I. General Considerations
THE type of obesity to be discussed here is the ordinary idiopathic or 'essential' type, and not those exceptional types associated with damage to, or tumours of, the diencephalon, or with disease of one of the 'target' endocrine glands. The author considers that such obesity is one of the most obvious manifestations of the saccharine disease, the single primary cause lying in the consumption of refined carbohydrates. As already shown, the refining processes lead to unnatural concentration in the carbohydrates concerned, which deceives the tongue and the appetite, and leads to over-consumption -- and this over-consumption is the sole primary cause of the overweight. With unrefined, unconcentrated carbohydrates over-consumption does not occur, and obesity does not occur either, as the author intends to demonstrate.
This line of reasoning positively excludes as a primary cause of obesity any fault in the instinct of appetite (such as the mysterious derangement, postulated by some, of a hypothetical 'appestat' centre in the brain); it likewise positively excludes as a primary cause any dislike of, and consequent abstention from, taking exercise. In short, it is advanced that, as regards obesity, the body, again, is not built wrongly, but is being used wrongly.
To refer to the two causes just rejected, the view that in obesity the appetite is at fault can easily be assailed. There is first of all the general evidence. In holding the view that the body is often imperfectly evolved over this instinct, the holders are faced with the incidence figures. Once again it may be stated that no known hereditary defect occurs more often than five times in one thousand births. How often does obesity occur? Besides, if the condition were a hereditary defect, the age of onset would tend to be different.
Then there is the specific evidence. A glance at any wild creature in its natural environment shows that no matter how plentiful its food supply, it never cats too much of it. Even a poulterer's shop reveals that no wild rabbit ever ate too much grass, no wood-pigeon ever ate too much wheat, and no herring ever ate too much plankton. No wild creature, in fact, is ever overweight. The forces of evolution have ensured that in nature organisms react to an abundant food supply never by developing a disease, such as obesity, but by raising the rate at which they propagate themselves. This is true for the whole of creation, from a lactic acid bacillus in a bottle of milk right up to man himself in circumstances of plenty. In Part II of this chapter it will be shown that the freedom from obesity in organisms living under natural conditions applies equally to man, as will be seen shortly in Africans living tribally on unrefined foods.
The view that obesity is due to insufficient exercise is just as vulnerable. In the first place, the lack of exercise held responsible is nearly always a voluntary lack, not an imposed lack. People are blamed for using lifts in office buildings and for not walking when they leave their offices. Yet this is what their natural inclinations often tell them to do. Some don't want to climb stairs, and don't want to go walking either; they would rather sit down when they get home and put their feet up. Therefore the argument that this instinct is wrong is just as vulnerable as the argument that the instinct of appetite is wrong. Throughout the whole animal kingdom, in fact, no living creature, unless forced to do so in order to get food, ever takes any more exercise than it wants to take. Nature obviously likes to conserve the heart -- and certainly never inflicts on any organism the penalty of obesity for 'laziness'.
Even in cases of imposed lack of exercise obesity does not occur as long as the food is not tampered with. A visit to any zoo will show this very clearly. Here will be seen the two opposite poles of creation -- a large animal like a tiger, accustomed to hunt its prey over many square miles of jungle, and now confined to a space measured in cubic feet; and a small bird, like a finch, accustomed to fly about many acres of countryside, and now confined to a space measured in cubic inches. In each case the natural exercise has been enormously reduced. Yet, just because each of these creatures continues to take its food in its natural form, in the one case raw meat and bones, and in the other case unaltered seeds, the weight remains the same and obesity does not occur.
An exception to this appears to exist in the fattening up of animals and birds for market. But a closer examination will nearly always reveal in these circumstances either that food concentrates have been given, in which case the whole argument instantly alters, or that the animal or bird is of a kind that has been evolved by selective breeding over many centuries to become much fatter than its wild counterpart. For example, in the Pekin (Aylesbury) duck the bird's muscles have been so replaced by fat that it is never able to fly off the ground. Finally, what is under discussion in humanity is not an imposed lack of exercise of this sort, but a voluntary one. No one in this country is prevented from taking exercise if he wants to. The point is that he often doesn't want to, and the present argument then applies.
It is therefore contended that the sole cause of obesity lies in the consumption of refined carbohydrates. A large appetite is not a cause, and a dislike of exercise is not a cause. These points have all been stressed in the author's past writings, as also have those below.
It is perfectly true that restraint of appetite or enforcement of exercise will reduce obesity, but as long as the true cause continues to operate -- the consumption of refined carbohydrates -- the use of either is an example of two wrongs not making a right. To be sure, these two factors are valuable in the removal of surplus weight already in existence, but in the basic matter of prevention the mind should be riveted on the essential cause and not confused by irrelevancies.
Equally, it should be thoroughly realized that unrefined carbohydrates, such as wholemeal bread, potatoes eaten in their skins,  raw fruit, etc., are no more fattening than any other natural food, including protein foods and fatty foods. Some starvation for established excess of weight is clearly indicated, but a distortion of the personal choice of the various classes of foodstuffs, except for the omission of fats, is emphatically not.
Finally, it will be realized that in this conception obesity is not due to diabetes, nor diabetes to obesity, but both arise from a common cause. Whether the one condition occurs, or the other, or both together, depends on the personal make-up in the individual concerned, in the presence of the unnatural environmental factor, held here to be the consumption of refined carbohydrates. In this respect there is no fundamental difference between the association of obesity with diabetes and, say, its association with gall-stones, coronary thrombosis, or any other manifestation of the saccharine disease.
II. Racial Studies
The author is indebted to Dr. G. D. Campbell for pointing out the rarity of obesity in Zulus living tribally, on a diet substantially unrefined, as opposed to its commonness in urban Zulus living on a diet of much more refined type. These differences in the two groups of Zulus have been fully documented by C. Slorne and others,  who at the time of making their study were members of the Department of Sociology and Anthropology of the State College of Washington, U.S.A., and to whose meticulous paper those interested are referred. The absence of obesity in humanity wherever still living on natural, unrefined foods has indeed been so often observed that it is not necessary to pursue the matter here, and we therefore pass on to a more important consideration.
From the argument presented above, it is clear that the treatment of obesity lies in the same fundamental step indicated in the other manifestations of the saccharine disease -- the avoidance of refined carbohydrates. This treatment may be summarized in the case of obesity as 'seeking safety in dilution' -- the dilution present in natural carbohydrates, through the existence of fibre. There are three points to be noted:
- In the matter of the prevention of obesity, and in the early stages of the condition, the above is all that is required, but for established cases a certain amount of starvation will at first also be necessary, such as the omission of breakfast and afternoon tea. However, as already explained, the natural pattern of the diet should not be distorted by substituting fats for carbohydrates. On the contrary, since, as the author hopes to have shown, unrefined carbohydrates are not fattening, any distortion of the natural pattern should lie in specially reducing the fats, since this forces the body to consume its own excess of these. The proteins, needless to say, are never a target of interference.
- Naturally desired exercise is encouraged, but forced exertions are not. The reasons for this have already been set out.
- The author has found that a careful explanation to the patient, of how Nature has been deceived, in the production of obesity, is of the greatest assistance. An intelligent person, looking around at the rest of creation, will recognize the truth for himself, and will then largely be in command of his own fate. It is, indeed, most advantageous that patients should have confidence in their own judgement in this way, rather than be obliged to accept edicts laid down by others. These points are largely covered in the diet card at the end of this book.
It will be noted that the fundamental difference in the present approach to obesity, from that based on the supposed faulty functioning of an 'appestat' centre in the brain, is that the appetite is not regarded as an enemy here, to be placed in a strait-jacket, but as a normal instinct, to be let loose on foods so naturally diluted by fibre that the instinct is neutralized in a natural manner. Hence the emphasis on crude wholemeal bread several days old, raw fruit such as the apple, and bulky vegetables, in the diet card just referred to. To the author, holding the line of reasoning that he does, it is anathema to try to antidote a supposed derangement of an appestat centre in the brain by filling the stomach before a meal with a substance like methyl cellulose. In his reasoning the only production of distension in the stomach to be considered is the distension produced by natural fibre in natural foods.
It will also be noted that the present approach is quite distinct from that of J. Yudkin, referred to in Chapter II, which regards many natural carbohydrates as an enemy, and leads to assessment of the danger in individual carbohydrates by their calorific value.  It is perfectly true, as has been shown previously (Chapter II), that the calories in, for example, an apple are much the same as those in a teaspoonful of sugar, and therefore at first sight the danger in cases of obesity would appear to be the same in each. But, as was pointed out, there is an enormous difference between the two in one vital respect -- the amount a person needs to consume of each before the appetite is appeased. As already said, a person may over-consume sugar very easily -- but not apples. In this distinction is seen nothing less than the difference between satisfaction and craving; between following a régime and departing from it; between obesity and no obesity. In the author's opinion the danger in carbohydrate foods should be assessed not by their calorific value, but simply by whether they are natural or refined.
At the same time considerable care must be exercised in deciding whether a carbohydrate food is natural, even if it is unrefined. For example, at first sight, honey, and certain fruits such as dates, would appear to be natural foods. A deeper look at these foods, however, considerably modifies this view. Until very recent evolutionary times honey, in fact, has seldom been available at all. It is true that ever since the discovery of fire mankind has in theory been capable of smoking out the nests of wild bees, and there is the archaeological evidence that he occasionally did this. A little reflection, however, will show that such a feat must have been an extremely difficult one to bring off, and in any case would have yielded so little reward as seldom to have been worth the effort. To the consumption of honey, which contains practically no other food material than sugar, man is therefore little more adapted than he is to that of sugar itself, as sold in grocers' shops, and anyone arguing that honey is a natural food, which he can eat ad libitum, is in for some nasty surprises. Solomon may not always have been wise, but he certainly showed his wisdom in advising people to keep off much honey (Proverbs XXV. 27). In short, honey should be regarded for practical purposes as being as dangerous as sugar. This applies to all the manifestations of the saccharine disease and not only to obesity.
As regards dates, these certainly are a natural food -- but not for the white races! In the date the sugar present is enormously concentrated. Thus, if the percentage of sugar present in the apple is about 10 per cent, and in the banana 20 per cent, in the date it is 60 per cent. In the white races such concentrations can easily deceive the tongue and the appetite. The same applies to certain dried fruits if consumed by themselves, such as raisins, which have a comparable sugar content to that of dates; and in fact the banana, with a sugar content of 20 per cent, which exceeds that of all the natural fruits of the British Isles, represents the rough limit of safety in this respect. Needless to say, the circumstances become much altered when these concentrated fruits are diluted by other natural foods, as currants are in a wholemeal currant loaf. Then, except where the obesity is very marked, they become desirable, since they lead to the avoidance of the much more dangerous sugar itself. Similarly, dates, or for that matter bananas, are best consumed with a glass of milk (with which either forms a most palatable combination), the tongue alone deciding for any given person the ratio of either fruit to the milk taken.
Arguing on the same lines as the above, it is clear that potatoes can only be allowed if boiled with their skins on, and the skins eaten. It is also important that people be warned that beer and other malted liquors, though they do not taste sweet, are -- through their content of malt sugar -- as fattening as any foods that exist. If alcohol must be taken by the obese, it should be taken in other forms than beer, which definitely counts as a refined carbohydrate.
In conclusion, the author may say that he has never been let down over the above natural approach to the treatment of obesity, and he hopes that the diet card at the end of the book may prove to be of help to those prepared to think deeply. If he were asked why the treatment of obesity is so often fraught with difficulty, he would say: 'Because people's minds are being directed towards calories instead of to the basic cause -- the unnatural concentration present in sugar and white flour. And also because the prevention and arrest of obesity is infinitely easier than the removal of obesity already in existence (but in which the basic approach still holds).'
1. Cleave, T. L. (1962), Peptic Ulcer. Bristol: Wright.
2. Slome, C., Gampiel, B., Abrahamson, J. H., and Scotch, N. (1960), S. Afr. Med. J., 34, 505.
3. Yudkin, J. (1960), This Slimming Business. London: MacGibbon & Kee.
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