Fat & Unhappy

Never before had the fat men & women of the U.S. received so much attention from doctors as they got last week at the annual meeting of the American Medical Association in Chicago. And none of it was flattering. Far from regarding the fatties as happy people, pleasant to have around, the doctors branded them as public-health problem No. 1 and cracked down hard on them. Said Philadelphia's Dr. Edward L. Bortz: "We're going to have to take off the kid gloves in dealing with people who are wallowing in their own grease."

One reason for the lively attention given to obesity is the fact that it can be cured here & now. Medical science does not have to wait for the answers; it is well established that overweight people can cure themselves by eating less. A second reason for the all-out attack on obesity: doctors are armed with more facts than ever to show how dangerous it is.

The Penalty Is Death. The man who passed most of the ammunition to the doctors was Louis I. Dublin, no physician but a Ph.D. and top statistician for the Metropolitan Life Insurance Co., who has been charting the lives and deaths of his fellow men for 40 years. Dr. Dublin and his assistants told visiting physicians (many of whom were toting too much weight around) what they have learned about health and disease in overweight subjects, and passed out sets of colored charts as reminders. The chief findings:

P: Between the ages of 20 and 64, overweight* men have a death rate just 50% higher than their "normal" contemporaries; overweight women pay for their poundage with a death rate 47% higher.

P: For both men & women, the death rate goes up in proportion to excess weight.

Life Sentence. The trouble often begins in the cradle, pediatricians and psychiatrists said, when an overanxious mother forces a full baby to take the last ounce of formula. Stuffing children through adolescence fixes a lifetime habit.

P: An estimated 25 million Americans are overweight, and 5,000,000 of them are "seriously obese" adults.

The other side of the medal presented by Dr. Dublin offered positive encouragement to reduce: among 6,000 people studied who had reduced and stayed reduced, the men's death rate was cut by one-fifth, the women's by one-third.

How Not to Reduce. There is no good painless-pill method of reducing, the doctors were told. The A.M.A.'s Dr. Robert Stormont reported that only one drug has proved reasonably safe and useful (amphetamine or a derivative), and even this needs to be used under a doctor's care.

Some extremely dangerous drugs have been promoted for reducing, said Dr. Stormont. Thyroid extract, still popular with some physicians, should not be; it can do grave harm, and there is no reason for giving it, since an underactive thyroid is very rarely the cause of obesity. Also sharply condemned: other hormones, such as pituitary extract (they have nothing to do with overweight), laxatives and dinitrophenol (it raises the temperature so that "the obese are literally frying in their own fat," and it causes cataracts).

Massage is tricky too, reported Chicago's Dr. Hugo R. Rony: in fact, massaging just the fat parts of the body may make those parts bigger. Surgery is dangerous. And exercise is hopeless: to take off one pound, said Dr. Ralph E. De Forest, a fat man would have to walk 36 miles, or do 2,400 pushups, or climb the Washington Monument 48 times. After losing some weight by dieting, the patient should take a little gentle exercise, such as walking or golf, and then go on to swimming. One trouble with heavy exercise: it boosts the appetite.

Among all the experts on obesity, only one looked overweight: roly-poly Dr. Morris Fishbein, onetime editor of the A.M.A. Journal. That morning, lamented Fishbein, he had had two breakfasts (the second for sociability); he was going to an alumni lunch, had a date for afternoon cocktails, a speaking date for dinner, and would probably have a snack before retiring. Attacking conviviality as a major cause of overeating, Dr. Fishbein estimated that three-fourths of his eating that day would be convivial.

P: Deaths from diseases of the heart, arteries and kidneys are 50% (men) to 77% (women) commoner among the obese; cerebral hemorrhages increase 60% above the normal; and death from diabetes goes up almost 300%.

For once, the experts all agreed on the crux of the matter: only diet will take weight off, and the diet should be tailored to each patient's bulging figure. Diets that take so & so many days are of no lasting good. The patient must be of a mind to reduce, and determined to stay reduced. Said Manhattan's Dr. Haynes H. Fellows: "The obese patient must be told frankly that he or she has a lifetime problem . . . He can't reduce and forget it. He has to keep it in mind and do something about it --at least to the extent of not overeating --for the rest of his life."

* Defined as those 10% or more above the ideal weight for any given height and body build.

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