to them un­mo­tiv­ated — is due to com­pul­sive eat­ing, while all the time it is mere­ly a grea­ter need for food. The only way to find out is to treat such pa­tients. Those that suf­fer from real com­pul­sive eat­ing con­tin­ue to have such at­tacks, while those who are not com­pul­sive eat­ers nev­er get an at­tack dur­ing treat­ment.

Reluctance to Lose Weight TOC

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Some patients are deeply attached to their fat, and cannot bear the thought of losing it. If they are in­tel­lig­ent, pop­ul­ar and suc­cess­ful in spite of their han­di­cap, this is a source of pride. Some fat girls look upon their con­di­tion as a safe­guard against erot­ic in­volve­ments, of which they are afraid. They work out a pat­tern of life in which their obes­ity plays a de­ter­min­ing role, and then be­come re­luc­tant to up­set this pat­tern and face a new kind of life which will be en­tire­ly dif­fer­ent af­ter their fig­ure has be­come nor­mal, and often very at­trac­tive. They fear that peo­ple will like them – or be jeal­ous – on ac­count of their fig­ure, rather than be at­trac­ted by their in­tel­lig­ence or char­ac­ter only. Some have a feel­ing that re­du­cing means giving up an almost cher­ished and in­tim­ate part of them­selves. In many of these cases, psy­cho­thera­py can be help­ful, as it ena­bles these pa­tients to see the whole situa­tion in the full light of con­scious­ness. An af­fec­tion­ate at­tach­ment to ab­nor­mal fat is usu­al­ly seen in pa­tients who be­came obese in child­hood, but this is not nec­es­sari­ly so.

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In all other cases, the best psychotherapy can do in the usual treat­ment of obes­ity is to ren­der the bur­den of hun­ger and nev­er-​en­ding die­tary re­stric­tions slight­ly more tol­er­ab­le. Pa­tients who have suc­cess­ful­ly es­tab­lished an er­otic trans­fer to their psy­chia­trist are of­ten bet­ter able to bear their suf­fer­ing as a se­cret la­bor of love.

There are thus a large number of ways in which obes­ity can be ini­tia­ted, though the dis­or­der it­self is al­ways due to the same mech­an­ism: an in­ade­qua­cy of the di­en­ceph­al­ic fat cen­ter and the lay­ing down of ab­nor­mal­ly fix­ed fat de­pos­its in ab­nor­mal pla­ces. This means that once obes­ity has be­come estab­lish­ed, it can no more be cured by elim­ina­ting those fac­tors which brought it on than a fire can be ex­tin­guished by re­mo­ving the cause of the con­fla­gra­tion. Thus, a dis­cus­sion of the vari­ous ways in which obes­ity can be­come estab­lish­ed is use­ful from a pre­ven­ta­tive point of view, but it has no bear­ing on the treat­ment of the estab­lish­ed con­di­tion. The elim­ina­tion of fac­tors which are clear­ly ha­sten­ing the course of the dis­or­der may slow down its prog­ress or even halt it, but they can nev­er cor­rect it.

Not by Weight alone…

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Weight alone is not a satisfactory criterion by which to judge wheth­er a per­son is suf­fer­ing from the dis­or­der we call obes­ity or not. Every phys­ic­ian is fam­il­iar with the sylph­like lady who en­ters the con­sul­ting room and de­clares em­phat­ic­al­ly that she is get­ting hor­rib­ly fat and wish­es to re­duce. Many an hon­est and sym­pa­thet­ic phys­ic­ian at once con­clu­des that he is deal­ing with a “nut.” If he is busy, he will give her short shrift; but if he has time, he will weigh her and show her ta­bles to prove that she is ac­tu­al­ly un­der­weight.

I have never yet seen or heard of such a lady being convinced by either procedure. The reason is that in my experience the lady is nearly always right and the doctor wrong. When such a patient is carefully examined one finds many signs of potential obes­ity, which is just about to become manifest as overweight. The patient distinctly feels that something is wrong with her, that a subtle change is taking place in her body, and this alarms her.

Signs & Symptoms of Obes­ity TOC

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There are a number of signs and symptoms which are char­ac­ter­is­tic of obes­ity. In manifest obes­ity many and often all these signs and symptoms are present. In latent or just beginning cases some are always found, and it should be a rule that if two or more of the bodily signs are present, the case must be regarded as one that needs immediate help.

The bodily signs may be divided into such as have developed before pu­ber­ty, in­di­ca­ting a strong in­heri­ted fac­tor, and those which de­vel­op at the on­set of mani­fest dis­or­der. Early signs are a dis­pro­por­tion­ate­ly large size of the two up­per front teeth, the first in­ci­sor, or a dim­ple on both sides of the sa­cral bone just above the but­tocks. When the arms are out­stretched with the palms up­ward, the fore­arms ap­pear sharp­ly an­gled out­ward from the up­per arms. The same ap­plies to the low­er ex­trem­it­ies. The pa­tient can­not bring his feet to­geth­er with­out the knees over­lap­ping; he is, in fact, knock-​kneed.

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The beginning accumulation of abnormal fat shows as a lit­tle pad just be­low the nape of the neck, col­lo­qui­al­ly known as the Duch­ess’ Hump. There is a tri­an­gu­lar fat­ty bul­ge in front of the arm­pit when the arm is held against the body. When the skin is stretched by fat rap­id­ly ac­cu­mu­la­ting un­der it, it may split in the low­er lay­ers. When large and fresh, such tears are pur­ple, but la­ter they are trans­formed into white scar tis­sue. Such stria­tion, as it is cal­led, com­mon­ly oc­curs on the ab­do­men of wom­en dur­ing preg­nan­cy, but in obes­ity it is fre­quent­ly found on the breasts, the hips and oc­ca­sion­al­ly on the shoul­ders. In many cases stria­tion is so fine that the small white lines are only just visi­ble. They are al­ways a sure sign of obes­ity, and though this may be slight at the time of ex­am­ina­tion such pa­tients can usu­al­ly re­mem­ber a peri­od in their child­hood when they were ex­ces­sive­ly chub­by.

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Another typical sign is a pad of fat on the insides of the knees, a spot where nor­mal fat re­serves are never stored. There may be a fold of skin over the pubic area and an­other fold may stretch round both sides of the chest, where a loose roll of fat can be picked up be­tween two fin­gers. In the male an ex­ces­sive ac­cu­mu­la­tion of fat in the breasts is always in­dica­tive, while in the fe­male the breast is usu­al­ly, but not nec­es­sar­ily, large. Ob­vi­ous­ly ex­ces­sive fat on the ab­do­men, the hips, thighs, upper arms, chin and shoulders are char­ac­ter­is­tic, and it is im­por­tant to re­mem­ber that any num­ber of these signs may be pres­ent in per­sons whose weight is sta­tis­tic­al­ly nor­mal; par­ticu­lar­ly if they are di­et­ing on their own with iron de­ter­min­ation.

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Common clinical symptoms which are indicative only in their as­so­cia­tion and in the frame of the whole clini­cal pic­ture are: fre­quent head­aches, rheu­mat­ic pains with­out de­tec­tab­le bony ab­nor­mal­ity; a feel­ing of lazi­ness and leth­ar­gy, often both physi­cal and men­tal, and fre­quent­ly as­so­cia­ted with in­som­nia, the pa­tients say­ing that all they want is to rest; the frigh­ten­ing feel­ing of be­ing fam­ished and some­times weak with hun­ger two to three hours after a hear­ty meal, and an ir­re­sis­tib­le yearn­ing for sweets and star­chy food, which often over­comes the pa­tient quite sud­den­ly, and is some­times sub­sti­tu­ted by a des­ire for al­co­hol; con­sti­pa­tion and a spas­tic or ir­rit­ab­le co­lon are unu­su­al­ly com­mon among the obese, and so are men­stru­al dis­or­ders.

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Returning once more to our sylphlike lady, we can say that a com­bina­tion of some of these symp­toms with a few of the typ­ic­al bodi­ly signs is suff­ic­ient evi­dence to take her case seri­ous­ly. A hu­man fig­ure, male or fe­male, can only be judged in the nude; any opin­ion based on the dres­sed ap­pear­ance can be quite fan­tas­tic­al­ly wide off the mark, and I feel myself driv­en to the con­clu­sion that apart from frank­ly psy­chot­ic pa­tients such as cases of ano­rex­ia ner­vosa; a mor­bid weight fixa­tion does not exist. I have yet to see a pa­tient who con­tin­ues to com­plain after the fig­ure has been ren­dered nor­mal by ade­quate treat­ment.

The Emaciated Lady TOC

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I remember the case of a lady who was escorted into my con­sul­ting room while I was tele­pho­ning. She sat down in front of my desk, and when I looked up to greet her, I saw the typ­ic­al pic­ture of ad­vanced ema­cia­tion. Her dry skin hung loos­ely over the bones of her face, her neck was scraw­ny, and col­lar­bones and ribs stuck out from deep hol­lows. I im­me­di­ate­ly thought of can­cer and de­ci­ded to which of my col­lea­gues at the hos­pit­al I would re­fer her. In­deed, I felt a little an­noyed that my as­si­stant had not ex­plained to her that her case did not fall under my spec­ial­ty. In an­swer to my que­ry as to what I could do for her, she re­plied that she wan­ted to re­duce. I tried to hide my sur­prise, but she must have no­ted a fleet­ing ex­pres­sion, for she smiled and said “I know that you think I’m mad, but just wait.” With that she rose and came round to my side of the desk. Jut­ting out from a tiny waist she had en­or­mous hips and thighs.

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By using a technique which will presently be described, the ab­nor­mal fat on her hips was trans­fer­red to the rest of her body, which had been ema­cia­ted by months of very severe diet­ing. At the end of a treat­ment lasting five weeks, she, a small wom­an, had lost 8 inches round her hips, while her face looked fresh and florid; the ribs were no lon­ger visible, and her weight was the same to the ounce as it had been at the first consul­ta­tion.

Fat, but not Obese TOC

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While a person who is statistically underweight may still be suf­fer­ing from the dis­or­der which cau­ses obes­ity, it is also pos­sib­le for a per­son to be sta­tis­tic­al­ly over­weight with­out suf­fer­ing from obes­ity. For such per­sons weight is no prob­lem, as they can gain or lose at will, and ex­peri­ence no dif­fic­ul­ty in re­du­cing their ca­lor­ic in­take. They are mas­ters of their weight, which the obese are not. More­over, their ex­cess fat shows no pref­er­ence for cer­tain typi­cal re­gions of the body, as does the fat in all ca­ses of obes­ity. Thus, the de­cis­ion wheth­er a bor­der­line case is real­ly suff­er­ing from obes­ity or not can­not be made mere­ly by con­sul­ting weight ta­bles.

THE TREATMENT OF OBES­ITY TOC

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If obesity is always due to one very specific di­en­ceph­al­ic de­fic­ien­cy, it fol­lows that the only way to cure it is to cor­rect this de­fic­ien­cy. At first this seemed an utterly hope­less un­der­ta­king. The great­est ob­stac­le was that one could hard­ly hope to cor­rect an in­her­it­ed trait lo­cal­ized deep in­side the brain, and while we did pos­sess a num­ber of drugs whose point of action was be­lieved to be in the di­en­ceph­al­on, none of them had the sligh­test effect on the fat cen­ter. There was not even a poin­ter show­ing a dir­ec­tion in which phar­ma­co­log­ic­al re­search could move to find a drug that had such a spe­cif­ic ac­tion. The clo­sest ap­proach were the ap­pet­ite-​re­du­cing drugs – the amphetamines —— but these cured noth­ing.

A Curious Observation TOC

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Mulling over this depressing situation, I remembered a rather cu­ri­ous ob­ser­va­tion made many years ago in India. At that time we knew very lit­tle about the func­tion of the di­en­ceph­al­on, and my in­ter­est cen­ter­ed round the pit­ui­ta­ry gland. Froehlich had des­cri­bed ca­ses of ex­tre­me obes­ity and sex­ual un­der­de­vel­op­ment in youths suf­fer­ing from a new growth of the an­ter­ior pit­ui­ta­ry lobe, pro­du­cing what then be­came known as Froeh­lich’s dis­ease. How­ev­er, it was very soon dis­cov­er­ed that the iden­tic­al syn­drome, though run­ning a less ful­mina­ting course, was quite com­mon in pa­tients whose pit­ui­ta­ry gland was per­fect­ly nor­mal. These are the so-​cal­led “fat boys” with long, slen­der hands, breasts any flat-​chested mai­den would be proud to pos­sess, large hips, but­tocks and thighs with stria­tion, knock-​knees and un­der­de­vel­oped geni­tals — of­ten with un­de­scen­ded tes­tic­les.

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It also became known that in these cases the sex organs could he developed by giving the patients injections of a substance extracted from the urine of pregnant women, it having been shown that when this substance was injected into sexually immature rats it made them precociously mature. The amount of substance which produced this effect in one rat was called one International Unit, and the purified extract was accordingly called “Human Chorionic Gonadotrophin” whereby chorionic signifies that it is produced in the placenta and gonadotropin that its action is sex gland directed.

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The usual way of treating “fat boys” with underdeveloped gen­it­als is to in­ject sev­er­al hun­dred In­ter­na­tion­al Units twice a week. Hu­man Chori­on­ic Go­na­do­tro­phin — which we shall hence­forth simp­ly call hCG — is ex­pen­sive, and as “fat boys” are fair­ly com­mon among In­di­ans, I tried to es­tab­lish the smal­lest ef­fec­tive dose. In the course of this study, three in­ter­es­ting things em­er­ged:
  1. When fresh pregnancy-urine from the female ward was giv­en in quan­tit­ies of about 300 cc. by re­ten­tion ene­ma, as good res­ults could be ob­tained as by in­jec­ting the pure sub­stance.
  2. Small daily doses appeared to be just as effective as much lar­ger ones given twice a week.
  3. This the observation that concerns us here: When such pa­tients were given small dai­ly do­ses, they seemed to lose their rav­en­ous ap­pet­ite, though they nei­ther gained nor lost weight. Strange­ly enough, how­ever, their shape did change. Though they were not re­stric­ted in diet, there was a dis­tinct de­crease in the cir­cum­fer­ence of their hips.
Fat on the Move TOC

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Remembering this, it occurred to me that the change in shape could only be ex­plain­ed by a move­ment of fat away from ab­nor­mal de­pos­its on the hips, and if that were so, there was just a chance that while such fat was in tran­si­tion it might be avail­ab­le to the body as fuel. This was easy to find out, as in that case, fat on the move would be able to re­place food. It should then he pos­sib­le to keep a “fat boy” on a sev­ere­ly re­stric­ted diet with­out a feel­ing of hun­ger, in spite of a rap­id loss of weight. When I tried this in typ­ic­al cases of Froeh­lich’s syn­drome, I found that as long as such pa­tients were given small daily do­ses of hCG, they could com­for­tab­ly go about their usu­al oc­cu­pa­tions on a diet of only 500 Cal­or­ies daily, and lose an aver­age of about one pound per day. It was also per­fect­ly evi­dent that only ab­nor­mal fat was being con­sumed, as there were no signs of any de­ple­tion of nor­mal fat. Their skin re­mained fresh and tur­gid, and grad­ual­ly their fig­ures be­came en­tire­ly nor­mal, nor did the dai­ly ad­mini­stra­tion of hCG ap­pear to have any side-​ef­fects oth­er than bene­fic­ial.

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From this point it was a small step to try the same method in all other forms of obes­ity. It took a few hun­dred ca­ses to es­tab­lish be­yond rea­son­ab­le doubt that the mech­an­ism op­er­ates in ex­act­ly the same way and seem­ing­ly with­out ex­cep­tion in every case of obes­ity. I found that, though most pa­tients were trea­ted in the out­pa­tients de­part­ment, gross diet­ary er­rors rare­ly occurred. On the con­tra­ry, most pa­tients com­plained that the two meals of 250 Cal­or­ies each were more than they could man­age, as they con­tin­ual­ly had a feel­ing of just hav­ing had a large meal.

Pregnancy and Obes­ity TOC

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Once this trail was opened, further ob­ser­va­tions seemed to fall into line. It is, for in­stance, well known that dur­ing preg­nan­cy, an obese wom­an can very easi­ly lose weight. She can dras­tic­al­ly re­duce her diet with­out feel­ing hun­ger or dis­com­fort, and lose weight with­out in any way har­ming the child in her womb. It is also sur­pri­sing to what ex­tent a wom­an can suf­fer from preg­nan­cy – vom­it­ing with­out com­ing to any real harm.

Pregnancy is an obese woman’s one great chance to reduce her excess weight. That she so rarely makes use of this opportunity is due to the erroneous notion, usually fostered by her elder relations, that she now has “two mouths to feed” and must “keep up her strength for the coming event. All modern obstetricians know that this is nonsense and that the more superfluous fat is lost the less difficult will be the confinement, though some still hesitate to prescribe a diet sufficiently low in Calories to bring about a drastic reduction.

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A woman may gain weight during pregnancy, but she nev­er be­comes obese in the strict sense of the word. Un­der the in­flu­ence of the hCG which cir­cu­lates in enor­mous quan­tit­ies in her body dur­ing preg­nan­cy, her di­en­ceph­al­ic bank­ing cap­ac­ity seems to be un­lim­it­ed, and ab­nor­mal fixed de­pos­its are nev­er formed. At con­fine­ment[5] she is sud­den­ly de­prived of hCG, and her di­en­ceph­al­ic fat cen­ter re­verts to its nor­mal ca­pac­ity. It is only then that the ab­nor­mal­ly ac­cu­mu­la­ted fat is locked away again in a fixed de­pos­it. From that mo­ment on she is suf­fer­ing from obes­ity, and is sub­ject to all its con­se­quen­ces.

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Pregnancy seems to be the only normal human con­di­tion in which the di­en­ceph­al­ic fat-​ban­king ca­pac­ity is un­lim­it­ed. It is only dur­ing preg­nan­cy that fixed fat de­pos­its can be trans­fer­red back into the nor­mal cur­rent ac­count and freely drawn upon to make up for any nu­tri­tion­al def­ic­it. Dur­ing preg­nan­cy, ev­ery ounce of re­serve fat is placed at the dis­po­sal of the grow­ing fe­tus. Were this not so, an obese wom­an, whose nor­mal res­er­ves are al­ready de­ple­ted, would have the great­est dif­fi­cul­ties in bring­ing her preg­nan­cy to full term. There is con­sid­er­ab­le evi­dence to sug­gest that it is the hCG pro­duced in large quan­ti­ties in the pla­cen­ta which brings about this di­en­ceph­al­ic change.

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Though we may be able to increase the dieneephalic fat-​ban­king ca­pac­ity by in­jec­ting hCG, this does not in it­self af­fect the weight, just as trans­fer­ring mon­et­ary funds from a fixed de­posit into a cur­rent ac­count does not make a man any poor­er; to become poor­er it is also nec­es­sary that he free­ly spends the mon­ey which thus be­comes avail­ab­le. In preg­nan­cy, the needs of the grow­ing em­bryo take care of this to some ex­tent; but in the treat­ment of obes­ity there is no embryo, and so a very se­vere diet­ary re­stric­tion must take its place for the du­ra­tion of treat­ment.

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Only when the fat which is in transit under the effect of hCG is ac­tu­al­ly con­sumed can more fat be with­drawn from the fixed de­pos­its. In preg­nan­cy it would be most un­des­ira­ble if the fe­tus were of­fer­ed am­ple food only when there is a high in­flux from the in­tes­tin­al tract. Ideal nu­tri­tion­al con­di­tions for the fe­tus can only be achieved when the moth­er’s blood is con­tin­ual­ly sat­ura­ted with food, re­gard­less of wheth­er she eats or not, as oth­er­wise a pe­ri­od of star­va­tion might ham­per the steady growth of the em­bryo. It seems that hCG brings about this con­tin­ual sat­ura­tion of the blood, which is the rea­son why obese pa­tients under treat­ment with hCG nev­er feel hun­gry in spite of their dras­tic­al­ly-​re­duced food in­take.

The Nature of Human Chorionic Gonadotropin TOC

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hCG is never found in the human body except during preg­nan­cy and in those rare ca­ses in which a resi­due of pla­cen­tal tis­sue con­tin­ues to grow in the womb in what is known as a cho­ri­on­ic epi­the­li­oma. It is never found in the male. The hu­man type of cho­ri­on­ic go­na­do­tro­phin is found only dur­ing the preg­nan­cy of wom­en and the great apes. It is pro­duced in enor­mous quan­ti­ties, so that dur­ing cer­tain pha­ses of her preg­nan­cy, a wom­an may ex­crete as much as one mil­lion In­ter­na­tion­al Units per day in her urine – enough to ren­der a mil­lion in­fan­tile rats pre­co­cious­ly ma­ture. Oth­er mam­mals make use of a dif­fer­ent hor­mone, which can be ex­trac­ted from their blood se­rum but not from their urine. Their pla­cen­ta dif­fers in this and other re­spects from that of man and the great apes. This ani­mal cho­ri­on­ic go­na­do­tro­phin is much less rap­id­ly broken down in the human body than hCG, and it is also less suit­ab­le for the treat­ment of obes­ity.

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As often happens in medicine, much confusion has been caused by giv­ing hCG its name be­fore its true mode of ac­tion was un­der­stood. It has been ex­plain­ed that go­na­do­tro­phin lit­er­al­ly means a sex-​gland-​dir­ec­ted sub­stance or hor­mone, and this is quite mis­lead­ing. It dates from the early days when it was first found that hCG is able to ren­der in­fan­tile sex glands ma­ture, where­by it was en­tire­ly over­looked that it has no stim­ula­ting ef­fect what­so­ev­er on nor­mal­ly de­vel­oped and nor­mal­ly func­tion­ing sex glands. No amount of hCG is ever able to in­crease a normal sex func­tion: It can only im­prove an ab­nor­mal one, and in the young ha­sten the on­set of pu­ber­ty. How­ever, this is no dir­ect ef­fect. hCG acts ex­clu­sive­ly at a di­en­ceph­al­ic lev­el, and there brings about a con­sid­er­ab­le in­crease in the func­tion­al cap­ac­ity of all those cen­ters which are wor­king at maxi­mum cap­ac­ity.

The Real Gonadotrophins TOC

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Two hormones known in the female as follicle-​stimulating hor­mone (FSH) and cor­pus-​luteum stimulating-​hormone (LSH) are se­cre­ted by the an­ter­ior lobe of the pit­ui­tary gland. These hor­mones are real go­na­do­tro­phins be­cause they dir­ect­ly gov­ern the func­tion of the ovar­ies. The an­ter­ior pit­ui­tary is in turn gov­erned by the di­en­ceph­al­on, and so when there is an ovar­ian de­fic­ien­cy, the di­en­ceph­al­ic cen­ter con­cerned is hard put to cor­rect mat­ters by in­creas­ing the se­cre­tion from the an­ter­ior pit­ui­ta­ry of FSH or LSH, as the case may be. When sex­ual de­fic­ien­cy is clin­ic­al­ly pres­ent, this is a sign that the di­en­ceph­al­ic cen­ter con­cerned is un­able, in spite of max­im­al ex­er­tion, to cope with the de­mand for an­ter­ior pit­ui­tary stim­ula­tion.[6] When then the ad­mini­stra­tion of hCG in­crea­ses the func­tion­al ca­pac­ity of the di­en­ceph­al­on, all de­mands can be ful­ly sat­is­fied, and the sex de­fic­ien­cy is cor­rec­ted.

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That this is the true mechanism underlying the presumed go­na­do­tro­phic ac­tion of hCG is con­firmed by the fact that when the pit­ui­tary gland of in­fan­tile rats is re­moved be­fore they are given hCG, the lat­ter has no ef­fect on their sex glands. hCG can­not there­fore have a dir­ect sex-​gland stim­ula­ting ac­tion like that of the an­teri­or pit­ui­tary go­na­do­tro­phins, as FSH and LSH are just­ly cal­led. The lat­ter are en­tire­ly dif­fer­ent sub­stan­ces from that which can be ex­trac­ted from preg­nan­cy urine and which, un­for­tu­nate­ly, is called cho­ri­on­ic go­na­do­tro­phin. It would be no more clum­sy, and cer­tain­ly far more ap­pro­pri­ate, if hCG were hence­forth called cho­ri­on­ic di­en­ceph­alo­tro­phin.

hCG no Sex Hormone TOC

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It cannot be sufficiently emphasized that hCG is not a sex hor­mone, that its ac­tion is iden­tic­al in men, wom­en, chil­dren, and in those ca­ses in which the sex glands no lon­ger func­tion ow­ing to old age or their sur­gic­al re­mo­val. The only sex­ual change it can bring about after pu­ber­ty is an im­prove­ment of a pre-​ex­is­ting de­fic­ien­cy, but nev­er a stimu­la­tion be­yond the nor­mal. In an in­dir­ect way via the an­ter­ior pit­ui­ta­ry, hCG regu­lates men­stru­ation and fa­cili­tates con­cep­tion, but it nev­er vir­ili­zes a wom­an or fem­ini­zes a man. It nei­ther makes men grow breasts, nor does it in­ter­fere with their vir­ili­ty, though where this was de­fic­ient, it may im­prove it. It nev­er makes wom­en grow a beard or de­vel­op a gruff voice. I have stres­sed this point only for the sake of my lay rea­ders, be­cause, it is our dai­ly ex­peri­ence that when pa­tients hear the word hor­mone, they im­me­di­ate­ly jump to the con­clu­sion that this must have some­thing to do with the sex sphere. They are not ac­cus­tom­ed as we are to think thyr­oid, in­sul­in, cor­ti­sone, ad­ren­al­in etc., as hor­mones.

Importance and Potency of hCG TOC

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Owing to the fact that hCG has no direct action on any endocrine gland, its en­or­mous im­por­tance in preg­nan­cy has been over­looked, and its po­ten­cy un­der­es­tima­ted. Though a preg­nant wom­an can pro­duce as much as one mil­li­on units per day, we find that the in­jec­tion of only 125 units per day is am­ple to re­duce weight at the rate of rough­ly one pound per day, even in a co­los­sus weigh­ing 400 pounds, when as­so­cia­ted with a 500-​Cal­or­ie diet. It is no ex­ag­gera­tion to say that the flood­ing of the fe­male body with hCG is by far the most spec­tac­ul­ar hor­mo­nal event in preg­nan­cy. It has an en­or­mous pro­tec­tive im­por­tance for moth­er and child, and I even go so far as to say that no wom­an, and cer­tain­ly not an obese one, could car­ry her preg­nan­cy to term with­out it. If I can be for­giv­en for com­par­ing my fel­low-​en­doc­rin­olo­gists with wick­ed God­moth­ers, hCG has cer­tain­ly been their Cin­der­el­la, and I can only ro­man­tic­al­ly hope that its ex­tra­or­din­ary ef­fect on ab­nor­mal fat will prove to be its Fairy God­moth­er.

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hCG has been known for over half a century. It is the sub­stance which Asch­heim and Zon­dek so bril­li­ant­ly used to diag­nose early preg­nan­cy out of the urine. Apart from that, the only thing it did in the ex­peri­men­tal lab­ora­tory was to pro­duce pre­co­cious rats, and that was not par­tic­ul­ar­ly stimu­la­ting to fur­ther re­search at a time when much more thril­ling en­doc­rino­log­ic­al dis­cov­er­ies were pour­ing in from all sides, sweep­ing hCG into the stil­ler back wa­ters.

Complicating Disorders TOC

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Some complicating disorders are often associated with obes­ity, and these we must brief­ly dis­cuss. The most im­por­tant as­so­cia­ted dis­or­ders, and the ones in which obes­ity seems to play a pre­cipi­ta­ting or at least an ag­gra­va­ting role, are the fol­low­ing: the stable type of dia­be­tes, gout, rheu­ma­tism and arth­ri­tis, high blood pres­sure and har­den­ing of the ar­ter­ies, coro­nary dis­ease and ce­re­bral hem­or­rhage. Apart from the fact that they are of­ten – though not ne­ces­sari­ly – as­so­cia­ted with obes­ity, these dis­or­ders have two things in common: In all of them, mod­ern re­search is be­com­ing more and more in­clined to be­lieve that di­en­ceph­al­ic reg­ula­tions play a dom­in­ant role in their cau­sa­tion. The other com­mon fac­tor is that they ei­ther im­prove or do not oc­cur dur­ing preg­nan­cy. In the lat­ter re­spect they are join­ed by many other dis­or­ders not nec­es­sari­ly as­so­cia­ted with obes­ity. Such dis­or­ders are, for in­stance, co­litis, du­od­en­al or gas­tric ul­cers, cer­tain al­ler­gies, pso­ria­sis, loss of hair, brit­tle fin­ger­nails, mi­graine, etc.

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If hCG + diet does in the obese bring about those di­en­ce­phal­ic chan­ges which are char­ac­ter­is­tic of preg­nan­cy, one would ex­pect to see an im­prove­ment in all these con­di­tions com­par­ab­le to that seen in real preg­nan­cy. The ad­mini­stra­tion of hCG does in fact do this in a re­mark­ab­le way.

Diabetes TOC

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In an obese patient suffering from a fairly advanced case of sta­ble dia­be­tes of many years du­ra­tion in which the blood sug­ar may range from 3-400 mg%, it is often pos­sib­le to stop all an­ti­dia­bet­ic medi­ca­tion after the first few days of treat­ment. The blood sug­ar con­tin­ues to drop from day to day, and often reaches nor­mal val­ues in 2-3 weeks. As in preg­nan­cy, this phe­nom­en­on is not ob­ser­ved in the brit­tle type of dia­be­tes, and as some ca­ses that are pre­dom­in­ant­ly sta­ble may have a small brit­tle fac­tor in their clin­ic­al make­up, all obese dia­bet­ics have to be kept under a very care­ful and ex­pert watch.

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A brittle case of diabetes is primarily due to the inability of the pan­cre­as to pro­duce suf­fic­ient in­su­lin, while in the sta­ble type, di­en­ceph­al­ic regu­la­tions seem to be of grea­ter im­por­tance. That is pos­sib­ly the rea­son why the sta­ble form res­ponds so well to the hCG meth­od of trea­ting obes­ity, where­as the brit­tle type does not. Obese pa­tients are gen­er­al­ly suf­fer­ing from the sta­ble type, but a sta­ble type may grad­ual­ly change into a brit­tle one, which is usu­al­ly as­so­cia­ted with a loss of weight. Thus, when an obese dia­bet­ic finds that he is lo­sing weight with­out diet or treat­ment, he should at once have his dia­be­tes ex­pert­ly at­ten­ded to. There is some evi­dence to sug­gest that the change from sta­ble to brit­tle is more lia­ble to oc­cur in pa­tients who are ta­king in­sul­in for their sta­ble dia­be­tes.

Rheumatism TOC

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All rheumatic pains, even those associated with demonstrable bony le­sions, im­prove sub­jec­tive­ly with­in a few days of treat­ment, and often re­quire neith­er cor­ti­sone nor sal­ic­yl­ates. Again this is a well-​known phe­nom­en­on in preg­nan­cy, and while un­der treat­ment with hCG + diet, the ef­fect is no less dra­mat­ic. As it does after preg­nan­cy, the pain of de­formed joints re­turns after treat­ment, but smal­ler do­ses of pain-​re­liev­ing drugs seem able to con­trol it sat­is­fac­tor­ily after weight re­duc­tion. In any case, the hCG meth­od makes it pos­sib­le in obese arth­rit­ic pa­tients to in­ter­rupt pro­longed cor­ti­sone treat­ment with­out a re­cur­rence of pain. This in it­self is most wel­come, but there is the added ad­van­tage that the treat­ment stimu­lates the se­cre­tion of ACTH in a phys­io­log­ic­al man­ner, and that this re­gen­er­ates the ad­ren­al cor­tex, which is apt to suf­fer un­der pro­longed cor­ti­sone treat­ment.

Cholesterol TOC

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The exact extent to which the blood cholesterol is involved in har­den­ing of the ar­ter­ies, high blood pres­sure, and cor­on­ary dis­ease is not as yet known, but it is now wide­ly ad­mit­ted that the blood cho­les­ter­ol lev­el is gov­ern­ed by di­en­ceph­al­ic mech­an­isms. The be­ha­vior of cir­cu­la­ting cho­les­ter­ol is there­fore of par­tic­ul­ar in­ter­est dur­ing the treat­ment of obes­ity with hCG. Chol­es­ter­ol cir­cu­lates in two forms, which we call “free” and “es­teri­fi­ed.” Nor­mal­ly, these frac­tions are pres­ent in a pro­por­tion of about 25% free to 75% es­teri­fi­ed cho­les­ter­ol, and it is the lat­ter frac­tion which dam­ag­es the walls of the ar­ter­ies. In preg­nan­cy this pro­por­tion is re­versed, and it may be ta­ken for gran­ted that ar­ter­io­scler­osis nev­er gets worse dur­ing preg­nan­cy for this very rea­son.

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To my knowledge, the only other condition in which the pro­por­tion of free to es­teri­fied cho­les­ter­ol is re­ver­sed is dur­ing the treat­ment of obes­ity with hCG + diet, when ex­act­ly the same phe­nom­en­on takes place. This seems an im­por­tant in­dica­tion of how close­ly a pa­tient under hCG treat­ment re­sem­bles a preg­nant wom­an in di­en­ceph­al­ic be­ha­vior.

When the total amount of circulating cholesterol is normal before treat­ment, this ab­so­lute amount is nei­ther sig­nif­ic­ant­ly in­creased nor de­creased. But when an obese pa­tient with an ab­nor­mal­ly high cho­les­ter­ol and al­ready show­ing signs of ar­ter­io­scler­osis is trea­ted with hCG, his blood pres­sure drops, and his cor­on­ary cir­cu­la­tion seems to im­prove, and yet his to­tal blood cho­les­ter­ol may soar to heights nev­er before reached.

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At first this greatly alarmed us; but then we saw that the pa­tients came to no harm even if treat­ment was con­tin­ued, and we found in fol­low-​up ex­am­ina­tions un­der­ta­ken some months af­ter treat­ment that the cho­les­ter­ol was much bet­ter than it had been before treat­ment. As the in­crease is most­ly in the form of the not dan­ger­ous free cho­les­ter­ol, we grad­ual­ly came to wel­come the phe­nom­en­on. Today we be­lieve that the rise is en­tire­ly due to the lib­era­tion of re­cent cho­les­ter­ol de­pos­its that have not yet un­der­gone cal­cif­ica­tion in the ar­ter­ial wall, and there­fore high­ly bene­fic­ial.

Gout TOC

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An identical behavior is found in the blood uric acid level of pa­tients suf­fer­ing from gout. Pre­dic­tab­ly, such pa­tients get an acute and often sev­ere at­tack after the first few days of hCG treat­ment, but then re­main en­tire­ly free of pain, in spite of the fact that their blood uric acid often shows a marked in­crease, which may per­sist for sev­er­al months after treat­ment. Those pa­tients who have re­gained their nor­mal weight re­main free of symp­toms re­gard­less of what they eat, while those that re­quire a sec­ond course of treat­ment get an­oth­er at­tack of gout as soon as the sec­ond course is ini­tia­ted. We do not yet know what di­en­ceph­al­ic mech­an­isms are in­volved in gout; pos­sib­ly emo­tion­al fac­tors play a role, and it is worth re­mem­ber­ing that the dis­ease does not oc­cur in wom­en of child­bear­ing age. We now give 2 tab­lets dai­ly of ZY­LOR­IC to all pa­tients who give a his­tory of gout and have a high blood uric-​acid lev­el. In this way we can com­plete­ly avoid at­tacks dur­ing treat­ment.

Blood Pressure TOC

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Patients who have brought themselves to the brink of mal­nu­tri­tion by ex­ag­gera­ted diet­ing, lax­at­ives etc, of­ten have an ab­nor­mal­ly low blood pres­sure. In these cases the blood pres­sure rises to nor­mal val­ues at the be­gin­ning of treat­ment, and then very grad­ual­ly drops, as it always does in pa­tients with a nor­mal blood pres­sure. Nor­mal val­ues are al­ways re­gained a few days after the treat­ment is over. Of this low­er­ing of the blood pres­sure dur­ing treat­ment the pa­tients are not aware. When the blood pres­sure is ab­nor­mal­ly high, and pro­vi­ded there are no de­tec­tab­le ren­al le­sions, the pres­sure drops, as it usu­al­ly does in preg­nan­cy. The drop is of­ten very rap­id — so rapid in fact, that it some­times is ad­visa­ble to slow down the proc­ess with pres­sure-​sus­tain­ing medi­ca­tion until the cir­cu­la­tion has had a few days time to ad­just it­self to the new sit­ua­tion. On the oth­er hand, among the thous­ands of ca­ses trea­ted, we have nev­er seen any un­to­ward in­cid­ent which could be at­tribu­ted to the rath­er sud­den drop in high blood pres­sure.

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When a woman suffering from high blood pressure becomes preg­nant, her blood pres­sure very soon drops; but after her con­fine­ment, it may grad­ual­ly rise back to its for­mer lev­el. Sim­ilar­ly, a high blood pres­sure pres­ent before hCG treat­ment tends to rise again after the treat­ment is over, though this is not al­ways the case. But the for­mer high lev­els are rare­ly reached, and we have gath­er­ed the im­pres­sion that such re­lap­ses res­pond bet­ter to or­tho­dox drugs such as Res­er­pine than be­fore treat­ment.

Peptic Ulcers TOC

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In our cases of obes­ity with gastric or duodenal ulcers, we have no­ticed a sur­pri­sing sub­jec­tive im­prove­ment in spite of a diet which would gen­er­al­ly be con­sid­er­ed most in­ap­pro­pri­ate for an ul­cer pa­tient. Here, too, there is a sim­ilar­ity with preg­nan­cy, in which pep­tic ul­cers hard­ly ever oc­cur. How­ever, we have seen two cases with a pre­vi­ous his­tory of sev­er­al hem­or­rhag­es in which a blee­ding oc­cur­red with­in 2 weeks of the end of treat­ment.

Psoriasis, Fingernails, Hair, Varicose Ulcers TOC

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As in pregnancy, psoriasis greatly improves during treatment, but may re­lapse when the treat­ment is over. Most pa­tients spon­ta­ne­ous­ly re­port a marked im­prove­ment in the con­di­tion of brit­tle fin­ger­nails. The loss of hair not in­fre­quen­tly as­so­cia­ted with obes­ity is tem­por­ari­ly ar­res­ted, though in very rare ca­ses an in­creased loss of hair has been re­por­ted.

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I remember a case in which a pa­tient de­vel­op­ed a pat­chy bald­ness – so-​cal­led alo­pec­ia are­ata – af­ter a sev­ere emo­tion­al shock, just before she was about to start an hCG treat­ment. Our der­ma­tol­og­ist diag­nosed the case as a par­ticu­lar­ly sev­ere one, pre­dic­ting that all the hair would be lost. He coun­sel­ed against the re­duc­ing treat­ment, but in view of my pre­vi­ous ex­peri­ence, and as the pa­tient was very an­xious not to post­pone red­uc­ing, I dis­cus­sed the mat­ter with the der­ma­tol­og­ist, and it was agreed that, hav­ing ful­ly ac­quain­ted the pa­tient with the sit­ua­tion, the treat­ment should be star­ted. Dur­ing the treat­ment, which las­ted four weeks, the fur­ther de­vel­op­ment of the bald patches was al­most, if not quite, ar­res­ted; how­ever, with­in a week of having fin­ish­ed the course of hCG, all the re­main­ing hair fell out as pre­dic­ted by the der­ma­tol­og­ist. The in­ter­es­ting point is that the treat­ment was able to post­pone this res­ult, but not to pre­vent it. The pa­tient has now grown a new shock of hair of which she is just­ly proud.

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In obese patients with large varicose ulcers, we were sur­prised to find that these ul­cers heal rap­id­ly un­der treat­ment with hCG. We have since treat­ed non-​obese pa­tients suf­fer­ing from vari­cose ul­cers with dai­ly in­jec­tions of hCG on nor­mal diet, with equal­ly good res­ults.

The “Pregnant” Male TOC

When a male patient hears that he is about to be put into a con­di­tion which in some res­pects res­em­bles preg­nan­cy, he is usu­al­ly shocked and hor­rif­ied. The phys­ic­ian must there­fore care­ful­ly ex­plain that this does not mean that he will be fem­in­ized, and that hCG in no way in­ter­feres with his sex. He must be made to un­der­stand that in the in­ter­est of the prop­ag­ation of the spe­cies, na­ture pro­vides for a per­fect func­tion­ing of the reg­ul­at­ory head­quarters in the di­en­ceph­al­on dur­ing preg­nan­cy, and that we are mere­ly using this nat­ur­al safe­guard as a means of cor­rec­ting the di­en­ceph­al­ic dis­or­der which is res­pon­sib­le for his over­weight.

TOC TECHNIQUE
Warnings
    

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I must warn the lay reader that what follows is mainly for the treat­ing phys­ic­ian, and is most cer­tain­ly not a do-​it-​you­rself pri­mer. Many of the ex­pres­sions used mean some­thing en­tire­ly dif­fer­ent to a qual­if­ied doc­tor than that which their com­mon use im­plies, and on­ly a phys­ic­ian can cor­rect­ly in­ter­pret the symp­toms which may arise dur­ing treat­ment. Any pa­tient who thinks he can red­uce by ta­king a few “shots” and eat­ing less is not only sure to be dis­ap­poin­ted, but may be head­ing for seri­ous troub­le. The ben­ef­it the pa­tient can der­ive from read­ing this part of the book is a ful­ler re­al­iza­tion of how very im­por­tant it is for him to fol­low to the let­ter his phys­ic­ian’s in­struc­tions.

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In treating obes­ity with the hCG + diet method, we are hand­ling what is per­haps the most com­plex or­gan in the hu­man body. The di­en­ceph­al­on’s func­tion­al equi­lib­ri­um is del­ic­ate­ly poised, so that what­ev­er hap­pens in one part has re­per­cus­sions in oth­ers. In obes­ity, this bal­ance is out of kilt­er, and can only be re­stored if the tech­nique I am about to des­cribe is foll­ow­ed im­plic­it­ly. Even seem­ing­ly in­sig­nif­ic­ant de­via­tions – par­ticu­lar­ly those that at first sight seem to be an im­prove­ment – are very li­ab­le to pro­duce most dis­ap­poin­ting res­ults, and even an­nul the ef­fect com­plete­ly.

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For in­stance, if the diet is in­creased from 500 to 600 or 700 Cal­or­ies, the loss of weight is quite un­sat­is­fac­tory. If the dai­ly dose of hCG is raised to 200 or more units dai­ly, its ac­tion often ap­pears to be re­ver­sed, pos­sib­ly be­cause lar­ger doses evoke di­en­ceph­al­ic coun­ter-​reg­ula­tions. On the oth­er hand, the di­en­ceph­al­on is an ex­treme­ly ro­bust or­gan in spite of its un­be­liev­ab­le in­tri­ca­cy. From an evo­lu­tion­ary point of view it is one of the old­est or­gans in our body, and its evo­lu­tion­ary his­tory dates back more than 500 mil­lion years. This has ten­der­ed it ex­tra­or­din­ari­ly ad­ap­tab­le to all nat­ur­al exi­gen­cies, and that is one of the main rea­sons why the hu­man spe­cies was able to evolve. What its evo­lu­tion did not pre­pare it for were the con­di­tions to which hu­man cul­ture and civil­iza­tion now ex­pose it.

History-taking TOC

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When a patient first presents himself for treatment, we take a gen­er­al his­tory, and note the time when the first signs of over­weight were ob­ser­ved. We try to es­tab­lish the high­est weight the pa­tient has ever had in his life (ob­vi­ous­ly ex­clu­ding preg­nan­cy), when this was, and what meas­ures have hith­er­to been ta­ken in an ef­fort to red­uce.

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It has been our ex­peri­ence that those pa­tients who have been ta­king thy­roid prep­ara­tions for long peri­ods have a slight­ly low­er aver­age loss of weight under treat­ment with hCG than those who have never taken thy­roid. This is even so in those pa­tients who have been ta­king thy­roid be­cause they had an ab­nor­mal­ly low ba­sal met­ab­ol­ic rate. In many of these cases the low BMR is not due to any in­trin­sic de­fic­ien­cy of the thy­roid gland, but rath­er to a lack of di­en­ceph­al­ic stimu­la­tion of the thy­roid gland via the an­ter­ior pit­ui­ta­ry lobe. We nev­er al­low thy­roid to be ta­ken dur­ing treat­ment, and yet a BMR which was very low be­fore treat­ment is usu­al­ly found to be nor­mal after a week or two of hCG + diet. Need­less to say, this does not ap­ply to those cases in which a thy­roid de­fic­ien­cy has been pro­duced by the sur­gic­al re­mo­val of a part of an over­ac­tive gland. It is also most im­por­tant to as­cer­tain wheth­er the pa­tient has ta­ken di­ur­et­ics (water eliminating pills), as this also de­crea­ses the weight loss under the hCG reg­im­en.

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Re­tur­ning to our pro­ce­dure, we next ask the pa­tient a few ques­tions to which he is held to re­ply simp­ly with “yes” or “no”. These ques­tions are: Do you suf­fer from head­aches? rheu­mat­ic pains? men­stru­al dis­or­ders? con­sti­pa­tion? breath­less­ness on ex­er­tion? swol­len an­kles? Do you con­sid­er your­self gree­dy? Do you feel the need to eat snacks be­tween meals? The pa­tient then strips, and is weighed and meas­ured. The nor­mal weight for his height, age, skel­et­al and mus­cul­ar build is es­tab­lish­ed from ta­bles of sta­tis­tic­al aver­ag­es, where­by in wom­en it is often nec­es­sa­ry to make an al­low­ance for par­tic­ul­ar­ly large and heavy breasts. The de­gree of over­weight is then cal­cu­la­ted, and from this the du­ra­tion of treat­ment can be rough­ly as­ses­sed on the ba­sis of an av­er­age loss of weight of a lit­tle less than a pound, say 300-400 grams per in­jec­tion, per day. It is a par­tic­ul­ar­ly in­ter­es­ting feat­ure of the hCG treat­ment that in rea­son­ab­ly co­oper­at­ive pa­tients, this fig­ure is re­mar­kab­ly con­stant, re­gard­less of sex, age and de­gree of over­weight.

The Duration of Treatment TOC

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Patients who need to lose 15 pounds (7 kg.) or less require 26 days treat­ment with 23 dai­ly in­jec­tions. The ex­tra three days are need­ed be­cause all pa­tients must con­tin­ue the 500-Cal­or­ie diet for three days after the last in­jec­tion. This is a very es­sen­tial part of the treat­ment, be­cause if they start eat­ing nor­mal­ly as long as there is even a trace of hCG in their body, they put on weight alarm­ing­ly at the end of the treat­ment. After three days, when all the hCG has been elim­ina­ted, this does not hap­pen, be­cause the blood is then no lon­ger sat­ura­ted with food, and can thus ac­com­mo­date an ex­tra in­flux from the in­tes­tines with­out in­crea­sing its vol­ume by re­tain­ing wat­er. We never give a treat­ment las­ting less than 26 days, even in pa­tients need­ing to lose only 5 pounds. It seems that even in the mild­est ca­ses of obes­ity, the di­enceph­al­on re­qui­res about three weeks rest from the max­im­al ex­er­tion to which it has been pre­vi­ous­ly sub­jec­ted in or­der to re­gain ful­ly its nor­mal fat-​ban­king cap­ac­ity. Clin­ic­al­ly, this ex­pres­ses it­self in the fact that, when in these mild cases, treat­ment is stop­ped as soon as the weight is nor­mal – which may be achieved in a week – it is much more eas­ily re­gained than after a full course of 23 in­jec­tions.

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As soon as such patients have lost all their abnormal, su­per­flu­ous fat, they at once be­gin to feel rav­en­ous­ly hun­gry in spite of con­tin­ued in­jec­tions. This is be­cause hCG only puts ab­nor­mal fat into cir­cu­la­tion and can­not, in the do­ses used, lib­er­ate nor­mal fat de­pos­its; in­deed, it seems to pre­vent their con­sump­tion. As soon as their sta­tis­tic­al­ly nor­mal weight is reached, these pa­tients are put on 800-1000 Cal­or­ies for the rest of the treat­ment.

The diet is arranged in such a way that the weight remains perfectly stationary and is thus continued for three days after the 23rd injection. Only then are the patients free to eat anything they please except sugar and starches for the next three weeks.

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Such early cases are common among actresses, models, and persons who are tired of obes­ity, hav­ing seen its rav­ag­es in oth­er mem­bers of their fam­ily. Film ac­tres­ses fre­quent­ly ex­plain that they must weigh less than nor­mal. With this re­quest we flat­ly re­fuse to com­ply: first, be­cause we un­der­take to cure a dis­or­der, not to cre­ate a new one; and sec­ond, be­cause it is in the na­ture of the hCG meth­od that it is self lim­it­ing. It be­comes com­plete­ly in­ef­fec­tive as soon as all ab­nor­mal fat is con­sumed. Ac­tres­ses with a slight ten­den­cy to obes­ity, hav­ing tried all man­ner of red­uc­ing meth­ods, in­vari­ab­ly come to the con­clu­sion that their fig­ure is sat­is­fac­tory only when they are un­der­weight, simp­ly be­cause none of these meth­ods re­move their su­per­flu­ous fat de­pos­its. When they see that under hCG their fig­ure im­proves out of all pro­por­tion to the amount of weight lost, they are near­ly al­ways con­tent to re­main within their nor­mal weight range.

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When a patient has more than 15 pounds to lose, the treat­ment takes lon­ger, but the maxi­mum we give in a sin­gle course is 40 in­jec­tions, nor do we as a rule al­low pa­tients to lose more than 34 lbs. (15 Kg.) at a time. The treat­ment is stop­ped when either 34 lbs. have been lost, or 40 in­jec­tions have been given. The only ex­cep­tion we make is in the case of gro­tesque­ly obese pa­tients, who may be al­low­ed to lose an ad­di­tion­al 5-6 lbs., if this oc­curs before the 40 in­jec­tions are up.

Immunity to hCG TOC

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The reason for limiting a course to 40 injections is that by then, some pa­tients may be­gin to show signs of hCG im­mu­nity. Though this phe­nom­en­on is well known, we can­not as yet de­fine the un­der­ly­ing mech­an­ism. May­be af­ter a cer­tain length of time the body learns to break down and elim­in­ate hCG very rap­id­ly, or pos­sib­ly pro­long­ed treat­ment leads to some sort of coun­ter-​reg­ula­tion, which an­nuls the di­en­ceph­al­ic ef­fect.

After 40 daily injections it takes about six weeks before this so-​cal­led im­mun­ity is lost, and hCG again be­comes ful­ly ef­fec­tive. Usu­al­ly after about 40 in­jec­tions, pa­tients may feel the on­set of im­mun­ity as hun­ger which was pre­vi­ous­ly ab­sent. In those com­par­at­ive­ly rare cases in which signs of im­mun­ity de­vel­op be­fore the full course of 40 in­jec­tions has been com­ple­ted — say at the 35th injection — treat­ment must be stop­ped at once, be­cause if it is con­tin­ued, the pa­tients be­gin to look weary and drawn, feel weak and hun­gry, and any fur­ther loss of weight achie­ved is then al­ways at the ex­pense of nor­mal fat. This is not only un­de­si­rab­le, but nor­mal fat is also in­stant­ly re­gained as soon as the pa­tient is re­turned to a free diet.

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Patients who need only 23 injections may be injected daily, in­clu­ding Sun­days, as they nev­er de­vel­op im­mun­ity. In those that take 40 in­jec­tions, the on­set of im­mun­ity can be de­lay­ed if they are given only six in­jec­tions a week, leav­ing out Sun­days or any other day they choose, pro­vi­ded that it is al­ways the same day. On the days on which they do not re­ceive the in­jec­tions, they usu­al­ly feel a slight sen­sa­tion of hun­ger. At first we thought that this might be pure­ly psy­cho­log­ic­al, but we found that when nor­mal sa­line is in­jec­ted with­out the pa­tient’s know­ledge, the same phe­nom­en­on occurs.

Menstruation TOC

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During menstruation, no injections are given, but the diet is con­tin­ued, and cau­ses no hard­ship; yet as soon as the men­stru­ation is over, the pa­tients be­come ex­treme­ly hun­gry un­less the in­jec­tions are re­sumed at once. It is very im­pres­sive to see the suf­fer­ing of a wom­an who has con­tin­ued her diet for a day or two be­yond the end of the peri­od with­out com­ing for her in­jec­tion, and then to hear the next day that all hun­ger ceas­ed with­in a few hours after the in­jec­tion, and to see her once again con­tent, flor­id, and cheer­ful. While on the ques­tion of men­stru­ation it must be ad­ded that in teen­aged girls, the peri­od may in some rare ca­ses be de­lay­ed, and ex­cep­tion­al­ly stop al­to­geth­er. If then la­ter this is ar­tif­ic­ial­ly in­duced, some weight may be re­gained.

Further Courses TOC

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Patients requiring the loss of more than 34 lbs. must have a sec­ond, or even more cour­ses. A sec­ond course can be star­ted after an in­ter­val of not less than six weeks, though the pause can be more than six weeks. When a third, fourth or even fifth course is nec­es­sa­ry, the in­ter­val be­tween cour­ses should be made pro­gres­sive­ly lon­ger. Be­tween a sec­ond and third course eight weeks should el­apse; be­tween a third and fourth course, twelve weeks; be­tween a fourth and fifth course, twen­ty weeks; and be­tween a fifth and sixth course, six months. In this way it is pos­sib­le to bring about a weight red­uc­tion of 100 lbs. and more if re­qui­red with­out the least hard­ship to the pa­tient.

In general, men do slightly better than women and often reach a some­what high­er aver­age dai­ly loss. Very ad­vanced ca­ses do a lit­tle bet­ter than early ones, but it is a re­mar­kab­le fact that this dif­fer­ence is only just sta­tis­tic­al­ly sig­nif­ic­ant.

Conditions That Must
Be Accepted Before Treatment
TOC

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On the basis of these data, the probable duration of treatment can be cal­cu­la­ted with con­sid­er­ab­le ac­cur­acy, and this is ex­plained to the pa­tient. It is made clear to him that dur­ing the course of treat­ment he must at­tend the clin­ic dai­ly to be weigh­ed, in­jec­ted, and gen­er­al­ly checked. All pa­tients that live in Rome or have res­id­ent friends or re­la­tions with whom they can stay, are treat­ed as out-​pa­tients, but pa­tients com­ing from abroad must stay in the hos­pit­al, as no ho­tel or res­tau­rant can be re­lied upon to pre­pare the diet with suf­fic­ient ac­cur­acy. These patients have their meals, sleep, and at­tend the clin­ic in the hos­pit­al, but are oth­er­wise free to spend their time as they please in the city and its sur­roun­dings sight­see­ing, ba­thing or thea­ter-​going.

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It is also made clear that between courses, the patient gets no treat­ment, and is free to eat any­thing he pleas­es ex­cept star­ches and sug­ar dur­ing the first 3 weeks. It is im­pres­sed upon him that he will have to fol­low the pre­scribed diet to the lett­er, and that after the first three days this will cost him no ef­fort, as he will feel no hun­ger, and may in­deed have dif­fic­ul­ty in get­ting down the 500 Cal­or­ies which he will be giv­en. If these con­di­tions are not ac­cep­tab­le the case is re­fused, as any com­prom­ise or half meas­ure is bound to prove ut­ter­ly dis­ap­poin­ting to pa­tient and phys­ic­ian alike, and is a waste of time and ene­rgy.

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Though a patient can only con­sid­er him­self real­ly cured when he has been red­uced to his sta­tis­tic­al­ly nor­mal weight, we do not in­sist that he com­mit him­self to that ex­tent. Even a par­tial loss of over­weight is high­ly ben­ef­ic­ial, and it is our ex­peri­ence that once a pa­tient has com­ple­ted a first course, he is so en­thu­si­as­tic about the ease with which the to-him-sur­pri­sing res­ults are achiev­ed, that he al­most in­vari­ab­ly comes back for more. There cer­tain­ly can be no doubt that in my clin­ic more time is spent on damp­ing over-​en­thu­si­asm than on in­sis­ting that the rules of the treat­ment be ob­served.

Examining the Patient TOC

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Only when agreement is reached on the points so far discussed do we pro­ceed with the ex­am­ina­tion of the pa­tient. A note is made of the size of the first up­per in­ci­sor, of a pad of fat on the nape of the neck, at the ax­il­la, and on the in­side of the knees. The pres­ence of stri­ation, a su­pra­pu­bic fold, a thor­ac­ic fold, an­gu­la­tion of el­bow and knee joint, breast-​de­vel­op­ment in men and women, ed­ema of the an­kles and the state of geni­tal de­vel­op­ment in the male, are noted.

Wherever this seems indicated, we X-ray the sella turcica, as the bony cap­sule which con­tains the pit­ui­ta­ry gland is called; meas­ure the ba­sal met­ab­ol­ic rate; X-ray the chest, and take an el­ec­tro­car­dio­gram. We do a blood-​count; sedi­men­ta­tion rate; and esti­mate uric acid, cho­les­ter­ol, io­dine, and sug­ar in the fas­ting blood.

Gain before Loss TOC

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Patients whose general condition is low, owing to excessive pre­vi­ous di­et­ing, must eat to cap­ac­ity for about one week be­fore star­ting treat­ment, re­gard­less of how much weight they may gain in the proc­ess. One can­not keep a pa­tient com­for­tab­ly on 500 Cal­or­ies un­less his nor­mal fat res­erves are reas­on­ab­ly well stocked. It is for this reas­on also that ev­ery case, even those that are ac­tu­al­ly gain­ing, must eat to cap­ac­ity of the most fat­ten­ing food they can get down un­til they have had the third in­jec­tion. It is a fun­da­men­tal mis­take to put a pa­tient on 500 Cal­or­ies as soon as the in­jec­tions are star­ted, as it seems to take about three in­jec­tions be­fore ab­nor­mal­ly de­pos­it­ed fat be­gins to cir­cu­late, and thus be­come avail­ab­le.

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We distinguish between the first three injections — which we call “non-​ef­fec­tive” as far as the loss of weight is con­cerned, and the sub­se­quent in­jec­tions given while the pa­tient is di­et­ing — which we call “ef­fec­tive”. The av­er­age loss of weight is cal­cu­la­ted on the num­ber of ef­fec­tive in­jec­tions, and from the weight reached on the day of the third in­jec­tion — which may be well above what it was two days ear­li­er, when the first in­jec­tion was given.

Most patients who have been struggling with diets for years, and know how rap­id­ly they gain if they let them­selves go, are very hard to con­vince of the ab­so­lute nec­es­sity of gor­ging for at least two days, and yet this must be in­sis­ted upon cate­gor­ic­al­ly if the fur­ther course of treat­ment is to run smooth­ly. Those pa­tients who have to be put on forced feed­ing for a week before star­ting the in­jec­tions usu­al­ly gain weight rap­id­ly — four to six pounds in 24 hours is not un­usu­al — but after a day or two, this rap­id gain gen­er­al­ly lev­els off. In any case, the whole gain is usu­al­ly lost in the first 48 hours of diet­ing. It is nec­es­sary to pro­ceed in this man­ner be­cause the gain re-​stocks the de­ple­ted nor­mal res­erves, where­as the sub­se­quent loss is from the ab­nor­mal de­pos­its only.

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Patients in a satisfactory general condition and those who have not just pre­vi­ous­ly re­stric­ted their diet start forced feed­ing on the day of the first in­jec­tion. Some pa­tients say that they can no lon­ger over­eat be­cause their stom­ach has shrunk after years of re­stric­tions. While we know that no stom­ach ever shrinks, we com­pro­mise by in­sis­ting that they eat fre­quent­ly of high­ly con­cen­tra­ted foods such as milk choc­ol­ate, pas­tries with whip­ped cream sug­ar, fried meats (particularly pork), eggs and ba­con, may­on­naise, bread with thick but­ter and jam, etc. The time and troub­le spent on pres­sing this point upon in­cred­ul­ous or re­luc­tant pa­tients is al­ways amp­ly re­war­ded af­ter­wards by the com­plete ab­sence of those dif­fic­ul­ties which pa­tients who have dis­re­gar­ded these in­struc­tions are lia­ble to ex­peri­ence. Dur­ing the two days of forced feed­ing from the first to the third in­jec­tion, many pa­tients are sur­prised that con­trary to their pre­vi­ous ex­peri­ence, they do not gain weight, and some even lose. The ex­pla­na­tion is that in these cases there is a com­pen­sa­to­ry flow of urine, which drains ex­ces­sive wat­er from the body. To some ex­tent this seems to be a dir­ect action of hCG, but it may also be due to a high­er pro­tein in­take, as we know that a pro­tein-​de­fic­ient diet makes the body re­tain water.

Starting Treatment TOC

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In menstruating women, the best time to start treatment is im­me­di­ate­ly af­ter a per­iod. Treat­ment may also be star­ted later, but it is ad­vi­sab­le to have at least ten days in hand be­fore the on­set of the next per­iod. Sim­il­arly, the end of a course of hCG should nev­er be made to co­in­cide with men­strua­tion. If things should hap­pen to work out that way, it is bet­ter to give the last in­jec­tion three days be­fore the ex­pec­ted date of the men­ses so that a nor­mal diet can he res­umed at on­set. Al­ter­na­tive­ly, at least three in­jec­tions should be giv­en af­ter the per­iod, fol­low­ed by the usu­al three days of di­et­ing. This rule need not be ob­served in such pa­tients who have reach­ed their nor­mal weight before the end of treat­ment and are al­ready on a high­er cal­or­ic diet.

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Patients who require more than the minimum of 23 in­jec­tions, and who there­fore skip one day a week in or­der to post­pone im­mun­ity to hCG, can­not have their third in­jec­tions on the day before the in­ter­val. Thus, if it is de­ci­ded to skip Sun­days, the treat­ment can be star­ted on any day of the week ex­cept Thurs­days. Sup­po­sing they start on Thurs­day, they will have their third in­jec­tion on Sat­ur­day, which is also the day on which they start their 500 Cal­or­ie diet. They would then have no in­jec­tion on the sec­ond day of di­et­ing; this ex­po­ses them to an un­nec­es­sary hard­ship, as with­out the in­jec­tion they will feel par­tic­ul­ar­ly hun­gry. Of course, the dif­fic­ul­ty can be over­come by ex­cep­tion­al­ly in­jec­ting them on the first Sun­day. If this day falls be­tween the first and sec­ond or be­tween the sec­ond and third in­jec­tion, we usu­al­ly pre­fer to give the pa­tient the ex­tra day of forced feed­ing, which the ma­jor­ity rap­tur­ous­ly en­joy.

The Diet TOC

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The 500-Calorie diet is explained on the day of the second in­jec­tion to those pa­tients who will be pre­par­ing their own food, and it is most im­por­tant that the per­son who will ac­tu­al­ly cook is pres­ent — the wife, the moth­er, or the cook, as the case may be. Here in Italy, pa­tients are giv­en the fol­low­ing diet sheet:

Breakfast:Tea or coffee in any quantity without sugar. Only one ta­ble­spoon­ful of milk al­low­ed in 24 hours. Sac­char­in or Ste­via may be used.
Lunch:
  1. 100 grams (3 oz.) of veal, beef, chicken breast, fresh white fish, lob­ster, crab, or shrimp. All vis­ib­le fat must be care­ful­ly re­moved be­fore cook­ing, and the meat must be weighed raw. It must be boil­ed or gril­led with­out ad­di­tion­al fat. Sal­mon, eel, tuna, her­ring, dri­ed or pick­led fish are not al­lowed. The chick­en breast must be re­moved from the bird.
  2. One type of vegetable only to be chosen from the fol­low­ing: spin­ach, chard, chic­ory, beet greens, green sal­ad, to­ma­toes, cel­ery, fen­nel, on­ions, red rad­ish­es, cu­cum­bers, as­para­gus, cab­bage.
  3. One breadstick (grissino) or one Melba toast.
  4. An apple, orange, or a handful of strawberries, or one-​half grape­fruit.
Dinner:The same four choices as lunch (above)

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The juice of one lemon daily is allowed for all pur­pos­es. Salt, pep­per, vin­eg­ar, mus­tard pow­der, gar­lic, sweet bas­il, par­sley, thyme, ma­jor­am, etc., may be used for sea­son­ing, but no oil, but­ter or dres­sing. Tea, cof­fee, plain wat­er, or min­er­al wat­er are the only drinks al­lowed, but they may be ta­ken in any quan­ti­ty and at all times. In fact, the patient should drink about 2 li­ters of these flu­ids per day. Many pa­tients are afraid to drink so much be­cause they fear that this may make them re­tain more wat­er. This is a wrong no­tion, as the body is more in­clined to store wat­er when the in­take falls be­low its nor­mal re­quire­ments.

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The fruit or the breadstick may be eaten between meals in­stead of with lunch or din­ner, but not more than than four items lis­ted for lunch and din­ner may be eat­en at one meal.

No medi­cines or cos­met­ics oth­er than lip­stick, eye­brow pen­cil and pow­der may be used with­out spec­ial per­mis­sion.

Every item in the list is gone over carefully, continually stres­sing the point that no var­ia­tions oth­er than those lis­ted may be in­tro­duced. All things not lis­ted are for­bid­den, and the pa­tient is as­sured that noth­ing per­mis­sib­le has been left out. The 100 (3 oz.) grams of meat must he scru­pu­lous­ly weighed raw after all vis­ib­le fat has been re­moved. To do this ac­cur­ate­ly, the pa­tient must have a let­ter scale, as kit­chen scales are not suf­fic­ient­ly ac­cur­ate, and the but­cher should cer­tain­ly not be re­lied upon. Those not un­com­mon pa­tients who feel that even so lit­tle food is too much for them, can omit any­thing they wish.

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There is no objection to breaking up the two meals — for in­stance, hav­ing a bread­stick and an ap­ple for break­fast, or an or­ange be­fore go­ing to bed — pro­vi­ded they are de­duc­ted from the reg­ul­ar meals. The whole dai­ly ra­tion of two bread­sticks or two fruits may not be eat­en at the same time, nor can any item saved from the pre­vi­ous day be ad­ded on the fol­low­ing day. In the be­gin­ning, pa­tients are ad­vised to check ev­ery meal against their diet sheet before star­ting to eat, and not to rely on their mem­ory. It is also worth poin­ting out that any at­tempt to ob­serve this diet with­out hCG will lead to troub­le in two to three days. We have had cases in which pa­tients have proud­ly flaun­ted their diet­ing powers in front of their friends without men­tion­ing the fact that they are also re­ceiv­ing treat­ment with hCG. They let their friends try the same diet, and when this proves to be a failure — as it ne­ces­sar­ily must — the pa­tient starts ra­king in un­mer­it­ed ku­dos for su­per­hu­man will­pow­er.

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It should also be mentioned that two small apples weighing as much as one large one nev­er­the­less have a high­er cal­or­ic val­ue, and are there­fore not al­lowed, though there is no re­stric­tion on the size of one ap­ple. Some peo­ple do not real­ize that a tan­ger­ine is not an or­ange, and that chick­en breast does not mean the breast of any oth­er fowl, nor does it mean a wing or drum­stick.

The most tiresome patients are those who start counting cal­or­ies, and then come up with all man­ner of in­ge­ni­ous var­ia­tions which they com­pile from their lit­tle books. When one has spent years of weary re­search try­ing to make a diet as at­trac­tive as pos­sib­le with­out jeo­par­di­zing the loss of weight, cu­lin­ary ge­ni­us­es who are out to im­prove their un­hap­py lot are hard to take.

Making up the Calories TOC

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The diet used in conjunction with hCG must not exceed 500 Cal­ories per day, and the way these Ca­lo­ries are made up is of ut­most im­por­tance. For in­stance, if a pa­tient drops the ap­ple and eats an ex­tra bread­stick in­stead, he will not be get­ting more Cal­or­ies, but he will not lose weight. There are a num­ber of foods, par­tic­ul­ar­ly fruits and veg­eta­bles, which have the same or even low­er cal­or­ic val­ues than those lis­ted as per­mis­sib­le, and yet we find that they in­ter­fere with the reg­ul­ar loss of weight under hCG, pre­sum­ab­ly ow­ing to the na­ture of their com­po­si­tion. Pi­mien­to pep­pers, okra, ar­ti­chokes, and pears are ex­am­ples of this.

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While this diet works satisfactorily in Italy, cer­tain mod­ifi­ca­tions have to be made in other coun­tries. For in­stance, Am­eri­can beef has al­most doub­le the cal­or­ic val­ue of South Italian beef, which is not mar­bled with fat. This mar­bling is im­pos­sib­le to re­move. In Am­eri­ca, there­fore, low-​grade veal should be used for one meal, and fish (ex­clu­ding all those spe­cies such as her­ring, mack­er­el, tuna, sal­mon, eel, etc., which have a high fat con­tent, and all dried, smoked or pick­led fish), chick­en breast, lob­ster, craw­fish, prawns, shrimps, crab meat or kid­neys for the other meal. Where the Ital­ian bread­sticks, the so-​cal­led gris­si­ni, are not av­ail­ab­le, one Mel­ba toast may be used in­stead, though they are psy­cho­log­ic­al­ly less sat­is­fy­ing. A Mel­ba toast has about the same weight as the very por­ous gris­si­ni, which is much more to look at and to chew.

In many countries, specially prepared unsweetened and low-​cal­or­ie foods are free­ly avail­ab­le, and some of these can be ten­ta­tive­ly used. When lo­cal con­di­tions or the feed­ing hab­its of the popu­la­tion make changes nec­es­sary, it must be borne in mind that the to­tal dai­ly in­take must not ex­ceed 500 cal­or­ies if the best pos­sib­le res­ults are to be ob­tained; that the daily ra­tion should con­tain 200 grams of fat-​free pro­tein, and a very small amount of starch.

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Just as the daily dose of hCG is the same in all cases, so the same diet proves to be sat­is­fac­tory for a small el­der­ly lady of lei­sure or a hard-​wor­king mus­cul­ar giant. Under the effect of hCG, the obese body is al­ways able to ob­tain all the Cal­or­ies it needs from the ab­nor­mal fat de­pos­its, re­gard­less of wheth­er it uses up 1500 or 4000 per day. It must be made very clear to the pa­tient that he is liv­ing to a far grea­ter ex­tent on the fat which he is los­ing than on what he eats.

Many pa­tients ask why eggs are not allowed. The contents of two good-​sized eggs are rough­ly equiv­al­ent to 100 grams (3 oz.) of meat, but un­for­tun­ate­ly, the yolk con­tains a large amount of fat, which is un­de­sira­ble. Very oc­ca­sion­al­ly we all­ow egg — boiled, poached, or raw — to pa­tients who de­vel­op an avers­ion to meat, but in this case they must add the white of three eggs to the one they eat whole (or, scoop out the yolk of a hard-​boiled egg with a teas­poon, and con­sume only the white — ed.). In coun­tries where cot­tage cheese made from skim­med milk is avail­able, 100 grams (3 oz.) may oc­ca­sion­al­ly be used in­stead of the meat, but no other cheeses are al­lowed.

Vegetarians TOC

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Strict vegetarians such as orthodox Hindus present a special prob­lem, be­cause milk and curds are the only ani­mal pro­tein they will eat. To sup­ply them with suf­fic­ient pro­tein of ani­mal ori­gin, they must drink 500 cc. (17 fl. oz., or 2c. 1oz.) of skim­med milk per day, though part of this ra­tion can be taken as curds. As far as fruit, veg­eta­bles and starch are con­cerned, their diet is the same as that of non-​veg­et­ari­ans: They can­not be al­lowed their usu­al in­take of veg­et­ab­le pro­teins from le­gu­min­ous plants such as beans or from wheat or nuts, nor can they have their cus­tom­ary rice. In spite of these sev­ere re­stric­tions, their av­er­age loss is about half that of non-​veg­et­ari­ans, pre­su­mab­ly ow­ing to the sug­ar con­tent of the milk.

Faulty Dieting TOC

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Few patients will take one’s word for it that the sligh­test de­vi­ation from the diet has un­der hCG dis­as­trous res­ults as far as the weight is con­cerned. This ex­treme sen­si­tiv­ity has the ad­van­tage that the smal­lest er­ror is im­me­di­ate­ly de­tec­tab­le at the dai­ly weigh­ing, but most pa­tients have to make the ex­peri­ence be­fore they will be­lieve it.

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Persons in high official positions such as embassy per­son­nel, poli­tic­ians, se­nior ex­ecu­tives, etc., who are ob­liged to at­tend so­cial func­tions to which they can­not bring their mea­ger meal, must be told be­fore­hand that an of­fic­ial din­ner will cost them the loss of about three days treat­ment, how­ev­er care­ful they are and in spite of a friend­ly and would-​be co­oper­at­ive host. We gen­er­al­ly ad­vise them to avoid all-​round em­bar­ras­sment, the al­most in­evi­tab­le turn of con­ver­sa­tion to their weight prob­lem, and the out­pour­ing of lay coun­sel from their ta­ble part­ners by not let­ting it be known that they are un­der treat­ment. They should take dain­ty ser­vings of ev­ery­thing, hide what they can under the cut­lery, and book the gain which may take three days to get rid of as one of the sac­ri­fi­ces which their pro­fes­sion en­tails. Al­low­ing three days for their cor­rec­tion, such in­ci­dents do not jeo­par­dize the treat­ment — pro­vi­ded they do not oc­cur all too fre­quent­ly, in which case treat­ment should be post­poned to a so­cial­ly more peace­ful sea­son.

Vitamins and Anemia TOC

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Sooner or later most patients express a fear that they may be run­ning out of vita­mins, or that the re­stric­ted diet may make them ane­mic. On this score the phys­ic­ian can con­fid­ent­ly re­lieve their ap­pre­hen­sion by ex­plain­ing that ev­ery time they lose a pound of fat­ty tis­sue — which they do almost daily — only the ac­tu­al fat is burned up: All the vita­mins, the pro­teins, the blood, and the min­er­als which this tis­sue con­tains in abun­dance (e.g., fat-​sol­ubles such as E & A – ed.) are fed back into the body. Ac­tu­al­ly, a low blood count not due to any seri­ous dis­or­der of the blood-​for­ming tis­sues im­proves dur­ing treat­ment, and we have nev­er en­coun­ter­ed a sig­nif­ic­ant pro­tein de­fic­ien­cy nor signs of a lack of vita­mins in pa­tients who are diet­ing reg­ul­ar­ly.

The First Days of Treatment TOC

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On the day of the third injection it is almost routine to hear two remarks. One is: “You know, Doc­tor, I’m sure it’s only psy­cho­log­ic­al, but I al­rea­dy feel quite dif­fer­ent.” So com­mon is this re­mark, even from very skep­tic­al pa­tients, that we hes­it­ate to ac­cept the psy­cho­log­ic­al in­ter­pre­ta­tion. The oth­er typ­ic­al re­mark is: “Now that I have been al­lowed to eat any­thing I want, I can’t get it down. Since yes­ter­day I feel like a stuf­fed pig. Food just doesn’t seem to in­ter­est me any more, and I am long­ing to get on with your diet.” Many pa­tients no­tice that they are pas­sing more urine, and that the swel­ling in their an­kles is less even be­fore they start diet­ing.

On the day of the fourth injection, most patients declare that they are feeling fine. They have usu­al­ly lost two pounds or more; some say they feel a bit emp­ty, but ha­sten to ex­plain that this does not amount to hun­ger. Some com­plain of a mild head­ache of which they have been fore­warned, and for which they have been given per­mis­sion to take as­pirin.

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During the second and third day of dieting — that is, the fifth and sixth in­jec­tion — these mi­nor com­plaints im­prove while the weight con­tin­ues to drop at about doub­le the usu­al­ly over­all aver­age of al­most one pound per day, so that a mod­er­ate­ly sev­ere case may by the fourth day of diet­ing have lost as much as 8-10 lbs.

It is usually at this point that a dif­fer­ence ap­pears be­tween those pa­tients who have lit­er­al­ly eaten to ca­pac­ity dur­ing the first two days of treat­ment and those who have not. The for­mer feel re­mark­ab­ly well: They have no hun­ger, nor do they feel temp­ted when oth­ers eat nor­mal­ly at the same ta­ble. They feel ligh­ter, more clear-​head­ed, and no­tice a des­ire to move quite con­tra­ry to their pre­vi­ous leth­ar­gy. Those who have dis­re­gar­ded the ad­vice to eat to cap­ac­ity con­tin­ue to have mi­nor dis­com­forts, and do not have the same eu­phor­ic sense of well-​being un­til about a week la­ter. It seems that their nor­mal fat res­erves re­quire that much more time be­fore they are ful­ly stocked.

Fluctuations In Weight Loss TOC

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After the fourth or fifth day of dieting, the daily loss of weight begins to de­crease to one pound or some­what less per day, and there is a smal­ler uri­na­ry out­put. Men of­ten con­tin­ue to lose reg­ul­ar­ly at that rate, but wom­en are more ir­reg­ul­ar in spite of fault­less diet­ing. There may be no drop at all for two or three days, and then a sud­den loss which re­es­tab­lish­es the nor­mal aver­age. These fluc­tua­tions are en­tire­ly due to var­ia­tions in the re­tention and elim­ina­tion of wat­er, which are more marked in wom­en than in men.

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The weight registered by the scale is determined by two proc­es­ses not nec­es­sari­ly syn­chron­ized: Un­der the in­flu­ence of hCG, fat is being ex­trac­ted from the cells, in which it is stored in the fat­ty tis­sue. When these cells are emp­ty and there­fore serve no pur­pose, the body breaks down the cel­lu­lar struc­ture, and ab­sorbs it; but break­ing up of use­less cells, con­nec­tive tis­sue, blood ves­sels, etc., may lag be­hind the proc­ess of fat-​ex­trac­tion. When this hap­pens, the body ap­pears to re­place some of the ex­trac­ted fat with wat­er, which is re­tained for this pur­pose. As wat­er is heav­ier than fat, the scales may show no loss of weight, al­though suf­fic­ient fat has ac­tu­al­ly been con­sumed to make up for the def­ic­it in the 500-​calorie diet. When, then, such tis­sue is fi­nal­ly bro­ken down, the wat­er is lib­era­ted, and there is a sud­den flood of urine and a marked loss of weight. This sim­ple in­ter­pre­ta­tion of what is real­ly an ex­treme­ly com­plex mech­an­ism is the one we give those pa­tients who want to know why it is that on cer­tain days they do not lose, though they have com­mit­ted no di­et­ary er­ror.

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Patients who have previously regularly used diuretics as a method of re­du­cing, lose fat dur­ing the first two or three weeks of treat­ment — which shows in their meas­ure­ments, but the scale may show little or no loss be­cause they are re­pla­cing the nor­mal wat­er con­tent of their body, which has been de­hy­dra­ted. Di­ur­et­ics should never be used for re­du­cing.

Interruptions of Weight Loss TOC

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We distinguish four types of interruption in the regular daily loss:
  1. The first is the one that has already been men­tioned, in which the weight stays sta­tion­ary for a day or two, and this occurs, par­tic­ul­ar­ly to­wards the end of a course, in al­most every case.
  2. The second type of interruption we call a “plateau.” A plateau lasts 4-6 days, and fre­quent­ly oc­curs dur­ing the sec­ond half of a full course, par­tic­ul­ar­ly in pa­tients that have been doing well, and whose over­all aver­age of near­ly a pound per ef­fec­tive in­jec­tion has been main­tained. Those who are lo­sing more than the aver­age all have a pla­teau sooner or later. A pla­teau al­ways cor­rects it­self, but many pa­tients who have be­come ac­cus­tom­ed to a reg­ul­ar dai­ly loss get un­nec­es­sar­ily wor­ried, and begin to fret. No amount of ex­pla­na­tion con­vin­ces them that a pla­teau does not mean that they are no lon­ger re­spon­ding nor­mal­ly to treat­ment. In such cases we con­sid­er it per­mis­sib­le, for pure­ly psy­cho­log­ic­al rea­sons, to break up the pla­teau. This can be done in two ways:
    • One is a so-​cal­led “ap­ple day”. An ap­ple-​day be­gins at lunch, and con­tin­ues until just be­fore lunch of the fol­low­ing day. The pa­tients are given six large ap­ples, and are told to eat one when­ev­er they feel the des­ire, though six ap­ples is the maxi­mum al­lowed. Dur­ing an ap­ple-​day, no oth­er food or liq­uids ex­cept plain wat­er are al­lowed, and of wat­er they may only drink just enough to quench an un­com­for­tab­le thirst, if eat­ing an ap­ple still leaves them thir­sty. Most pa­tients feel no need for wat­er, and are quite hap­py with their six ap­ples. Need­less to say, an ap­ple-​day may nev­er be giv­en on the day on which there is no in­jec­tion. The ap­ple-​day pro­du­ces a grati­fy­ing loss of weight on the fol­low­ing day, chief­ly due to the elim­ina­tion of wat­er. This wat­er is not re­gained when the pa­tients re­sume their nor­mal 500-​cal­or­ie diet at lunch, and on the fol­low­ing days, they con­tin­ue to lose weight sat­is­fac­tor­ily.
    • The other way to break up a plateau is by giving a non-mercurial di­ur­et­ic[7] for one day. This is simp­ler for the pa­tient, but we pre­fer the ap­ple-​day, as we some­times find that, though the di­ur­et­ic is very ef­fec­tive on the fol­low­ing day, it may take two to three days be­fore the nor­mal dai­ly re­duc­tion is re­sumed, throw­ing the pa­tient into a new fit of des­pair. It is use­less to give ei­ther an ap­ple-​day or a di­ur­et­ic un­less the weight has been sta­tion­ary for at least four days with­out any di­et­ary er­ror hav­ing been com­mit­ted.
  3. UPThe third type of interruption in the regular loss of weight may last much longer — ten days to two weeks. For­tu­nate­ly it is rare, and only oc­curs in very ad­vanced ca­ses, and then hard­ly ever dur­ing the first course of treat­ment. It is seen only in those pa­tients who dur­ing some per­iod of their lives have main­tained a cer­tain fixed deg­ree of obes­ity for ten years or more, and have then at some time rap­id­ly in­creased be­yond that weight. When, then, in the course of treat­ment the for­mer lev­el is reached, it may take two weeks of no loss, in spite of hCG and diet, be­fore fur­ther re­duc­tion is nor­mal­ly res­umed.
  4. UPThe fourth type of interruption is the one which often oc­curs a few days be­fore and dur­ing the men­stru­al per­iod, and in some wom­en at the time of ovu­la­tion. It must also be men­tion­ed that when a wom­an be­comes preg­nant dur­ing treat­ment — and this is by no means un­com­mon — she at once cea­ses to lose weight. An un­ex­plain­ed ar­rest of re­duc­tion has on sev­er­al oc­ca­sions raised our sus­pic­ion be­fore the first per­iod was mis­sed. If in such cases, men­stru­ation is de­layed, we stop in­jec­ting, and do a pre­cip­ita­tion test five days la­ter. No preg­nan­cy test should be car­ried out earli­er than five days after the last in­jec­tion, as ot­her­wise the hCG may give a false pos­it­ive res­ult. Oral con­tra­cep­tives may be used dur­ing treat­ment.
Dietary Errors TOC

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Any interruption of the normal loss of weight which does not fit per­fect­ly into one of these cate­gor­ies is al­ways due to some pos­sib­ly very mi­nor di­et­ary err­or. Sim­il­ar­ly, any gain of more than 100 grams (3 oz.) is in­vari­ab­ly the res­ult of some trans­gres­sion or mis­take, un­less it hap­pens on or about the day of ovu­la­tion or dur­ing the three days pre­ce­ding the on­set of men­stru­ation, in which case it is ig­nored. In all oth­er ca­ses, the rea­son for the gain must be es­tab­lished at once. The pa­tient who frank­ly ad­mits that he has step­ped out of his reg­im­en when told that some­thing has gone wrong is no prob­lem. He is al­ways sur­prised at being found out, be­cause un­less he has seen this him­self, he will not be­lieve that a sal­ted al­mond, a cou­ple of po­ta­to chips, a glass of to­ma­to juice, or an ex­tra or­ange, will bring about a def­in­ite in­crease in his weight on the foll­ow­ing day.

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Very often he wants to know why extra food weighing one ounce should in­crease his weight by six ounces. We ex­plain this in the fol­low­ing way: Un­der the in­flu­ence of hCG, the blood is sat­ura­ted with food, and the blood vol­ume has ad­ap­ted it­self so that it can only just ac­com­mo­date the 500 cal­or­ies which come in from the in­tes­tin­al tract in the course of the day. Any ad­di­tion­al in­come, how­ev­er lit­tle this may be, can­not be ac­com­mo­da­ted, and the blood is there­fore forced to in­crease its vol­ume suf­fic­ient­ly to hold the ex­tra food, which it can only do in a very di­lu­ted form. Thus, it is not the weight of what is eat­en that plays the de­ter­min­ing role, but rath­er the amount of wat­er which the body must re­tain to ac­com­mo­date this food.

This can be il­lus­tra­ted by men­tion­ing the case of salt. In or­der to hold one tea­spoon­ful of salt, the body re­quires one li­ter of wat­er, as it can­not ac­com­mo­date salt in any high­er con­cen­tra­tion. Thus, if a per­son eats one tea­spoon­ful of salt, his weight will go up by more than two pounds (the weight of a liter water – ed.) as soon as this salt is ab­sorbed from his in­tes­tine. To this ex­pla­na­tion many pa­tients reply: Well, if I put on that much ev­ery time I eat a little ex­tra, how can I hold my weight af­ter the treat­ment? It must there­fore be made clear that this only hap­pens as long as they are under hCG. When treat­ment is over, the blood is no lon­ger sat­ura­ted, and can eas­ily ac­com­mo­date ex­tra food with­out hav­ing to in­crease its vol­ume. Here again the pro­fes­sion­al read­er will be aware that this in­ter­pre­ta­tion is a sim­plif­ica­tion of an ex­treme­ly in­tric­ate phys­io­log­ic­al proc­ess, which ac­tu­al­ly ac­counts for the phe­nom­en­on.

Salt and Reducing TOC

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While we are on the subject of salt, I can take this opportunity to ex­plain that we make no re­stric­tion in the use of salt, and in­sist that the pa­tients drink large quan­ti­ties of wat­er through­out the treat­ment. We are out to re­duce ab­nor­mal fat, and are not in the least in­ter­es­ted in such il­lu­sory weight los­ses as can be achieved by de­pri­ving the body of salt, or by de­sic­ca­ting it. Though we al­low the free use of salt, the dai­ly amount ta­ken should be rough­ly the same, as a sud­den in­crease will of course be fol­lowed by a cor­re­spon­ding in­crease in weight as shown by the scale. An in­crease in the in­take of salt is one of the most com­mon cau­ses for an in­crease in weight from one day to the next. Such an in­crease can be ig­nored, pro­vi­ded it is ac­coun­ted for. It in no way in­flu­en­ces the reg­ul­ar loss of fat.

Water TOC

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Patients are usually hard to convince that the amount of water they re­tain has noth­ing to do with the am­ount of wat­er they drink. When the body is forced to re­tain wat­er, it will do this at all costs. If the flu­id in­take is in­suf­fic­ient to pro­vide all the wat­er re­qui­red, the body with­holds wat­er from the kid­neys, and the urine be­comes scan­ty and high­ly con­cen­tra­ted, im­po­sing a cer­tain strain on the kid­neys. If that is in­suf­fic­ient, ex­ces­sive water will be with­drawn from the in­tes­tin­al tract, with the res­ult that the fe­ces be­come hard and dry. On the oth­er hand, if a pa­tient drinks more than his body re­qui­res, the sur­plus is prompt­ly and eas­ily elim­ina­ted. Try­ing to pre­vent the body from re­tain­ing wat­er by drin­king less is there­fore not only fu­tile, but even harm­ful.

Constipation TOC

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An excess of water keeps the feces soft, and that is very im­por­tant in the obese, who com­mon­ly suf­fer from con­sti­pa­tion and a spas­tic co­lon. While a pa­tient is un­der treat­ment, we nev­er per­mit the use of any kind of lax­at­ive taken by mouth. We ex­plain that ow­ing to the re­stric­ted diet, it is per­fect­ly sat­is­fac­to­ry and nor­mal to have an evacua­tion of the bow­el only once ev­ery three to four days and that, pro­vi­ded plen­ty of flu­ids are taken, this nev­er leads to any dis­tur­bance. Only in those pa­tients who be­gin to fret after four days do we al­low the use of a sup­pos­it­ory. Pa­tients who ob­serve this rule find that after treat­ment, they have a per­fect­ly nor­mal bow­el ac­tion, and this de­lights many of them al­most as much as their loss of weight.

Investigating Dietary Errors TOC

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When the reason for a slight gain in weight is not immediately evi­dent, it is nec­es­sary to in­ves­tig­ate fur­ther. A pa­tient who is un­aware of hav­ing com­mit­ted an er­ror or is un­wil­ling to ad­mit a mis­take pro­tests in­dig­nant­ly when told he has done some­thing he ought not to have done. In that at­mo­sphere no fruit­ful in­ves­ti­ga­tion can be con­duc­ted; so we calm­ly ex­plain that we are not ac­cu­sing him of any­thing, but that we know for cer­tain from our not in­con­sid­er­ab­le ex­peri­ence that some­thing has gone wrong, and that we must now sit down quiet­ly to­geth­er and try and find out what it was. Once the pa­tient re­ali­zes that it is in his own in­ter­est that he play an ac­tive and not mere­ly a pas­sive role in this search, the rea­son for the set­back is al­most in­vari­ab­ly dis­cov­erved. Hav­ing been through hun­dreds of such ses­sions, we are near­ly al­ways able to dis­tin­guish the de­lib­er­ate liar from the pa­tient who is mere­ly fool­ing him­self, or is real­ly un­aware of hav­ing er­red.

Liars and Fools TOC

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When we see obese patients, there are generally two of us pres­ent in or­der to speed up rou­tine hand­ling. Thus, when we have to in­vesti­gate a rise in weight, a glance is suf­fic­ient to make sure that we agree or dis­agree. If af­ter a few ques­tions we both feel rea­son­ab­ly sure that the pa­tient is de­lib­er­ate­ly ly­ing, we tell him that this is our opin­ion, and warn him that un­less he comes clean, we may re­fuse fur­ther treat­ment. The way he reacts to this fur­nish­es ad­di­tion­al proof wheth­er we are on the right track or not. We now very rare­ly make a mis­take. If the pa­tient breaks down and con­fes­ses, we melt and are all for­give­ness, and treat­ment pro­ceeds. Yet, if such per­for­man­ces have to be re­peat­ed more than two or three times, we re­fuse fur­ther treat­ment. This hap­pens in less than 1% of our cases. If the pa­tient is stub­born, and will not ad­mit what he has been up to, we usu­al­ly give him one more chance and con­tin­ue treat­ment even though we have been un­able to find the rea­son for his gain. In many such cases there is no rep­eti­tion, and fre­quent­ly the pa­tient does then con­fess a few days later after he has thought things over.

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The patient who is fooling himself is the one who has com­mit­ted some tri­fling of­fense against the rules, but who has been able to con­vince him­self that this is of no im­por­tance, and can­not pos­sib­ly ac­count for the gain in weight. Wom­en seem par­ticu­lar­ly prone to get­ting them­selves en­tan­gled in such de­lu­sions. On the oth­er hand, it does fre­quent­ly hap­pen that a pa­tient will in the midst of a con­ver­sa­tion un­thin­king­ly spear an olive or for­get that he has al­ready eat­en his bread­stick. A moth­er pre­par­ing food for the fam­ily may out of sheer hab­it for­get that she must not taste the sauce to see wheth­er it needs more salt. Some­times a rich mai­den aunt can­not be of­fen­ded by re­fu­sing a cup of tea into which she has put two tea­spoons of sug­ar, thought­ful­ly re­mem­ber­ing the pa­tient’s taste from pre­vi­ous oc­ca­sions. Such in­cid­ents are le­gion, and are usu­al­ly con­fes­sed with­out hesi­ta­tion, but some pa­tients seem gen­uine­ly able to for­get these lap­ses, and re­mem­ber them with a vis­ib­le shock only af­ter in­sis­tent ques­tion­ing.

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In these cases we go carefully over the day. Sometimes the pa­tient has been in­vi­ted to a meal or gone to a res­tau­rant, na­ive­ly be­liev­ing that the food has ac­tu­al­ly been pre­pared ex­act­ly ac­cor­ding to in­struc­tions. They will say: “Yes, now that I come to think of it the steak did seem a bit big­ger than the one I have at home, and it did taste bet­ter; may­be there was a lit­tle fat on it, though I spec­ial­ly told them to cut it all away.” Some­times the bread­sticks were bro­ken, and a few frag­ments eaten, and “May­be they were a lit­tle more than one.” It is not un­com­mon for pa­tients to place too much re­li­ance on their mem­ory of the diet sheet, and start eat­ing car­rots, beans, or peas, and then to seem gen­uine­ly sur­prised when their at­ten­tion is cal­led to the fact that these are for­bid­den, as they have not been listed.

Cosmetics TOC

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When no dietary error is elicited, we turn to cosmetics. Most wom­en find it hard to be­lieve that fats, oils, creams, and oint­ments ap­plied to the skin are ab­sorbed, and in­ter­fere with weight re­duc­tion by hCG just as if they had been eat­en. This al­most in­cred­ib­le sen­si­tiv­ity to even such very mi­nor in­crea­ses in nu­tri­tion­al in­take is a pe­cu­li­ar fea­ture of the hCG meth­od. For in­stance, we find that per­sons who ha­bit­ual­ly han­dle or­gan­ic fats, such as wor­kers in beau­ty par­lors, mas­seurs, but­chers, etc., never show what we con­sid­er a sat­is­fac­tory loss of weight un­less they can avoid fat com­ing into con­tact with their skin.

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The point is so important, that I will illustrate it with two cases:

  1. A lady who was cooperating perfectly suddenly increased half a pound. Care­ful ques­tion­ing brought noth­ing to light. She had cer­tain­ly made no diet­ary er­ror, nor had she used any kind of face cream, and she was al­ready in the meno­pause. As we felt that we could trust her im­plic­it­ly, we left the ques­tion sus­pen­ded. Yet just as she was about to leave the con­sul­ting room, she sud­den­ly stop­ped, turned, and snap­ped her fin­gers: “I’ve got it!” she said. This is what had happened: She had bought her­self a new set of make­up pots and bot­tles and, using her fin­gers, had trans­fer­red her large as­sort­ment of cos­met­ics to the new con­tain­ers in an­tici­pa­tion of the day she would be able to use them again after her treat­ment.
  2. The other case concerns a man who impressed us as being very con­sci­en­tious. He was about 20 lbs. over­weight, but did not lose sat­is­fac­tori­ly from the on­set of treat­ment. Again and again we tried to find the reason, but with no suc­cess, un­til one day he said:“I never told you this, but I have a glass eye. In fact, I have a whole set of them. I fre­quent­ly change them, and eve­ry time I do that, I put a spec­ial oint­ment in my eye sock­et. Do you think that could have any­thing to do with it?” As we thought just that, we asked him to stop using this oint­ment, and from that day on his weight loss was reg­ul­ar.

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We are particularly averse to those modern cosmetics which con­tain hor­mones, as any in­ter­fe­rence with en­do­crine reg­ula­tions dur­ing treat­ment must be ab­so­lute­ly avoi­ded. Many wom­en whose skin has in the course of years be­come ad­jus­ted to the use of fat-​con­tain­ing cos­metics find that their skin gets dry as soon as they stop using them. In such cases we per­mit the use of plain min­er­al oil, which has no nu­tri­tion­al val­ue. On the oth­er hand, min­er­al oil should not be used in pre­par­ing the food — first because of its un­des­ira­ble lax­at­ive qual­ity, and sec­ond be­cause it ab­sorbs some fat-​solu­ble vita­mins, which are then lost in the stool. We do per­mit the use of lip­stick, pow­der, and such lo­tions as are en­tire­ly free of fat­ty sub­stan­ces. We also al­low bril­li­an­tine to be used on the hair, but it must not be rub­bed into the scalp. Ob­vi­ous­ly, sun­tan oil is pro­hib­it­ed.

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Many women are horrified when told that for the duration of treat­ment they can­not use face creams or have fa­cial mas­sag­es. They fear that this and the loss of weight will ruin their com­plex­ion. They can be ful­ly re­as­sured. Un­der treat­ment, nor­mal fat is re­stored to the skin, which rap­id­ly be­comes fresh and tur­gid, ma­king the ex­pres­sion much more youth­ful. This is a char­ac­ter­is­tic of the hCG meth­od that is a con­stant source of won­der to pa­tients who have ex­peri­enced or seen in oth­ers the fa­cial rav­ag­es pro­duced by the usual meth­ods of re­du­cing. An obese wom­an of 70 ob­vi­ous­ly can­not ex­pect to have her puck­er­ed face re­duced to nor­mal with­out a wrin­kle, but it is re­mar­kab­le how youth­ful her face re­mains in spite of her age.

The Voice TOC

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Incidentally, another interesting feature of the hCG method is that it does not ruin a sing­ing voice. The typ­ic­al­ly obese pri­ma don­na usu­al­ly finds that when she tries to re­duce, the tim­bre of her voice is lia­ble to change, and un­der­stan­dab­ly this ter­ri­fies her. Un­der hCG this does not hap­pen; in­deed, in many ca­ses the voice im­proves, and the brea­thing in­vari­ab­ly does. We have had many cases of pro­fes­sion­al sing­ers very care­ful­ly con­trol­led by ex­pert voice teach­ers, and the maes­tros have been so en­thu­si­as­tic that they now fre­quent­ly send us pa­tients.

Other Reasons for a Gain TOC

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Apart from diet and cosmetics, there can be a few other rea­sons for a small rise in weight. Some pa­tients un­wit­ting­ly take chew­ing gum, throat pas­til­les, vi­ta­min pills, cough syr­ups etc., with­out re­ali­zing that the sug­ar or fats they con­tain may in­ter­fere with a reg­ul­ar loss of weight. Sex hor­mones or cor­ti­sone in its vari­ous mod­ern forms must be avoi­ded, though oral con­tra­cep­tives are per­mit­ted. In fact, the only self-​medi­ca­tion we al­low is as­pir­in for a head­ache, though head­aches al­most in­vari­ab­ly dis­ap­pear after a week of treat­ment, par­tic­ul­ar­ly if of the mi­graine type.

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Occasionally we allow a sleeping tablet or a tranquilizer, but pa­tients should be told that while un­der treat­ment, they need and may get less sleep. For in­stance, here in Italy where it is cus­tom­ary to sleep dur­ing the si­es­ta which lasts from one to four in the af­ter­noon, most pa­tients find that though they lie down, they are un­able to sleep. We en­cour­age swim­ming and sun ba­thing dur­ing treat­ment, but it should be re­mem­ber­ed that a sev­ere sun­burn al­ways pro­duces a tem­por­ary rise in weight, evi­dent­ly due to wat­er re­ten­tion. The same may be seen when a pa­tient gets a com­mon cold dur­ing treat­ment.

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Fi­nal­ly, the weight can tem­por­ari­ly in­crease — para­dox­ic­al though this may sound — af­ter an ex­cep­tion­al phys­ic­al ex­er­tion of long du­ra­tion that leads to a feel­ing of ex­haus­tion. A game of ten­nis, a vig­or­ous swim, a run, a ride on horse­back, or a round of golf do not have this ef­fect; but a long trek, a day of ski­ing, row­ing or cy­cling or dan­cing into the small hours usu­al­ly res­ult in a gain of weight on the fol­low­ing day, un­less the pa­tient is in per­fect train­ing. In pa­tients com­ing from abroad, where they al­ways use their cars, we often see this ef­fect after a stren­uous day of shop­ping on foot, sight­see­ing and vis­its to gal­ler­ies and mu­se­ums. Though the ex­tra mus­cul­ar ef­fort in­volved does con­sume some ad­di­tion­al cal­or­ies, this ap­pears to be off­set by the re­ten­tion of wat­er that the ti­red cir­cu­la­tion can­not at once elim­in­ate.

Appetite-reducing Drugs TOC

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We hardly ever use amphetamines, the appetite-reducing drugs such as Dexe­drin, Dexa­mil, Pre­lu­din, etc., as there seems to be no need for them during the hCG treat­ment. The only time we find them use­ful is when a pa­tient is, for im­pel­ling and un­fore­seen rea­sons, ob­liged to fore­go the in­jec­tions for three to four days, and yet wishes to con­tin­ue the diet so that he need not in­ter­rupt the course.

Unforeseen Interruptions of Treatment TOC

If an interruption of treatment lasting more than four days is nec­es­sa­ry, the pa­tient must in­crease his diet to at least 800 cal­or­ies by ad­ding meat, eggs, cheese, and milk to his diet after the third day, as oth­er­wise he will find himself so hun­gry and weak that he is un­able to go about his usu­al oc­cu­pa­tion. If the in­ter­val lasts less than two weeks, the pa­tient can dir­ect­ly res­ume in­jec­tions and the 500-​cal­or­ie diet, but if the in­ter­rup­tion lasts lon­ger, he must again eat nor­mal­ly un­til he has had his third in­jection.

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When a patient knows beforehand that he will have to trav­el and be ab­sent for more than four days, it is al­ways bet­ter to stop in­jec­tions three days be­fore he is due to leave so that he can have the three days of strict diet­ing which are nec­es­sa­ry af­ter the last in­jec­tion at home. This saves him from the al­most im­pos­sib­le task of hav­ing to ar­range the 500-​cal­or­ie diet while en route, and he can thus en­joy a much grea­ter diet­ary free­dom from the day of his de­par­ture. In­ter­rup­tions oc­cur­ring be­fore 20 ef­fec­tive in­jec­tions have been giv­en are most un­de­si­rab­le, be­cause with less than that num­ber of in­jec­tions, some weight is li­ab­le to be re­gained. After the 20th in­jec­tion, an un­avoid­ab­le in­ter­rup­tion is mere­ly a loss of time.

Muscular Fatigue TOC

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Towards the end of a full course, when a good deal of fat has been rap­id­ly lost, some pa­tients com­plain that lif­ting a weight or climb­ing stairs re­quires a grea­ter mus­cul­ar ef­fort than be­fore. They feel nei­ther breath­less­ness nor ex­haus­tion, but sim­ply that their mus­cles have to work har­der. This phe­nom­en­on, which dis­ap­pears soon after the end of the treat­ment, is caused by the re­mo­val of ab­nor­mal fat de­pos­it­ed be­tween, in, and around the mus­cles (in­ter­sti­tial fat – ed.). The re­mo­val of this fat makes the mus­cles too long, and so in or­der to achieve a cer­tain skel­et­al move­ment — say the ben­ding of an arm — the mus­cles have to per­form grea­ter con­trac­tion than be­fore. With­in a short while the mus­cle ad­justs it­self per­fect­ly to the new sit­ua­tion, but un­der hCG, the loss of fat is so rap­id that this ad­just­ment can­not keep up with it. Pa­tients often have to be re­as­sured that this does not mean that they are “get­ting weak.” This phe­nom­en­on does not oc­cur in pa­tients who reg­ul­ar­ly take vig­or­ous ex­er­cise, and con­tin­ue to do so during treat­ment.

Massage TOC

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I never allow any kind of massage during treatment. It is en­tire­ly un­nec­es­sa­ry, and mere­ly dis­turbs a very deli­cate proc­ess which is go­ing on in the tis­sues. Few in­deed are the mas­seurs and mas­seu­ses who can re­sist the temp­ta­tion to knead and ham­mer ab­nor­mal fat de­pos­its. In the course of rap­id re­duc­tion it is some­times pos­si­ble to pick up a fold of skin which has not yet had time to ad­just it­self, as it al­ways does under hCG, to the changed fig­ure. This fold con­tains its nor­mal sub­cu­ta­ne­ous fat, and may be al­most an inch thick. It is one of the main ob­jects of the hCG treat­ment to keep that fat there. Pa­tients and their mas­seurs do not al­ways un­der­stand this, and give this fat a wor­king-​over. I have seen such pa­tients who were as black and blue as if they had re­ceived a sound thrash­ing.

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In my opinion, massage, thumping, rolling, kneading, and shiv­er­ing un­der­ta­ken for the pur­pose of re­du­cing ab­nor­mal fat can do noth­ing but harm. We once had the hon­or of treat­ing the pro­pri­et­ress of a high-​class in­sti­tu­tion that spec­ial­ized in such an­tics. She had the au­dac­ity to con­fess that she was ta­king our treat­ment to con­vince her cli­ents of the ef­fi­ca­cy of her meth­ods, which she had found use­less in her own case.

How anyone in his right mind is able to believe that fatty tis­sue can be shif­ted mech­an­ic­al­ly or be made to van­ish by squee­zing, is be­yond my com­pre­hen­sion. The only ef­fect ob­tained is sev­ere brui­sing. The torn tissue then forms scars, and these slow­ly con­tract, ma­king the fat­ty tis­sue even har­der and more un­yiel­ding.

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A lady once consulted us for her most ungainly legs. Large mas­ses of fat bulged over the ank­les of her tiny feet, and there were about 40 lbs. too much on her hips and thighs. We as­sured her that this over­weight could be lost, and that her ank­les would mar­ked­ly im­prove in the proc­ess. Her treat­ment pro­gres­sed most sat­is­fac­tor­ily, but to our sur­prise there was no im­prove­ment in her ank­les. We then dis­cov­er­ed that she had for years been ta­king ev­ery kind of mech­ani­cal, elec­tric, and heat treat­ment for her legs, and that she had made up her mind to res­ort to plas­tic sur­gery if we fail­ed.

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Re-examining the fat above her ankles, we found that it was un­usu­al­ly hard. We at­tri­bu­ted this to the count­less mi­nor in­jur­ies in­flic­ted by knead­ing. These in­jur­ies had healed, but had left a tough net­work of con­nec­tive scar tis­sue in which the fat was im­pris­on­ed. Ready to try any­thing, she was put to bed for the re­main­ing three weeks of her first course with her lower legs tight­ly strap­ped in un­yiel­ding ban­dag­es. Ev­ery day the pres­sure was in­creased. The com­bi­na­tion of hCG, diet, and strap­ping brought about a marked im­prove­ment in the shape of her ank­les. At the end of her first course, she re­turned to her home abroad. Three months later she came back for her sec­ond course. She had main­tained both her weight and the im­prove­ment of her ank­les. The same pro­ce­dure was re­peat­ed, and after five weeks she left the hos­pit­al with a nor­mal weight and legs that, if not exactly shape­ly, were at least un­ob­tru­sive. Where no such in­jur­ies of the tis­sues have been in­flic­ted by in­ap­pro­pri­ate meth­ods of treat­ment, these dras­tic meas­ures are nev­er nec­es­sary.

Blood Sugar TOC

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Towards the end of a course, or when a pa­tient has near­ly reached his nor­mal weight, it oc­ca­sion­al­ly hap­pens that the blood sugar drops be­low nor­mal, and we have even seen this in pa­tients who had an ab­nor­mal­ly high blood sug­ar be­fore treat­ment. Such an at­tack of hy­po­gly­ce­mia is al­most iden­tic­al with the one seen in dia­bet­ics who have ta­ken too much in­sul­in. The at­tack comes on sud­den­ly; there is the same feel­ing of light-​head­ed­ness, weak­ness in the knees, tremb­ling, and un­mo­ti­va­ted sweat­ing; but un­der hCG, hy­po­gly­ce­mia does not pro­duce any feel­ing of hun­ger. All these symp­toms are al­most in­stant­ly re­lieved by ta­king two heaped tea­spoons of sug­ar.

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In the course of treatment, the possibility of such an at­tack is ex­plained to those pa­tients who are in a phase in which a drop in blood sugar may oc­cur. They are in­struc­ted to keep sug­ar or glu­cose sweets han­dy, par­ticu­lar­ly when dri­ving a car. They are also told to watch the ef­fect of ta­king sug­ar very care­ful­ly, and re­port the fol­low­ing day. This is im­por­tant, be­cause anx­ious pa­tients to whom such an at­tack has been ex­plained are apt to take sug­ar un­nec­es­sar­ily, in which case it in­evi­tab­ly pro­duces a gain in weight, and does not dra­mat­ic­al­ly re­lieve the symp­toms for which it was taken, prov­ing that these were not due to hy­po­gly­ce­mia. Some pa­tients mis­take the ef­fects of emo­tion­al stress for hy­po­gly­ce­mia. When the symp­toms are quick­ly re­lieved by sug­ar, this is proof that they were in­deed due to an ab­nor­mal low­er­ing of the blood sug­ar, and in that case there is no in­crease in the weight on the fol­low­ing day. We al­ways sug­gest that sug­ar be ta­ken if the pa­tient is in doubt.

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Once such an attack has been relieved with sugar, we have nev­er seen it re­cur on the im­me­di­ate­ly sub­se­quent days, and only very rare­ly does a pa­tient have two such at­tacks sep­ara­ted by sev­er­al days dur­ing a course of treat­ment. In pa­tients who have not eat­en suf­fic­ient­ly dur­ing the first two days of treat­ment, we some­times give sug­ar when the mi­nor symp­toms usu­al­ly felt dur­ing the first three days of treat­ment con­tin­ue be­yond that time, and in some cases this has seemed to speed up the eu­phor­ia or­din­ari­ly as­so­cia­ted with the hCG met­hod.

The Ratio of Pounds to Inches TOC

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An interesting feature of the hCG method is that, regardless of how fat a pa­tient is, the great­est cir­cum­fer­ence — ab­do­men or hips, as the case may be — is re­duced at a con­stant rate which is ex­tra­or­din­ari­ly close to 1 cm. per ki­lo­gram of weight lost. At the be­gin­ning of treat­ment, the change in meas­ure­ments is some­what grea­ter than this; but at the end of a course it is al­most in­vari­ab­ly found that the girth is as many cen­ti­me­ters less as the num­ber of ki­lo­grams by which the weight has been re­duced. I have nev­er seen this clear-​cut re­la­tion­ship in pa­tients that try to re­duce by di­et­ing only.

Preparing the Solution TOC

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Human chorionic gonadotrophin comes on the market as a high­ly sol­uble pow­der, which is the pure sub­stance ex­trac­ted from the urine of preg­nant wom­en. Such prep­ara­tions are care­ful­ly stan­dard­ized, and any brand made by a re­lia­ble phar­ma­ceu­tic­al com­pany is prob­ab­ly as good as any oth­er. The sub­stance should be ex­trac­ted from the urine and not from the pla­cen­ta; and it must of course be of hu­man, and not of ani­mal ori­gin. The pow­der is sealed in am­poules or in rub­ber-​cap­ped bot­tles in vary­ing amounts, which are stated in In­ter­na­tion­al Units. In this form hCG is sta­ble; how­ever, only such prep­ara­tions should be used that have the date of manu­fac­ture and the date of expiry clear­ly sta­ted on the la­bel or pack­age. A suit­ab­le sol­vent is al­ways sup­plied in a sep­ar­ate am­poule in the same pack­age.

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Once hCG is in solution, it is far less stable. It may be kept at room tem­per­at­ure for two to three days, but if the so­lu­tion must be kept lon­ger, it should al­ways be re­frig­era­ted. When treat­ing only one or two cases si­mul­ta­ne­ous­ly, vials con­tain­ing a small num­ber of units — say 1000 I.U. — should be used. The 10 cc. of sol­vent which is sup­plied by the manu­fac­tur­er is in­jec­ted into the rub­ber-​cap­ped bot­tle con­tain­ing the hCG, and the pow­der must dis­solve in­stan­tly. Of this so­lu­tion, 1.25 cc. are with­drawn for each in­jec­tion. One such bot­tle of 1000 I.U. there­fore fur­nish­es 8 in­jec­tions. When more than one pa­tient is be­ing trea­ted, they should not each have their own bot­tle, but, rather, all be in­jec­ted from the same vial, and a fresh so­lu­tion made when this is emp­ty.

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As we are usually treating a fair number of patients at the same time, we pre­fer to use vials con­tain­ing 5000 units. With these the manu­fac­tur­ers also sup­ply 10 cc. of sol­vent. Of such a solu­tion 0.25 cc. con­tains the 125 I.U., which is the stan­dard dose for all cases, and which should nev­er be ex­cee­ded. This small amount is awk­ward to han­dle ac­cur­ate­ly (it re­quires an in­sul­in syr­inge) and is waste­ful, be­cause there is a loss of solu­tion in the noz­zle of the syr­inge and in the nee­dle. We there­fore pre­fer a high­er di­lu­tion, which we pre­pare in the fol­low­ing way: The sol­vent sup­plied is in­jec­ted into the rub­ber-​cap­ped bot­tle con­tain­ing the 5000 I.U . As these bot­tles are too small to hold more sol­vent, we with­draw 5 cc., in­ject it into an emp­ty rub­ber-​cap­ped bot­tle, and add 5 cc. of nor­mal sa­line to each bot­tle. This gives us 10 cc. of so­lu­tion in each bot­tle, and of this so­lu­tion 0.5 cc. con­tains 125 I.U. This amount is con­ve­ni­ent to in­ject with an or­din­ary syr­inge.

Injecting TOC

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hCG produces little or no tissue-reaction. It is completely pain­less, and in the many thou­sands of in­jec­tions we have giv­en, we have nev­er seen an in­flam­ma­tory or sup­pur­at­ive re­ac­tion at the site of the in­jec­tion.

One should avoid leaving a vacuum in the bottle after preparing the so­lu­tion or af­ter with­draw­al of the am­ount re­qui­red for the in­jec­tions, as oth­er­wise, al­co­hol used for steri­li­zing a fre­quent­ly-​per­fo­ra­ted rub­ber cap might be drawn in­to the so­lu­tion. When sharp nee­dles are used, it some­times hap­pens that a lit­tle bit of rub­ber is punched out of the rub­ber cap, and can be seen as a small black speck floa­ting in the so­lu­tion. As these bits of rub­ber are heav­ier than the so­lu­tion, they rap­id­ly set­tle out, and it is thus easy to avoid draw­ing them into the syr­inge.

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We use very fine needles that are two inches long, and in­ject deep in­tra­glu­te­al­ly in the ou­ter up­per quad­rant of the but­tocks. The in­jec­tion should, if pos­sib­le, not be given into the su­per­fic­ial fat lay­ers, which in very obese pa­tients must be com­pres­sed so as to ena­ble the nee­dle to reach the mus­cle. Ob­vi­ous­ly, nee­dles and syr­in­ges must be care­ful­ly washed, ster­il­ized, and han­dled asep­tic­al­ly[8]. It is also im­por­tant that the daily in­jec­tion should be giv­en at in­ter­vals as close to 24 hours as pos­sib­le. Any at­tempt to econo­mize in time by giving lar­ger do­ses at lon­ger in­ter­vals is doomed to pro­duce less sat­is­fac­tory res­ults.

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There are hardly any contraindications to the hCG meth­od. Treat­ment can be con­tin­ued in the pres­ence of ab­sces­ses, sup­pur­ation, large in­fec­ted wounds, and ma­jor frac­tures. Sur­gery and gen­er­al an­es­the­sia are no reason to stop, and we have giv­en treat­ment dur­ing a sev­ere at­tack of mal­aria. Acne or boils are no con­tra­in­di­ca­tion: The for­mer usu­al­ly clears up, and fur­un­cu­lo­sis comes to an end. Throm­bo­phle­bi­tis is no con­tra­in­di­ca­tion, and we have treat­ed sev­er­al obese pa­tients with hCG and the 500-​cal­or­ie diet while they were suf­fer­ing from this con­di­tion. Our im­pres­sion has been that in obese pa­tients, the phle­bi­tis does rath­er bet­ter, and cer­tain­ly no worse than un­der the usu­al treat­ment alone. This also ap­plies to pa­tients suf­fer­ing from vari­cose ul­cers, which tend to heal rap­id­ly.

Fibroids TOC

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While uterine fibroids seem to be in no way affected by hCG in the doses we use, we have found that very large, ex­ter­nal­ly pal­pa­ble uter­ine my­omas are apt to give trouble. We are con­vinced that this is en­tire­ly due to the rath­er sud­den dis­ap­pear­ance of fat from the pel­vic bed upon which they rest, and that it is the weight of the tu­mor pres­sing on the un­der­ly­ing tis­sues that ac­counts for the dis­com­fort or pain which may arise during treat­ment. While we dis­re­gard even fair-​sized or mul­tip­le my­omas, we in­sist that very large ones be oper­ated be­fore treat­ment. We have had pa­tients pre­sent them­selves for re­du­cing fat from their ab­do­men who showed no signs of obes­ity, but had a large ab­dom­in­al tu­mor.

Gallstones TOC

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Small stones in the gall bladder may in patients who have re­cent­ly had typ­ic­al col­ics cause more fre­quent col­ics un­der treat­ment with hCG. This may be due to the al­most com­plete ab­sence of fat from the diet, which pre­vents the nor­mal emp­ty­ing of the gall blad­der. Be­fore un­der­ta­king treat­ment, we ex­plain to such pa­tients that there is a risk of more fre­quent, and pos­sib­ly sev­ere symp­toms, and that it may be­come nec­es­sa­ry to op­er­ate. If they are pre­pared to take this risk, and pro­vi­ded they agree to un­der­go an op­era­tion if we con­sid­er this im­pera­tive, we pro­ceed with treat­ment, as af­ter weight re­duc­tion with hCG the op­era­tive risk is con­sid­er­ab­ly re­duced in an obese pa­tient. In such cases we al­ways give a drug that stimu­lates the flow of bile, and in the ma­jor­ity of ca­ses, noth­ing un­to­ward hap­pens. On the oth­er hand, we have looked for and not found any evi­dence to sug­gest that the hCG treat­ment leads to the for­ma­tion of gall­stones, as preg­nan­cy some­times does.

The Heart TOC

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Disorders of the heart are not as a rule contraindications. In fact, the re­mo­val of ab­nor­mal fat — par­tic­ul­ar­ly from the heart mus­cle and from the sur­roun­ding of the cor­on­ary ar­ter­ies — can only be ben­ef­ic­ial in ca­ses of myo­car­di­al weak­ness, and many such pa­tients are re­fer­red to us by car­di­olo­gists. With­in the first week of treat­ment, all patients — not only heart ca­ses — re­mark that they have lost much of their breath­less­ness.

Coronary Occlusion TOC

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In obese patients who have recently survived a coronary oc­clu­sion, we ad­opt the fol­low­ing pro­ce­dure in col­lab­ora­tion with the car­di­olo­gist. We wait until no fur­ther el­ec­tro­car­dio­grap­hic changes have oc­cur­red for a peri­od of three months. Rou­tine treat­ment is then star­ted under care­ful con­trol, and it is usu­al to find a fur­ther el­ec­tro­car­dio­graph­ic im­prove­ment of a con­di­tion which was pre­vi­ous­ly sta­tion­ary. In the thou­sands of ca­ses we have trea­ted, we have not once seen any sort of cor­on­ary in­cid­ent oc­cur dur­ing or short­ly af­ter treat­ment. The same ap­plies to cere­bral vas­cul­ar ac­cid­ents. Nor have we ever seen a case of throm­bo­sis of any sort de­vel­op dur­ing treat­ment, even though a high blood pres­sure is rap­id­ly low­er­ed. In this re­spect, too, the hCG treat­ment res­em­bles preg­nan­cy.

Teeth and Vitamins TOC

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Patients whose teeth are in poor repair sometimes get more trouble un­der pro­longed treat­ment, just as may oc­cur in preg­nan­cy. In such cases we do al­low cal­ci­um and vi­ta­min D, though not in an oily so­lu­tion. The only other vi­ta­min we per­mit is vi­ta­min C, which we use in large do­ses com­bined with an an­ti­his­ta­mine at the on­set of a com­mon cold. There is no ob­jec­tion to the use of an an­ti­bi­ot­ic if this is re­qui­red – for instance, by the den­tist. In cases of bron­chi­al asth­ma and hay fe­ver, we have oc­ca­sion­al­ly res­or­ted to co­rti­sone dur­ing treat­ment, and find that tri­am­ci­no­lone is the least likely to in­ter­fere with the loss of weight, but many asth­mat­ics im­prove with hCG alone.

Alcohol TOC

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Obese heavy drinkers, even those bordering on alcoholism, of­ten do sur­pri­sing­ly well un­der hCG, and it is ex­cep­tion­al for them to take a drink while un­der treat­ment. When they do, they find that a rela­tive­ly small quan­ti­ty of al­co­hol pro­du­ces in­tox­ica­tion. Such pa­tients say that they do not feel the need to drink. This may in part be due to the eu­phor­ia which the treat­ment pro­du­ces, and in part to the com­plete ab­sence of the need for quick sus­ten­ance from which most obese pa­tients suf­fer.

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Though we have had a few cases that have continued ab­stin­ence long after treat­ment, oth­ers re­lapse as soon as they are back on a nor­mal diet. We have a few “reg­ul­ar cus­tom­ers” who, hav­ing once been re­duced to their nor­mal weight, start to drink again – though wat­ching their weight. Then, af­ter some months they pur­pose­ly over­eat in or­der to gain suf­fic­ient weight for an­oth­er course of hCG, which tem­por­ari­ly gets them out of their drin­king rou­tine. We do not par­tic­ul­ar­ly wel­come such cases, but we see no rea­son for re­fu­sing their re­quest.

Tuberculosis TOC

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It is interesting that obese patients suffering from inactive pul­mon­ary tu­ber­cu­lo­sis can be safe­ly treat­ed. We have under very care­ful con­trol treat­ed pa­tients as early as three months after they were pro­noun­ced in­ac­tive, and have nev­er seen a re­lapse oc­cur dur­ing or short­ly af­ter treat­ment. In fact, we only have one case on our rec­ords in which ac­tive tu­ber­cu­lo­sis de­vel­oped in a young man about one year after a treat­ment that had las­ted three weeks. Earl­ier X-rays showed a cal­cif­ied spot from a child­hood in­fec­tion that had not pro­duced clin­ic­al symp­toms. There was a fam­ily his­tory of tu­ber­cu­lo­sis, and his ill­ness star­ted un­der ad­verse con­di­tions that cer­tain­ly had noth­ing to do with the treat­ment. Res­id­ual cal­cif­ica­tions from an early in­fec­tion are ex­ceed­ing­ly com­mon, and we nev­er con­sid­er them a con­tra­in­di­ca­tion to treat­ment.

The Painful Heel TOC

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In obese patients who have been trying desperately to keep their weight down by sev­ere di­et­ing, a cu­rious symp­tom some­times oc­curs: They com­plain of an un­bear­ab­le pain in their heels, which they feel only while stan­ding or walk­ing. As soon as they take the weight off their heels, the pain ceases. These ca­ses are the bane of the rheu­ma­tol­og­ists and or­tho­pe­dic sur­geons who have treat­ed them be­fore they come to us. All the usu­al in­ves­ti­ga­tions are en­tire­ly nega­tive, and there is not the sligh­test res­ponse to anti-​rheu­mat­ic medi­ca­tion or phys­io­thera­py. The pain may be so sev­ere that the pa­tients are ob­liged to give up their oc­cu­pa­tion, and they are not in­fre­quent­ly la­bel­ed as a case of hys­teria. When their heels are care­ful­ly ex­am­ined, one finds that the sole is sof­ter than nor­mal, and that the heel bone – the cal­ca­ne­us – can be dis­tinct­ly felt, which is not the case in a nor­mal foot.

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We interpret the condition as a lack of the hard fatty pad on which the cal­ca­ne­us rests, and which pro­tects both the bone and the skin of the sole from pres­sure. This fat is like a springy cush­ion that car­ries the weight of the body. Stan­ding on a heel in which this fat is mis­sing or re­duced must ob­vi­ous­ly be very pain­ful. In their ef­forts to keep their weight down, these pa­tients have con­sumed this nor­mal struc­tur­al fat.

Those pa­tients who have a nor­mal or sub­normal weight while showing the typically obese fat deposits are made to eat to capacity, often much against their will, for one week. They gain weight rap­id­ly, but there is no im­prove­ment in the pain­ful heels. They are then star­ted on the rou­tine hCG treat­ment. Over­weight pa­tients are treat­ed im­me­di­ate­ly. In both cases the pain com­plete­ly dis­ap­pears in 10-20 days of diet­ing, usu­al­ly around the 15th day of treat­ment, and so far no case has had a re­lapse though we have been able to fol­low up such pa­tients for years.

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We are particularly interested in these cases, as they fur­nish fur­ther proof of the con­ten­tion that hCG + 500 cal­or­ies not only re­moves ab­nor­mal fat, but ac­tu­al­ly per­mits nor­mal fat to be re­placed, in spite of the de­fic­ient food in­take. It is cer­tain­ly not so that the mere loss of weight re­du­ces the pain, be­cause it fre­quent­ly dis­ap­pears before the weight the pa­tient had prior to the peri­od of forced feeding is reached.

The Skeptical Patient TOC

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Any doctor who starts using the hCG method for the first time will have considerable difficulty — particularly if he himself is not fully convinced — in making patients believe that they will not feel hungry on 500 cal­or­ies, and that their face will not col­lapse. New pa­tients al­ways an­tic­ip­ate the phe­nom­ena they know so well from pre­vi­ous treat­ments and diets, and are in­cred­ul­ous when told that these will not oc­cur. We over­come all this by let­ting new pa­tients spend a little time in the wait­ing room with ol­der hands, who can al­ways be re­lied upon to al­lay these fears with evan­gel­is­tic zeal, of­ten dem­on­stra­ting the fi­ner points on their own body.

A waiting-room filled with obese patients who congregate daily is a sort of group ther­apy. They com­pare notes and pop back into the wait­ing room af­ter the con­sul­ta­tion to an­nounce the score of the last 24 hours to an en­thral­led au­di­ence. They cross-​check on their diets, and some­times con­fess sins which they try to hide from us, usu­al­ly with the res­ult that the pa­tient in whom they have con­fi­ded pal­pi­ta­ting­ly tat­tles the whole dis­grace­ful story to us with a “But don’t let her know I told you!”

Concluding a Course TOC

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When the three days of dieting after the last injection are over, the pa­tients are told that they may now eat any­thing they please — ex­cept sug­ar and starch, pro­vi­ded they faith­ful­ly ob­serve one sim­ple rule: This rule is that they must have their own por­tab­le bath­room scale al­ways at hand, par­tic­ul­ar­ly while trav­el­ing. They must with­out fail weigh them­selves ev­ery mor­ning as they get out of bed, hav­ing first emp­tied their blad­der. If they are in the hab­it of hav­ing break­fast in bed, they must weigh before break­fast.

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It takes about 3 weeks before the weight reached at the end of the treat­ment be­comes sta­ble — i.e., does not show vio­lent fluc­tua­tions af­ter an oc­ca­sion­al ex­cess. Dur­ing this peri­od, pa­tients must real­ize that the so-​cal­led car­bo­hy­drates — that is, sug­ar, rice, bread, po­ta­toes, pas­tries, etc. — are by far the most dan­ger­ous. If no car­bo­hy­drates what­so­ev­er are eat­en, fats can be in­dul­ged in some­what more lib­er­al­ly; and even small quan­ti­ties of al­co­hol, such as a glass of wine with meals, does no harm; but as soon as fats and starch are com­bined, things are very lia­ble to get out of hand. This has to be ob­served very care­ful­ly dur­ing the first three weeks after the treat­ment is ended, oth­er­wise dis­ap­point­ments are al­most sure to occur.

Skipping a Meal TOC

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As long as their weight stays within two pounds of the weight reached on the day of the last in­jec­tion, pa­tients should take no no­tice of any in­crease; but the mo­ment the scale goes be­yond two pounds — even if this is only a few oun­ces, they must on that same day en­tire­ly skip break­fast and lunch, but take plen­ty to drink. In the even­ing they must eat a huge steak with only an ap­ple or a raw to­ma­to. Of course, this rule ap­plies only to the mor­ning weight. Ex-​obese pa­tients should nev­er check their weight during the day, as there may be wide fluc­tua­tions, and these are mere­ly al­arm­ing and con­fu­sing.

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It is of utmost importance that the meal is skipped on the same day as the scale reg­is­ters an in­crease of more than two pounds, and that mis­sing the meals is not post­poned until the fol­low­ing day. If a meal is skip­ped on the day in which a gain is reg­is­ter­ed in the mor­ning, this brings about an im­me­di­ate drop of often over a pound; but if the skipping of the meal — and skip­ping means lit­er­al­ly skip­ping, not just hav­ing a light meal — is post­poned, the phen­om­en­on does not oc­cur, and sev­er­al days of strict di­et­ing may be nec­es­sary to cor­rect the sit­ua­tion.

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Most patients hardly ever need to skip a meal. If they have eaten a heavy lunch, they feel no des­ire to eat their din­ner, and in this case no in­crease takes place. If they keep their weight at the point reached at the end of the treat­ment, even a heavy din­ner does not bring about an in­crease of two pounds on the next mor­ning, and does not there­fore call for any spec­ial meas­ures. Most pa­tients are sur­prised how small their ap­pet­ite has be­come, and yet how much they can eat without gain­ing weight. They no lon­ger suf­fer from an ab­nor­mal ap­pet­ite, and feel satis­fied with much less food than be­fore. In fact, they are usu­al­ly dis­ap­poin­ted that they can­not man­age their first nor­mal meal, which they have been plan­ning for weeks.

Losing more Weight TOC

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An ex-patient should never gain more than two pounds without im­me­di­ate­ly cor­rec­ting this; but it is equal­ly un­des­ira­ble that more than two lbs. be lost after treat­ment, be­cause a grea­ter loss is al­ways achieved at the ex­pense of nor­mal fat. Any nor­mal fat that is lost is in­vari­ab­ly re­gained as soon as more food is ta­ken, and it often hap­pens that this re­bound over­shoots the up­per two lbs. lim­it.

Trouble After Treatment TOC

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Two difficulties may be encountered in the immediate post-​treat­ment peri­od: When a pa­tient has con­sumed all his ab­nor­mal fat or, when after a full course, the in­jec­tion has tem­por­ari­ly lost its ef­fic­acy ow­ing to the body hav­ing grad­ual­ly evol­ved a coun­ter-​reg­ula­tion, the pa­tient at once be­gins to feel much more hun­gry, and even weak. In spite of re­peat­ed warn­ings, some over-​en­thu­si­as­tic pa­tients do not re­port this. How­ev­er, in about two days, the fact that they are being un­der­nour­ished be­comes vis­ib­le in their fa­ces, and treat­ment is then stop­ped at once. In such cases — and only in such cases — we al­low a very slight in­crease in the diet, such as an ex­tra apple, 150 grams (5 oz.) of meat, or two or three ex­tra bread­sticks dur­ing the three days of di­et­ing after the last in­jec­tion.

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When abnormal fat is no longer being put into circulation — ei­ther be­cause it has been con­sumed, or be­cause im­mun­ity has set in, this is al­ways felt by the pa­tient as sud­den, in­tol­er­ab­le, and con­stant hun­ger. In this sense, the hCG meth­od is com­plete­ly self-​lim­it­ing. With hCG, it is im­pos­sib­le to re­duce a pa­tient, how­ev­er en­thu­si­as­tic, be­low his nor­mal weight. As soon as no more ab­nor­mal fat is being is­sued, the body starts con­su­ming nor­mal fat, and this is al­ways re­gained as soon as or­din­ary feed­ing is re­sumed. The pa­tient then finds that the 2-3 lbs. he has lost dur­ing the last days of treat­ment are im­me­di­ate­ly re­gained. A meal is skipp­ed, and may­be a pound is lost. The next day this pound is re­gained, in spite of a care­ful watch over the food in­take. In a few days, a tear­ful pa­tient is back in the con­sul­ting room, con­vinced that her case is a fail­ure.

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All that is hap­pen­ing is that the es­sen­tial fat lost at the end of the treat­ment, owing to the pa­tient’s re­luc­tance to re­port a much grea­ter hun­ger, is being re­placed. The weight at which such a pa­tient must sta­bil­ize thus lies 2-3 lbs. high­er than the weight reached at the end of the treat­ment. Once this high­er ba­sic lev­el is es­tab­lished, fur­ther dif­fic­ul­ties in con­trol­ling the weight at the new point of sta­bil­iza­tion hard­ly arise.

Beware of Over-enthusiasm TOC

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The other trouble that is frequently encountered immediately af­ter treat­ment is again due to over-​en­thu­si­asm. Some pa­tients can­not be­lieve that they can eat fair­ly nor­mal­ly with­out re­gain­ing weight. They dis­re­gard the ad­vice to eat any­thing they please ex­cept sug­ar and starch, and want to play safe. They try more or less to con­tin­ue the 500-​cal­or­ie diet on which they felt so well dur­ing treat­ment, and make only mi­nor var­ia­tions — such as re­pla­cing the meat with an egg, cheese, or a glass of milk. To their hor­ror they find that in spite of this bra­vu­ra, their weight goes up. So, fol­low­ing in­struc­tions, they skip one mea­ger lunch, and at night eat only a lit­tle sal­ad and drink a pot of un­swee­ten­ed tea, be­com­ing in­creas­ing­ly hun­gry and weak. The next mor­ning they find that they have in­creased yet an­oth­er pound. They feel ter­rib­le, and even the dread­ed swel­ling of their ank­les is back. Nor­mal­ly we check our pa­tients one week af­ter they have been eat­ing free­ly, but these ca­ses re­turn in a few days. Ei­ther their eyes are fil­led with tears, or they an­gri­ly im­ply that when we told them to eat nor­mal­ly, we were just fool­ing them.

Protein Deficiency TOC

UP
Here too, the explanation is quite simple. During treatment the patient has been only just above the verge of pro­tein de­fic­ien­cy, and has had the ad­van­tage of pro­tein being fed back into his sys­tem from the break­down of fat­ty tis­sue. Once the treat­ment is over, there is no more hCG in the body, and this proc­ess no lon­ger takes place. Un­less an ade­quate amount of pro­tein is eaten as soon as the treat­ment is over, pro­tein de­fic­ien­cy is bound to de­vel­op, and this in­evi­tab­ly cau­ses the marked re­ten­tion of wat­er known as hun­ger-­ed­ema (kwa­shi­or­kor, ed.). The treat­ment is very sim­ple. The pa­tient is told to eat two eggs for break­fast and huge steaks for lunch and din­ner fol­lowed by a large hel­ping of cheese, and to phone in the weight the next mor­ning. When these in­struc­tions are fol­lowed, a stun­ned voice is heard to re­port that two lbs. have van­ished over­night, that the an­kles are nor­mal, but that sleep was dis­turbed owing to an ex­tra­or­din­ary need to pass large quan­ti­ties of wat­er. The pa­tient hav­ing learned this les­son usu­al­ly has no fur­ther trouble.

Relapses TOC

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As a general rule, one can say that 60%-70% of our cases ex­peri­ence lit­tle or no dif­fic­ul­ty in hol­ding their weight per­ma­nent­ly. Re­lap­ses may be due to neg­lig­ence in the basic rule of dai­ly weigh­ing. Many pa­tients think that this is un­nec­es­sary, and that they can judge any in­crease from the fit of their clothes. Some do not carry their scale with them on a jour­ney, as it is cum­ber­some, and takes a big bite out of their lug­gage al­low­ance when fly­ing. This is a dis­as­trous mis­take, be­cause after a course of hCG, as much as 10 lbs. can be re­gained with­out any no­tice­ab­le change in the fit of the clothes. The rea­son for this is that af­ter treat­ment, newly ac­quired fat is at first even­ly dis­tribu­ted, and does not show the for­mer pref­er­ence for cer­tain parts of the body.

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Pregnancy or the menopause may annul the effect of a pre­vi­ous treat­ment. Wom­en who take treat­ment dur­ing the one year after the last men­strua­tion — that is, at the on­set of the meno­pause — do just as well as oth­ers; but among them, the re­lapse rate is high­er un­til the meno­pause is ful­ly es­tab­lish­ed. The peri­od of one year after the last men­strua­tion ap­plies only to wom­en who are not being treat­ed with ovar­ian hor­mones. If these are taken, the pre­meno­pau­sal peri­od may be in­def­in­ite­ly pro­longed.

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Late-teenage girls who suffer from attacks of compulsive eating have by far the worst rec­ord of all as far as re­lap­ses are con­cerned. Pa­tients who have once taken the treat­ment, nev­er seem to hesi­tate to come back for an­oth­er short course as soon as they no­tice that their weight is once again get­ting out of hand. They come quite cheer­ful­ly and hope­ful­ly, as­sured that they can be helped again. Re­peat cour­ses are of­ten even more sat­is­fac­tory than the first treat­ment, and have the ad­van­tage, as do sec­ond cour­ses, that the pa­tient al­ready knows that he will feel com­for­tab­le through­out.

UP Plan of a Normal Course TOC

CONCLUSION
TOC

UP
The hCG + diet method can bring relief to every case of obes­ity, but the meth­od is not sim­ple. It is very time con­su­ming, and re­quires per­fect co­op­era­tion be­tween phys­ic­ian and pa­tient. Each case must be han­dled in­div­id­ual­ly, and the phys­ic­ian must have time to an­swer ques­tions, al­lay fears, and re­move mis­un­der­stan­dings. He must also check the pa­tient dai­ly. When some­thing goes wrong, he must at once in­vesti­gate un­til he finds the rea­son for any gain that may have oc­cur­red. In most ca­ses it is use­less to hand the pa­tient a diet sheet, and let the nurse give him a “shot.”

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The method involves a highly complex bodily mechanism; and even though our theo­ry may be wrong, the phys­ic­ian must make him­self some sort of pic­ture of what is ac­tu­al­ly hap­pen­ing; other­wise he will not be able to deal with such dif­fic­ul­ties as may arise dur­ing treat­ment. I must beg those try­ing the meth­od for the first time to ad­here very strict­ly to the tech­nique and the in­ter­pre­ta­tions here out­lined, and thus treat a few hun­dred cases be­fore em­bar­king on ex­peri­ments of their own, and un­til then re­frain from in­tro­du­cing in­no­va­tions, how­ev­er thril­ling they may seem. In a new meth­od, in­no­va­tions or de­par­tures from the or­ig­in­al tech­nique can only be use­ful­ly eval­ua­ted against a sub­stan­tial back­ground of ex­peri­ence with what is at the mo­ment the or­tho­dox pro­ce­dure.

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I have tried to cover all the problems that come to my mind. Yet, a be­wil­der­ing ar­ray of new ques­tions keeps ari­sing, and my in­ter­pre­ta­tions are still fluid. In par­ti­cul­ar, I have nev­er had an op­por­tu­ni­ty of con­duc­ting the lab­ora­to­ry in­ves­ti­ga­tions that are so nec­es­sa­ry for a theo­ret­ic­al un­der­stan­ding of clin­ic­al ob­ser­va­tions, and I can only hope that those more for­tu­nate­ly placed will in time be able to fill this gap.

The problems of obes­ity are perhaps not so dramatic as the prob­lems of can­cer, or po­lio, but they of­ten cause life-​long suf­fer­ing. How many prom­is­ing car­eers have been ru­ined by ex­ces­sive fat; how many lives have been shor­ten­ed. If some way — how­ev­er cum­ber­some — can be found to cope ef­fec­tive­ly with this uni­ver­sal prob­lem of mod­ern civ­il­ized man, our world will be a hap­pi­er place for count­less fel­low men and wom­en.


UP GLOSSARY[9] TOC

ACNECommon skin disease in which pimples, often con­tain­ing pus, ap­pear on face, neck and shoul­ders.
ACTHAbbreviation for adrenocorticotrophic hormone. One of the many hor­mones pro­duced by the an­teri­or lobe of the pit­ui­ta­ry gland. ACTH con­trols the ou­ter part, rind, or cor­tex of the ad­ren­al glands. When ACTH is in­jec­ted, it dra­mat­ic­al­ly re­lieves arth­rit­ic pain, but it has many un­des­ira­ble side ef­fects, among which is a con­di­tion sim­il­ar to sev­ere obes­ity. ACTH is now usu­al­ly re­placed by cor­tis­one.
ADRENALINHormone produced by the inner part of the Adrenals. Among many other functions, adrenalin is concerned with blood pressure, emotional stress, fear and cold.
ADRENALSEndocrine glands. Small bodies situated atop the kidneys and hence also known as suprarenal glands. The adrenals have an outer rind or cortex which produces vitally important hormones, among which are Cortisone similar substances. The adrenal cortex is controlled by ACTH. The inner part of the adrenals, the medulla, secretes adrenalin and is chiefly controlled by the autonomous nervous system.
ADRENOCORTEXSee adrenals
AMPHETAMINES Synthetic drugs that reduce the awareness of hunger and stimu­late men­tal ac­tiv­ity, ren­der­ing sleep im­pos­sib­le. When used for the lat­ter two pur­pos­es, they are dan­ger­ous­ly hab­it-​for­ming. They do not dim­in­ish the body’s need for food, but mere­ly sup­press the per­cep­tion of that need. The or­ig­in­al drug was known as Ben­ze­drine, from which mod­ern vari­ants such as Dex­ed­rine, Dex­am­il, and Pre­lu­din, etc., have been de­rived. Am­phet­am­ines may help an obese pa­tient to pre­vent a fur­ther in­crease in weight, but are un­sat­is­fac­to­ry for re­du­cing, as they do not cure the un­der­ly­ing dis­order, and as their pro­longed use may lead to mal­nu­tri­tion and ad­dic­tion.
ARTERIO-
SCLEROSIS
Hardening of the arterial wall through the calcification of ab­nor­mal de­pos­its of a fat­like sub­stance known as cho­les­ter­ol.
ASCHHIEIM-
ZONDEK
Authors of a test by which early pregnancy can be diagnosed by in­jec­ting a wom­an’s urine into fe­male mice. The hCG pres­ent in preg­nan­cy urine pro­du­ces cer­tain chan­ges in the va­gi­na of these ani­mals. Many sim­il­ar tests, using oth­er ani­mals such as rab­bits, frogs, etc., have been de­vised.
ASSIMILATEAbsorb digested food from the intestines.
AUTONOMOUSHere used to describe the independent or vegetative nervous system, which manages the automatic regulations of the body.
BASAL
METABOLISM
The body’s chemical turnover at complete rest, and when fas­ting. The ba­sal me­tab­ol­ic rate is ex­pres­sed as the amount of oxy­gen used up in a giv­en time. The ba­sal me­tab­ol­ic rate (BMR) is con­trol­led by the thy­roid gland.
CALORIE The physicist’s calorie is the amount of heat required to raise the tem­pera­ture of 1 cc. of wat­er by 1 de­gree Cel­si­us. The di­et­ic­ian’s Cal­or­ie (al­ways writ­ten with a cap­it­al C) is 1000 times grea­ter — i.e., 1 kcal. Thus, when we speak of a 500-​Cal­or­ie diet, this means that the body is be­ing sup­pli­ed with as much fuel as would be re­qui­red to raise the tem­pe­ra­ture of 500 li­ters of wa­ter by 1 de­gree Cel­si­us, or 50 liters by 10 de­grees. This is quite in­suf­fic­ient to cov­er the heat- and en­er­gy re­quire­ments of an ad­ult body. In the hCG meth­od, the def­ic­it is made up from the ab­nor­mal fat de­po­sits, of which 1 lb. fur­nish­es the body with more than 2000 Cal­or­ies. As this is rough­ly the amount lost ev­ery day, a pa­tient under hCG is nev­er short of fuel.
CEREBRALOf the brain. Cerebral vascular disease is a disorder con­cer­ning the blood ves­sels of the brain, such as ce­re­bral throm­bo­sis or hem­or­rhage, known as apo­plexy or stro­ke.
CHOLESTEROLA fatlike substance contained in almost every cell of the body. In the blood it ex­ists in two forms, known as free and es­teri­fied. The lat­ter form is under cer­tain con­di­tions de­pos­it­ed in the in­ner li­ning of the ar­teries (see ar­ter­io­scle­ro­sis). No clear and def­in­ite re­la­tion­ship be­tween fat in­take and cho­les­ter­ol lev­el in the blood has yet been es­tab­lished.
CHORIONICOf the chorion, which is part of the placenta or afterbirth. The term is just­ly ap­plied to hCG, as this hor­mone is ex­clu­sive­ly pro­duced in the pla­cen­ta, from where it en­ters the hu­man moth­er’s blood, and is la­ter ex­cre­ted in her urine.
COMPULSIVE
EATING
UP
A form of oral gratification with which a repressed sex in­stinct is some­times vi­ca­ri­ous­ly re­lieved. Com­pul­sive eat­ing must not be con­fused with the real hun­ger from which most obese pa­tients suf­fer.
CONGENITALAny condition which exists at or before birth.
CORONARY
ARTERIES
Two blood vessels that encircle the heart, and supply all the blood required by the heart muscle.
CORPUS
LUTEUM
A yellow body that forms in the ovary at the follicle, from which an egg has been de­tached. This body acts as an en­do­crine gland, and plays an im­por­tant role in men­stru­ation and preg­nan­cy. Its se­cre­tion is one of the sex hor­mones, and it is stimu­la­ted by an­oth­er hor­mone known as LSH, which stands for lu­te­um-​stimu­la­ting hor­mone. LSH is pro­duced in the an­teri­or lobe of the pit­ui­tary gland. LSH is tru­ly go­na­do­troph­ic, and must nev­er be con­fused with hCG, which is a to­tal­ly dif­fer­ent sub­stance, hav­ing no dir­ect ac­tion on the cor­pus lu­te­um.
CORTEXOuter covering or rind. The term is applied to the outer part of the ad­ren­als, but also used to des­cribe the gray mat­ter that cov­ers the white mat­ter of the brain.
CORTISONEA synthetic substance which acts like an adrenal hormone. It is today used in the treat­ment of a large num­ber of ill­nes­ses, and sev­er­al chem­ic­al vari­ants have been pro­duced, among which are pred­nis­one and tri­am­cin­ol­one.
CUSHING A great American brain surgeon who described a condition of extreme obes­ity as­soc­ia­ted with symp­toms of ad­ren­al dis­or­der. Cush­ing’s Syn­drome may be caused by or­gan­ic dis­ease of the pit­ui­ta­ry or the ad­ren­al glands, but, as was la­ter dis­cov­er­ed, it also oc­curs as a res­ult of ex­ces­sive ACTH medi­ca­tion.
DIENCEPHALONA primitive, and hence very old, part of the brain that lies be­tween and un­der the two large hemi­spheres. In man, the di­en­ceph­al­on (or hy­po­thal­am­us) is sub­or­din­ate to the high­er brain or cor­tex, and yet it ul­tim­ate­ly con­trols all that hap­pens in­side the body. It reg­ul­ates all the en­do­crine glands, the au­ton­om­ous ner­vous sys­tem, the turn­over of fat and sug­ar. It seems also to be the seat of the prim­it­ive ani­mal in­stincts, and is the re­lay sta­tion at which emo­tions are trans­la­ted into bod­ily re­ac­tions.
DIURETICAny substance that increases the flow of urine.
DYSFUNCTIONAbnormal functioning of any organ, be this excessive, de­fic­ient, or in any way al­ter­ed.
EDEMAAn abnormal accumulation of water in the tissues.
ELECTRO-
CARDIOGRAM
Tracing of electric phenomena taking place in the heart dur­ing each beat. The tra­cing pro­vides in­for­ma­tion about the con­di­tion and wor­king of the heart that is not oth­er­wise ob­tain­ab­le.
ENDOCRINE We distinguish endocrine and exocrine glands. The for­mer pro­duce hor­mones, chem­ic­al reg­ula­tors, which they se­crete dir­ect­ly into the gland’s blood cir­cu­la­tion, from where they are car­ried all over the body. Ex­am­ples of en­do­crine glands are the pit­ui­ta­ry, the thy­roid, and the ad­ren­als. Exo­crine glands pro­duce a vis­ib­le se­cre­tion such as sa­li­va, sweat, urine. There are also glands that are both en­do­crine and exo­crine. Ex­am­ples are the tes­tic­les the pros­tate; and the pan­cre­as, which pro­du­ces the hor­mone in­sul­in and di­ges­tive fer­ments that flow from the gland in­to the in­tes­tin­al tract. En­do­crine glands are close­ly in­ter­de­pen­dent of each other: They are linked to the au­ton­om­ous ner­vous sys­tem, and the di­en­ceph­al­on pre­sides over this whole in­cred­ib­ly com­plex reg­ula­to­ry sys­tem.
EMACIATEDGrossly undernourished.
EUPHORIAA feeling of particular physical- and mental well being.
FERALWild, unrestrained.
FIBROIDAny benign new growth of connective tissue. When such a tu­mor or­ig­in­ates from a mus­­cle, it is known as a my­oma. The most com­mon seat of my­omas is the uter­us.
FOLLICLEAny small bodily cyst or sac containing a liquid. Here the term ap­plies to the ovar­ian cyst in which the egg is formed. The egg is ex­pel­led when a ripe fol­lic­le bursts, and this is known as ov­ula­tion (see cor­pus lu­te­um).
FSH Abbreviation for follicle-stimulating hormone. FSH is an­oth­er (see cor­pus lu­te­um) an­ter­ior pit­ui­ta­ry hor­mone that acts di­rec­tly on the ovar­ian fol­lic­le, and is there­fore cor­rec­tly called a go­na­do­tro­phin.
GLANDSSee endocrine.
GONADO-
TROPHIN
See cor­pus lu­te­um, follicle, and FSH. “Go­na­do­tro­phic” lit­er­al­ly means sex-​gland di­rec­ted. FSH, LSH – and the equiv­al­ent hor­mones in the male, all pro­duced in the an­ter­ior lobe of the pit­ui­tary gland, are true go­na­do­tro­phins. Un­for­tun­ate­ly and con­fu­sing­ly, the term go­na­do­tro­phin has also been ap­plied to the pla­cen­tal hor­mone of preg­nan­cy known as hu­man cho­ri­on­ic go­na­do­tro­phin (hCG). This hor­mone acts on the di­en­ceph­al­on, and can only in­dir­ect­ly in­flu­ence the sex glands via the an­ter­ior lobe of the pit­ui­tary.
HORMONESSee endocrine.
HYPER-
TENSION
High blood pressure.
HYPO-
GLYCEMIA
A condition in which the blood sugar is below normal. It can be relieved by eating sugar.
HYPOPHYSISAnother name for the pituitary gland.
HYPOTHESIS A tentative explanation or speculation on how observed facts and iso­la­ted sci­en­tif­ic data can be brought into an in­tel­lec­tu­all­y-​sat­is­fy­ing re­la­tion­ship of cause and ef­fect. Hy­poth­es­es are use­ful for dir­ec­ting fur­ther re­search, but they are not nec­es­sar­ily an ex­po­si­tion of what is be­lieved to be the truth. Be­fore a hy­poth­es­is can ad­vance to the dig­nity of a theo­ry or a law, it must be con­firmed by all fu­ture re­search. As soon as re­search turns up data that no lon­ger fit the hy­poth­es­is, it is im­me­di­ate­ly aban­doned for a bet­ter one.
LSH See corpus luteum.
METABOLISMSee See basal metabolism
MIGRAINESevere half-sided headache, often associated with vomiting.
MUCOIDSlime-like.
MYOCARDIUMThe heart-muscle.
MYOMASee fibroid.
MYXEDEMAAccumulation of a mucoid substance in the tissues that occurs in cases of severe primary thyroid deficiency.
NEOLITHICIn the history of human culture, we dis­tin­guish the Early Stone Age or Pa­leo­lith­ic, the Mid­dle Stone Age or Me­so­lith­ic, and the New Stone Age or Neo­lith­ic per­iod. The Neo­lith­ic per­iod star­ted about 8000 years ago when the first at­tempts at agri­cul­ture, pot­tery, and ani­mal do­mes­ti­ca­tion made at the end of the Me­so­lith­ic per­iod sud­den­ly be­gan to de­vel­op rap­id­ly along the road that led to mod­ern civ­il­iza­tion.
NORMAL
SALINE
A low concentration of salt in water equal to the salinity of body fluids.
PHLEBITIS An inflammation of the veins. When a blood-clot forms at the site of the inflammation, we speak of thrombophlebitis.
PITUITARYA very complex endocrine gland that lies at the base of the skull, con­sis­ting chief­ly of an an­ter­ior and a pos­ter­ior lobe. The pit­ui­ta­ry is con­trol­led by the di­en­ceph­al­on, which reg­ul­ates the an­ter­ior lobe by means of hor­mones that reach it through small blood ves­sels. The pos­ter­ior lobe is con­trol­led by nerves that run from the di­en­ceph­al­on into this part of the gland. The an­ter­ior lobe se­cretes many hor­mones, among which are those that reg­ul­ate oth­er glands such as the thy­roid, the ad­ren­als, and the sex glands.
PLACENTAThe afterbirth. In women, a large and highly complex organ through which the child in the womb re­ceives its nour­ish­ment from the moth­er’s body. It is the or­gan in which hCG is manu­fac­tured and then giv­en off into the moth­er’s blood.
PROTEINThe living substance in plant and animal cells. Herbivorous ani­mals can thrive on plant pro­tein alone, but man must have some pro­tein of ani­mal origin (milk, eggs or flesh) to live heal­thi­ly. When in­suf­fic­ient pro­tein is eat­en, the body re­tains water.
PSORIASISA skin disease which produces scaly patches. These tend to dis­ap­pear dur­ing preg­nan­cy and dur­ing the treat­ment of obes­ity by the hCG meth­od.
RENALOf the kidney.
RESERPINEAn Indian drug extensively used in the treatment of high blood pres­sure and some forms of men­tal dis­or­der.
RETENTION
ENEMA
The slow infusion of a liquid into the rectum, from where it is ab­sorbed, and not evac­ua­ted.
SACRUM A fusion of the lower vertebrate into the large bony mass to which the pelvis is attached.
SEDIMENTATION
RATE
The speed at which a suspension of red blood cells settles out. A rap­id set­tling out is called a high sed­im­en­ta­tion rate, and may be in­dic­at­ive of a large num­ber of bod­ily dis­or­ders of preg­nan­cy.
SEXUAL
SELECTION
A sexual preference for individuals which show certain traits. If this pref­er­ence or se­lec­tion goes on gen­era­tion after gen­era­tion, more and more in­div­idu­als show­ing the trait will ap­pear among the gen­er­al pop­ula­tion. The nat­ur­al en­vi­ron­ment has lit­tle or noth­ing to do with this proc­ess. Sex­ual sel­ec­tion there­fore dif­fers from nat­ur­al sel­ec­tion, to which mod­ern man is no lon­ger sub­ject be­cause he changes his en­vi­ron­ment rath­er than let the en­vi­ron­ment change him.
STRIATIONTearing of the lower layers of the skin owing to rapid stretching in obes­ity or dur­ing preg­nan­cy. When first formed, stri­ae are dark-​red­dish lines that la­ter change into white scars.
SUPRARENAL
GLANDS
See adrenals.
SYNDROMEA group of symptoms which in their association are characteristic of a par­tic­ul­ar dis­or­der.
THROMBO-PHLEBITISSee phlebitis.
THROMBUSA blood clot in a blood vessel.
TRIAMCINO-
LONE
A modern derivative of cortisone.
URIC ACID A product of incomplete protein breakdown or -util­iza­tion in the body. When uric acid be­comes de­pos­it­ed in the gris­tle of the joints, we speak of gout.
VARICOSE ULCERSChronic ulceration above the ankles, due to varicose veins that in­ter­fere with the nor­mal blood cir­cu­la­tion in the af­fec­ted areas.
VEGETATIVESee autonomous.
VERTEBRATEAny animal that has a back-bone

UP Literary References to the Use of Chorionic Gonadotrophin in Obesity TOC
THE LANCET
Nov. 6, 1954 Article, Simeons
Nov. 15, 1958Letter to Editor, Simeons
July 29, 1961Letter to Editor, Lebon
Dec. 9, 1961Article, Carne
Dec. 9, 1961Letter to Editor, Kalina
Jan. 6, 1962Letter to Editor, Simeons
Nov. 26, 1966Letter to Editor, Lebon
THE JOURNAL OF THE AMERICAN GERIATRIC SOCIETY
Jan. 1956Article, Simeons
Oct. 1964Article, Harris & Warsaw
Feb. 1966Article, Lebon
UP THE AMERICAN JOURNAL OF CLINICAL NUTRITION TOC
Sept.-Oct. 1959Article, Sohar
March 1963Article, Craig et al.
Sept. 1963Letter to Editor, Simeons
March 1964Article, Frank
Sept. 1964Letter to Editor, Simeons
Feb. 1965Letter to Editor, Hutton
June 1969Editorial, Albrink
June 1969Special Article, Gusman
THE JOURNAL OF PLASTIC SURGERY (British)
April 1962Article, Lebon
THE SOUTH AFRICAN MEDICAL JOURNAL
Feb 1963Article, Politzer, Berson & Flaks

UP DOWN
SIMEONS, A.T.W.
Pounds And Inches
Privately printed: obtainable only from A.T.W. Simeons,
Salvator Mundi International Hospital,
Rome, Italy

Vetsucht (Netherlands Edition)
Wetenschappelijke Uitgeverij, N.V.
Amsterdam

TOP Man’s Presumptuous Brain
Longman’s, Green, London
E.P. Dutton, New York (hardback)
Dutton Paperbacks, New York


[1] A list of references to the more important articles is given above, at the end of this booklet.
[2] “Current account” is the British name for what Americans call a checking account.
[3] There is some clinical evidence to suggest that those symptoms of Cushing’s Syndrome which resemble true obes­ity are caused by the same mechanism which causes common obes­ity, while the other symptoms of the syndrome are directly due to adrenocortical dysfunction.
[4] World War II.
[5] Confinement = the concluding state of pregnancy
[6] As we are speaking of purely regulatory disorders, we obviously exclude all such cases in which there are gross organic lesions of the pituitary or of the sex-glands themselves.
[7] We use 1 tablet of hygroton.
[8] NOTE: This practice is obsolete. Modern sanitary methods dictate throwing away used needles and syringes and using new ones for each injection.
[9] Wherever unfamiliar terms are used, they will be found in their respective alphabetical place. The lay reader can therefore make his own cross-reference.

[why?]The theory of homeopathics is that, by diluting a solution of an active ingredient many times, even though the ac­tive in­gre­di­ent it­self is then al­most ab­sent, an in­vis­ib­le “vi­bra­tory es­sence” re­mains be­hind that re­tains its ef­fec­tive­ness. This is a du­bi­ous as­ser­tion. In or­der to cir­cum­vent reg­ula­tion of the ac­tual hCG hor­mone, many com­mer­cial ven­dors sup­ply “ho­meo­path­ic,” di­lu­ted so­lu­tions or sub­lin­gual loz­en­ges that are sup­po­sed to be just as ef­fec­tive in the 500-​cal­or­ie Sim­eons diet as in­jec­tions — though such loz­en­ges con­tain­ing ac­tu­al hCG may work — caveat emptor, but do­sage may be hard to con­trol. How­ev­er, be­cause of the ul­tra-​low cal­or­ies, though sim­il­ar weight loss does occur, there may be prob­lems with sev­ere loss of lean tis­sue and/or heal­thy fat — as well as rav­en­ous hun­ger — that real hCG pre­vents, as this book des­cribes. Without hCG, on the ul­tra-​low-, 500-​cal­or­ie diet, a person will  starve . Don’t be sed­uced by do-​it-​quick-​and-​easy, cir­cum­ven­tory scams. Use the diet ex­act­ly as des­cri­bed by Sim­eons here­in un­der com­pet­ent med­ic­al su­per­vis­ion. That does work.