SECTION II. Notes on Overweight and Underweight

NOTES ON OVERWEIGHT AND UNDERWEIGHT

How many people after age 35 have a conformation of body that is in accord with proper ideals of health and symmetry? The average individual, as age progresses, gains weight until he reaches old age, when the weight usually decreases.

This movement of weight is so universal that it has been accepted as normal, or physiological, whereas it is not normal, and is the result of disease-producing and life-shortening influences.

The standards for weight at the various ages and heights have been established by life insurance experience, but these standards, which show an increase in weight as age advances, by no means reflect the standards of health and efficiency. They merely indicate the average condition of people accepted for life insurance, whose death rate--while covered by life insurance premiums--is yet far above that obtaining among people of the best physical type, who live a thoroughly hygienic life.

MEN--OVER AVERAGE WEIGHTS Experience of 43 American Companies--1885-1908. Number of Policyholders 186,579 -------+---------------+---------------+---------------+--------------- Ages | Overweight | Overweight | Overweight | Overweight at | 5 to 10 lbs. | 15 to 20 lbs. | 25 to 45 lbs. | 50 to 80 lbs. Entry | | | | -------+---------------+---------------+---------------+--------------- | Death | Death | Death | Death | Death | Death | Death | Death | Rate | Rate | Rate | Rate | Rate | Rate | Rate | Rate | Below | Above | Below | Above | Below | Above | Below | Above |Std.| Std. | Std. | Std. | Std. | Std. | Std. | Std. -------+-------+-------+-------+-------+-------+-------+-------+------- 20-24 | 4% | ... | 4% | ... | ... | 1% | ... | 3% 25-29 | 7 | ... | 10 | ... | ... | 12 | ... | 17 30-34 | 1 | ... | 14 | ... | ... | 19 | ... | 34 35-39 | 0 | ... | ... | 1% | ... | 31 | ... | 55 40-44 | 6 | ... | ... | 10 | ... | 40 | ... | 75 45-49 | ... | 3% | ... | 9 | ... | 31 | ... | 51 50-56 | ... | 2 | ... | 21 | ... | 24 | ... | 49 57-62 | ... | 2 | ... | 25 | ... | 12 | ... | 38 -------+-------+-------+-------+-------+-------+-------+-------+-------

The heaviest mortality (75 per cent. above the standard), is found among those aged 40 to 44 who are 50 to 80 pounds overweight.

Medico-Actuarial Mortality Investigation, Volume II, page 13, compiled and published by The Association of Life Insurance Medical Directors and The Actuarial Society of America.

The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

It seems reasonable to deduce from these figures that the usual gain in weight with advancing years is not an advantage but a handicap. We should endeavor to keep our weight at approximately the average weight for age 30, the period of full maturity, as experience shows that those so proportioned exhibit the most favorable mortality. This weight, for the various heights, is shown in the following table:

AGE 30--MEN ------------------------------------------------------------------------ Height. | Pounds. || Height. | Pounds. || Height. | Pounds. -----------|----------||-----------|----------||------------|----------- Ft. In. | || Ft. In. | || Ft. In. | 5 | 126 || 5 7 | 148 || 6 1 | 178 5 1 | 128 || 5 8 | 152 || 6 2 | 184 5 2 | 130 || 5 9 | 156 || 6 3 | 190 5 3 | 133 || 5 10 | 161 || 6 4 | 196 5 4 | 136 || 5 11 | 166 || 6 5 | 201 5 5 | 140 || 6 | 172 || .......... | ......... 5 6 | 144 || ....... | ...... || .......... | ......... ------------------------------------------------------------------------

AGE 30--WOMEN ------------------------------------------------------------------------ Height. | Pounds. || Height. | Pounds. || Height. | Pounds. -----------|----------||-----------|----------||------------|----------- Ft. In. | || Ft. In. | || Ft. In. | 4 8 | 112 || 5 2 | 124 || 5 8 | 146 4 9 | 114 || 5 4 | 127 || 5 9 | 150 4 10 | 116 || 5 4 | 131 || 5 10 | 154 4 11 | 118 || 5 5 | 134 || 5 11 | 157 5 | 120 || 5 6 | 138 || 6 | 161 5 1 | 122 || 5 7 | 142 || .......... | ......... ------------------------------------------------------------------------

In fat people, the number of working cells is relatively less in proportion to the weight than in thin people, as fat cells do not work. Also, there is less body surface exposed in proportion to the body weight, and consequently less heat loss. Likewise, fat people are less active, and their little cell-engines do not call for so much fuel; but in most cases the fuel is furnished right along in the ordinary diet, and what is not burned up is stored up.

For extreme overweight, diet should be prescribed accurately by the physician to suit the needs of each individual case. Certain general principles may be stated, however, as applicable to the average case.

Meals should be light and frequent, rather than hearty and infrequent. A little fruit may be taken on rising and a glass of hot water.

A light breakfast is advisable; one or two poached eggs, no sugar, bread and butter in small quantity.

For dinner, choice may be made of chicken, game, lean meat, fish not cooked in fat, in moderate portions, and of such vegetables as celery, spinach, sea-kale, lettuce, string beans, cucumbers, carrots, tomatoes, cabbage, Brussels sprouts, turnips, bulky vegetables of low food value. Tapioca or similar pudding may be used for desserts, and melon, and other cooked unsweetened fruits.

A glass of hot water on retiring is advisable.

It is surprising what an enormous fuel value certain foods have which are eaten very carelessly, and what a very low fuel value others have which are quite satisfying to hunger. For example: One would have to eat $9.00 worth of lettuce and tomato salad to furnish 2,500 calories, the amount of fuel for the day's requirements (Lusk), while about 30 cents' worth of butter, or 10 cents' worth of sugar would furnish the same amount of energy. No one would think of feeding exclusively on any one of these foods, but it is easy to see how the elimination of butter and sugar and the introduction of such foods as lettuce, tomatoes, celery, carrots, spinach and fruits, all of which have a low fuel value, would enormously reduce the available energy and therefore the fat-forming elements in the diet, yet fill the stomach and satisfy the hunger-craving. Hunger is largely dependent upon the contractions of the empty stomach and not upon a general bodily craving for food.

Foods to avoid, in cases of overweight, are sugar, fats, milk as a beverage, salmon, lobster, crabs, sardines, herring, mackerel, pork and goose, fat meats, nuts, butter, cream, olive oil, pastry and sweets, water at meals. Alcohol, which is not a food, although often so called, should be avoided, as it is a fuel. It is good to burn in a stove, but not in the human body.

Walking, swimming, golf, billiards, hill-climbing, are all beneficial forms of exercise for the middle-aged and elderly, who are chiefly affected by overweight.

Irksome and monotonous forms of exercise, while difficult to follow regularly, are usually of more benefit, as they are less likely to create an appetite. Simple exercises, if repeated from twenty to forty times, night and morning, will accomplish much. No apparatus is required, and any movements that bring into play the entire muscular system, and especially the muscles of the trunk, with deep breathing, are sufficient. (See "Setting-up" exercises described in the "Notes on Posture," page 221.) The main reliance should be upon dietetic regulation rather than upon exercise. A very moderate increase of exercise and a persistent adherence to a proper diet will work wonders in weight reduction.

It is unwise to attempt a sudden reduction in weight. Profound nervous depression may be caused by too rapid reduction in people of nervous temperament, especially if they have long been overweight. By gradually modifying the diet and moderately increasing the exercise, the results can be obtained with mathematical precision and without undue hardship. It may be necessary to forego certain pet dietetic indulgences, but such indulgences, are, after all, a mere matter of habit and a liking for new forms of food can usually be acquired. One can not have the cake and penny too. One can not safely reduce one's weight by any mysterious method that will leave one at liberty to continue the indulgences, whether of sloth or of appetite, that are responsible for its accumulation.

The reduction of weight is really a very simple matter. No mysterious or elaborate "systems" or drugs are needed.

If a reduction in the amount of energy food and an increase in the amount of exercise is made, no power on earth can prevent a reduction in weight.

Even a sedentary worker uses up about 2,500 calories a day. By reducing the food to 1,200 calories (this can be done without decreasing its bulk) and increasing the exercise to the point of burning up 3,000 calories, the tissues are drawn upon for the difference, and a reduction in weight must be experienced just as surely as a reduction in a bank account is made by drawing checks on it.

MEN--UNDER AVERAGE WEIGHT

Experience of 43 American Companies Duration of Experience, 1885-1908 Number of Policyholders, 530,108

--------+------------------------------------------------------------- | Underweight, || Underweight, || Underweight, | 5 to 10 lbs. || 15 to 20 lbs. || 25 to 45 lbs. Ages |-------------------||---------+---------||---------+--------- at | Death | Death || Death | Death || Death | Death Entry. | Rate | Rate || Rate | Rate || Rate | Rate | Below | Above || Below | Above || Below | Above | Std.| Std. || Std. | Std. || Std. | Std. --------+---------+---------||---------+---------||---------+--------- 20-24 | ... | 7% || ... | 15% || ... | 34% 25-29 | 1% | ... || ... | 8 || ... | 16 30-34 | ... | 4 || ... | 0 || ... | 8 35-39 | 9 | ... || ... | 3 || ... | 2 40-44 | 15 | ... || 13% | ... || 3% | ... 45-49 | 3 | ... || 1 | ... || 11 | ... 50-56 | 10 | ... || 8 | ... || 9 | ... 57-62 | 7 | ... || 18 | ... || 19 | ... --------+---------+--------------------+--------------------+---------

Medico-Actuarial Mortality Investigation, Volume 11, page 10.

The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

The most favorable mortality (19 per cent. below the average) is found among those aged 57 to 62 who are extremely light in weight, compared with the average weight for those ages. The next lowest mortality in any other age group (15 per cent. below the average) is among those aged 40 to 44 who are 5 to 10 pounds under the average weight.

Thin people lose heat more readily than stout people, as they have a larger percentage of active tissue and expose more skin surface in proportion to the body weight. They require, therefore, an abundant supply of energy food, or fuel foods, fats, starch and sugar. Butter and olive oil are better than other fats and less likely to disturb the digestion. Sugar is a valuable fuel food, but should not be taken in concentrated form into an empty stomach. Sweets are best taken at the end of a meal, but in such cases the teeth should be well cleansed. Fruit at the end of a meal tends to prevent any injury to the teeth from sugar and starches.

Potatoes, cereals, bread and all starchy vegetables are fattening, but should be well chewed and tasted before swallowing. Thin, anemic people derive much benefit from egg lemonade or egg-nogs (without alcohol) made from the yolks, which contain fat, iron and other valuable elements.

Overfatigue and exhausting physical exertion should be avoided.

Moderate systematic exercises, with deep breathing, and sleeping out of doors, or approaching as near to it as one can, are advisable. At middle life and after, underweight, unless extreme or accompanied by evidence of impaired health, should not give any concern. Other things being equal, the old motto "A lean horse for a long race," holds good.