program of weight reduction in many obese people can indeed be harmful. A reducing diet is synonymous with partial starvation. Anyone who is starving, be it an obese individual on a self-imposed diet or a victim of a prison camp, is edgy, irritable, and hungry. Most starved people also are depressed. They are willingly or unwillingly deprived of a form of sustenance which gives us all satisfaction—obese people particularly. Their spirits fall to rock bottom. Patients on weight-losing programs occasionally deteriorate into a serious melancholia requiring psychiatric attention. Only patients with an intense desire and good motivation should be encouraged in their efforts to lose weight.

If a patient earnestly desires to lose weight (fat), it should only be attempted when his other life situations are reasonably stable and tranquil. To take on a program of weight reduction when he has major problems is unfair and dangerous, as well as generally unsuccessful. Other conflicts may be overpowering in his present situation. No physician should add to the edginess and subsequent failure of his weight reduction program. I do not accept patients seeking weight loss if they have additional problems at the time. I tell them to forget about their weight temporarily and that it is not sinful. I suggest they maintain their present weight in spite of the implied and unapplied exhortations of friends and family, that they should feel neither ashamed nor guilty about their present weight and that they may come back to see me when “the heat is off.”

While the overwhelming majority of obese people will always be fat, physicians can often spot the patient who will lose weight. This is the patient who comes in on his own initiative. He was not pushed; he was not frightened; he did not do it as part of an over-all “health check-up.” He was so miserable, embarrassed, insecure, and humiliated he insisted on an appointment. This is the patient who is not primarily concerned with living longer, feeling better, or obtaining another job. This is the person who is disgusted with how he looks. This is the patient who has a genuine, deep-seated desire to appear neat, trim, and poised. This is the honest, forthright person who once again yearns to look attractive and desirable. Married or single, the thinking and alert individual wants to look sexy. This is motivation of the greatest magnitude. It also is universal, moral, legal, socially acceptable, and profitable in dollars and cents.

Consider now an important aspect of eating. Until recently medical science ascribed obesity solely to an excessive intake of food. Anyone who was fat ate too much. It really was very simple and logical. Then studies were performed on well-proportioned adolescent girls and their chubby classmates. The plump girls universally denied overeating—in fact, they all claimed to be eating just enough to keep a fly alive. The doctors all nodded profound agreement but indulged in incredulous skepticism as soon as they had left the office. Fat girls not eating much! The study consisted of a careful analysis of the diets of the trim girls and the chubbies. It also made careful measurements of their daily activity by means of a pedometer attached to the waist., the fat girls ate no more than their more slender classmates; in fact, they often ate less. The explanation for their excessive weight was that their daily activity was only one third as much.

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