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TREATMENT OF THE FAT AND THE LEAN FREE

CLIFFORD F. GASTINEAU, M.D.; EDWARD H. RYNEARSON, M.D.; ALICE KARSLAKE IRMISCH, M.S.
[+] Author Affiliations

Read at the Interim Session of the American Medical Association, Cleveland, Jan. 7, 1948.


Rochester, Minn.

From the Mayo Foundation (Dr. Gastineau, Fellow in Medicine) and the Mayo Clinic (Dr. Rynearson and Mrs. Irmisch).


JAMA. 1949;139(2):86-91. doi:10.1001/jama.1949.02900190016005
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The extreme variation which body weight may undergo is indeed remarkable. There is a report, probably true, of a man weighing over 1,000 pounds (453.5 Kg.), while a subject weighing 779 pounds (353.3 Kg.) has been studied by competent observers.1 At the other extreme, a 30 year old woman has recently been observed at the Mayo Clinic who weighed 44 pounds (20 Kg.) and was 5 feet 3.5 inches (161.3 cm.) in height.

While such spectacular deviations attract interest, lesser grades of underweight and overweight are of great importance in the health of the individual and are of much greater importance from the standpoint of public health than are sideshow freaks. In the latter half of life even moderate obesity is dangerous, and it has been shown that between the ages of 45 and 50 years 25 pounds (11.3 Kg.) of excess weight results in an increase of 25

REFERENCES

Beardwood, J. T., Jr.: Obesity, in Piersol, G. M.: The Cyclopedia of Medicine, Surgery and Specialties , Philadelphia, F. A. Davis Company, 1945;, vol. 10, pp. 706-739.
Newburgh, L. H.:  Obesity , Arch. Int. Med. 70: 1033-1096 ( (Dec.) ) 1942;.
Dublin, L. I.:  Influence of Weight on Certain Causes of Death , Human Biol. 2:159-184 ( (May) ) 1930;.
 Girth and Death , Statist. Bull. Metrop. Life Ins. Co. 18:2-5 ( (May) ) 1937;.
Bruch, H., and Touraine, G.:  Obesity in Childhood; Family Frame of Obese Children , Psychosom. Med. 2: 141-206 ( (April) ) 1940;.
Freed, S. C.:  Psychic Factors in the Development and Treatment of Obesity , J. A. M. A. 133:369-373 ( (Feb. 8) ) 1947;.
Rahman, L.; Richardson, H. B., and Ripley, H. S.:  Anorexia Nervosa with Psychiatric Observations , Psychosom. Med. 1:335-365 ( (July) ) 1939;.
Johnson, W. M.:  Different Weight Responses to the Same Provocation , J. A. M. A. 133: 1238 ( (April 19) ) 1947;.
Brobeck, J. R.:  Mechanism of the Development of Obesity in Animals with Hypothalamic Lesions , Physiol. Rev. 26:541-559 ( (Oct.) ) 1946;.
Heinbecker, P.; White, H. L., and Rolf, D.:  Experimental Obesity in Dog , Am. J. Physiol. 141:549-565 ( (June) ) 1944;.
Hetherington, A. W.:  The Production of Hypothalamic Obesity in Rats Already Displaying Chronic Hypopituitarism , Am. J. Physiol. 140:89-92 ( (Oct.) ) 1943;.
Wilder, R. M.:  The Regulation of the Weight of the Body , Internat. Clin. 1:30-41 ( (March) ) 1932;.
Bruch, H.:  Fröhlich Syndrome; Report of Original Case , Am. J. Dis. Child 58:1282-1289 ( (Dec.) ) 1939;.
Plummer, W. A.: Body Weight in Spontaneous Myxedema, Tr. Am. A. Study Goiter, 1940, pp. 88-98.
Boothby, W. M., and Sandiford, I.:  Summary of the Basal Metabolism Data on 8,614 Subjects with Especial Reference to the Normal Standards for the Estimation of the Basal Metabolic Rate , J. Biol. Chem. 54:783-803 ( (Dec.) ) 1922;.
Berkman, J. M.:  Anorexia Nervosa: Diagnosis and Treatment of Inanition Resulting from Functional Disorders , Ann. Int. Med. 22:679-691 ( (May) ) 1945;
 Anorexia Nervosa, Anterior-Pituitary Insufficiency, Simmond's Cachexia and Sheehan's Disease: Including Some Observations on Disturbances in Water Metabolism Associated with Starvation , Post-grad. Med. 3:237-246 ( (April) ) 1948;.
Sheehan, H. L., and Murdoch, R.:  Post-Partum Necrosis of Anterior Pituitary: Effect of Subsequent Pregnancy , Lancet 2: 132-135 ( (July 16) ) 1938;.
Strang, J. M., and Evans, F. A.:  Undernutrition and Its Treatment by Adequate Diet , Ann. Int. Med. 7:45-63 ( (July) ) 1933;.
Strang, J. M., and Cox, A. B.:  The Analysis of High Caloric Diets in Relation to Weight Changes , Ann. Int. Med. 7:152-164 ( (Aug.) ) 1933;.
Small, S. M., and Milhorat, A. T.:  Anorexia Nervosa: Metabolism and Its Relation to Psychopathologic Reactions , Am. J. Psychiat. 100:681-685 ( (March) ) 1944;.
Danforth, C. H.:  Hereditary Adiposity in Mice , J. Hered. 18: 153-162 ( (April) ) 1927;
Gurney, R.:  The Hereditary Factor in Obesity , Arch. Int. Med. 57:557-561 ( (March) ) 1936;.
Rynearson, E. H., and Gastineau, C. F.: Obesity , Springfield, Ill., Charles C Thomas, Publisher, to be published.
Boothby and Sandiford.12 Rynearson and Gastineau.18
Berkman, J. M.; Weir, J. F., and Kepler, E. J.:  Clinical Observations on Starvation Edema, Serum Protein, and the Effect of Forced Feeding in Anorexia Nervosa , Gastroenterology 9: 357-390 ( (Oct.) ) 1947;.
Weiss, E., and English, O. S.: Psychosomatic Medicine: The Clinical Application of Psychopathology to General Medical Problems , Philadelphia, W. B. Saunders Company, 1943;, pp. 233-238 and 335-349.
Harris, S. C.; Ivy, A. C., and Searle, L.:  The Mechanism of Amphetamine-Induced Loss of Weight: A Consideration of the Theory of Hunger and Appetite , J. A. M. A. 134: 1468-1475 ( (Aug. 23) ) 1947;.
Beyer, K. H.:  The Effect of Benzedrine Sulfate (Beta-Phenylisopropylamine) on Metabolism and the Cardiovascular System in Man , J. Pharmacol. & Exper. Therap. 66:318-325 ( (July) ) 1939;.
Bram, I.:  Therapeutic Hyperthyroidism , Internat. Clin. 1:48-61 ( (March) ) 1937;.
Evans, F. A.:  Obesity , in Duncan, G. G.: Diseases of Metabolism: Detailed Methods of Diagnosis and Treatment; a Text for the Practitioner , Philadelphia, W. B. Saunders Company, 1942;, chap. 10, pp. 513-591.
Albrecht, F. K.:  The Use of Benzedrine Sulfate in Obesity , Ann. Int. Med. 21:983-989 ( (Dec.) ) 1944;.
Rasmussen, H.:  Influence of the Thyroid Hormone on Heart and Circulation , Acta med. Scandinav. ( (supp.) ) 115:1-202, 1941;.
Winkler, A. W.; Lavieties, P. H.; Robbins, C. L., and Man, E. B.:  Tolerance to Oral Thyroid and Reaction to Intravenous Thyroxine in Subjects Without Myxedema , J. Clin. Investigation 22:535-544 ( (July) ) 1943;.
Short, J. J., and De Paul, J.:  An Attempt to Mobilize Lipoids from Storage Depots by Deep Massage and Increased Tissue Temperatures , J. Lab. & Clin. Med. 24: 395-397 ( (Jan.) ) 1939;.
Maclagan, N. F.:  The Role of Appetite in the Control of Body Weight , J. Physiol. 90:385-394 ( (Sept.) ) 1937;.
Freyberg, R. H.:  A Study of the Value of Insulin in Undernutrition , Am. J. M. Sc. 190:28-42 ( (July) ) 1935;.

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Beardwood, J. T., Jr.: Obesity, in Piersol, G. M.: The Cyclopedia of Medicine, Surgery and Specialties , Philadelphia, F. A. Davis Company, 1945;, vol. 10, pp. 706-739.
Newburgh, L. H.:  Obesity , Arch. Int. Med. 70: 1033-1096 ( (Dec.) ) 1942;.
Dublin, L. I.:  Influence of Weight on Certain Causes of Death , Human Biol. 2:159-184 ( (May) ) 1930;.
 Girth and Death , Statist. Bull. Metrop. Life Ins. Co. 18:2-5 ( (May) ) 1937;.
Bruch, H., and Touraine, G.:  Obesity in Childhood; Family Frame of Obese Children , Psychosom. Med. 2: 141-206 ( (April) ) 1940;.
Freed, S. C.:  Psychic Factors in the Development and Treatment of Obesity , J. A. M. A. 133:369-373 ( (Feb. 8) ) 1947;.
Rahman, L.; Richardson, H. B., and Ripley, H. S.:  Anorexia Nervosa with Psychiatric Observations , Psychosom. Med. 1:335-365 ( (July) ) 1939;.
Johnson, W. M.:  Different Weight Responses to the Same Provocation , J. A. M. A. 133: 1238 ( (April 19) ) 1947;.
Brobeck, J. R.:  Mechanism of the Development of Obesity in Animals with Hypothalamic Lesions , Physiol. Rev. 26:541-559 ( (Oct.) ) 1946;.
Heinbecker, P.; White, H. L., and Rolf, D.:  Experimental Obesity in Dog , Am. J. Physiol. 141:549-565 ( (June) ) 1944;.
Hetherington, A. W.:  The Production of Hypothalamic Obesity in Rats Already Displaying Chronic Hypopituitarism , Am. J. Physiol. 140:89-92 ( (Oct.) ) 1943;.
Wilder, R. M.:  The Regulation of the Weight of the Body , Internat. Clin. 1:30-41 ( (March) ) 1932;.
Bruch, H.:  Fröhlich Syndrome; Report of Original Case , Am. J. Dis. Child 58:1282-1289 ( (Dec.) ) 1939;.
Plummer, W. A.: Body Weight in Spontaneous Myxedema, Tr. Am. A. Study Goiter, 1940, pp. 88-98.
Boothby, W. M., and Sandiford, I.:  Summary of the Basal Metabolism Data on 8,614 Subjects with Especial Reference to the Normal Standards for the Estimation of the Basal Metabolic Rate , J. Biol. Chem. 54:783-803 ( (Dec.) ) 1922;.
Berkman, J. M.:  Anorexia Nervosa: Diagnosis and Treatment of Inanition Resulting from Functional Disorders , Ann. Int. Med. 22:679-691 ( (May) ) 1945;
 Anorexia Nervosa, Anterior-Pituitary Insufficiency, Simmond's Cachexia and Sheehan's Disease: Including Some Observations on Disturbances in Water Metabolism Associated with Starvation , Post-grad. Med. 3:237-246 ( (April) ) 1948;.
Sheehan, H. L., and Murdoch, R.:  Post-Partum Necrosis of Anterior Pituitary: Effect of Subsequent Pregnancy , Lancet 2: 132-135 ( (July 16) ) 1938;.
Strang, J. M., and Evans, F. A.:  Undernutrition and Its Treatment by Adequate Diet , Ann. Int. Med. 7:45-63 ( (July) ) 1933;.
Strang, J. M., and Cox, A. B.:  The Analysis of High Caloric Diets in Relation to Weight Changes , Ann. Int. Med. 7:152-164 ( (Aug.) ) 1933;.
Small, S. M., and Milhorat, A. T.:  Anorexia Nervosa: Metabolism and Its Relation to Psychopathologic Reactions , Am. J. Psychiat. 100:681-685 ( (March) ) 1944;.
Danforth, C. H.:  Hereditary Adiposity in Mice , J. Hered. 18: 153-162 ( (April) ) 1927;
Gurney, R.:  The Hereditary Factor in Obesity , Arch. Int. Med. 57:557-561 ( (March) ) 1936;.
Rynearson, E. H., and Gastineau, C. F.: Obesity , Springfield, Ill., Charles C Thomas, Publisher, to be published.
Boothby and Sandiford.12 Rynearson and Gastineau.18
Berkman, J. M.; Weir, J. F., and Kepler, E. J.:  Clinical Observations on Starvation Edema, Serum Protein, and the Effect of Forced Feeding in Anorexia Nervosa , Gastroenterology 9: 357-390 ( (Oct.) ) 1947;.
Weiss, E., and English, O. S.: Psychosomatic Medicine: The Clinical Application of Psychopathology to General Medical Problems , Philadelphia, W. B. Saunders Company, 1943;, pp. 233-238 and 335-349.
Harris, S. C.; Ivy, A. C., and Searle, L.:  The Mechanism of Amphetamine-Induced Loss of Weight: A Consideration of the Theory of Hunger and Appetite , J. A. M. A. 134: 1468-1475 ( (Aug. 23) ) 1947;.
Beyer, K. H.:  The Effect of Benzedrine Sulfate (Beta-Phenylisopropylamine) on Metabolism and the Cardiovascular System in Man , J. Pharmacol. & Exper. Therap. 66:318-325 ( (July) ) 1939;.
Bram, I.:  Therapeutic Hyperthyroidism , Internat. Clin. 1:48-61 ( (March) ) 1937;.
Evans, F. A.:  Obesity , in Duncan, G. G.: Diseases of Metabolism: Detailed Methods of Diagnosis and Treatment; a Text for the Practitioner , Philadelphia, W. B. Saunders Company, 1942;, chap. 10, pp. 513-591.
Albrecht, F. K.:  The Use of Benzedrine Sulfate in Obesity , Ann. Int. Med. 21:983-989 ( (Dec.) ) 1944;.
Rasmussen, H.:  Influence of the Thyroid Hormone on Heart and Circulation , Acta med. Scandinav. ( (supp.) ) 115:1-202, 1941;.
Winkler, A. W.; Lavieties, P. H.; Robbins, C. L., and Man, E. B.:  Tolerance to Oral Thyroid and Reaction to Intravenous Thyroxine in Subjects Without Myxedema , J. Clin. Investigation 22:535-544 ( (July) ) 1943;.
Short, J. J., and De Paul, J.:  An Attempt to Mobilize Lipoids from Storage Depots by Deep Massage and Increased Tissue Temperatures , J. Lab. & Clin. Med. 24: 395-397 ( (Jan.) ) 1939;.
Maclagan, N. F.:  The Role of Appetite in the Control of Body Weight , J. Physiol. 90:385-394 ( (Sept.) ) 1937;.
Freyberg, R. H.:  A Study of the Value of Insulin in Undernutrition , Am. J. M. Sc. 190:28-42 ( (July) ) 1935;.
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